Maternal, Infant and Young Child Nutrition

Solidarity and Action Against

The HIV Infection in India

Counselling Cards for Health Care Workers

Acknowledgement
This set of Counseling Cards is part of The Health Infant and Young Child Feeding (IYCF) Counseling Package, developed under a strategic collaboration
between the United Nations Children's Fund (UNICEF) New York and the combined technical and graphic team of Nutrition Policy Practice (NPP) and the Center
for Human Services, the not-for-profit affiliate of University Research Co., LLC (URC/CHS). The counseling cards were adapted from the Rwandan IYCF
Counseling Cards. We would like to acknowledge the EGPAF Rwanda Program, The Rwanda Ministry of Health, and Path for their strategic vision in developing
the initial cards.
The Health IYCF Counseling Package includes the Facilitator Guide. Appendices, and Training Aids, for use in training health workers; the Participant Materials,
training handouts and monitoring tools; a set of 28 IYCF Counseling Cards and companion key Messages Booklet; 3 Take-home Brochures; and an
Adaptation Guide including a Clip Art compendium for use by national or local stakeholders in adapting this package for use in their own settings. All of the
materials found in the health IYCF Counseling Package are available in their electronic formats to facilitate their dissemination and adaptation.
The various elements of The Health IYCF Counseling Package are based on several WHO/UNICEF guidance documents, training and other materials, including
the WHO/UNICEF Breastfeeding, Complementary Feeding and Infant and Young Child Feeding Counseling training courses. The package also builds on
materials developed by the \Academy for Educational Develpiment's LINKAGES Project; the CARE USA and URC/CHS collaboration in Dadaab, Kenya; and the
Integration of IYCF Support into Health Management of Acute Malnutrition (CMAM), produced by the ENN/IFE Core Group and IASC. The technical content of
the package aims to reflect the Guidelines on HIV and Infant Feeding 2010: Principles and Recommendations for Infant Feeding in the Context of HIV and a
Summary of Evidence related to IYCF in the context of HIV. The graphic package draws heavily from IYCF behavior change materials and other job aids
developed with the technical support of URC/CHS, financed by the United States Agency for International Development (USAID) in Tanzania, Uganda, Niger
and Benin; CARE USA in Dadaab, Kenya; and the UNICEF offices in Kenya and Malawi.
The Health IYCF Counseling Package has been developed by the UNICEF New York team of Nune Mangasaryan, Senior Advisor, Infant and Young Child
Nutrition; Christiane Rudert, Nutrition Specialist (infant feeding); Mandana Arabi, Nutrition Specialist (Complementary Feeding); in close collaboration with
the NPP and URC/CHS team of Maryanne Stone-Jimenez, IYCF Training Expert; Mary Lung'aho, IYCF Health/Emenrgencies Expert; Peggy Koniz Booher, IYCF
Behaviour Change and Job Aids Expert. The package illustrations were developed Kurt Mulholland, Senior Graphic Artist; and Victor Nolasco, Senior Graphic
Illustrator. Many country teams (national authorities, program staff and communities) involved in developing and pretesting previous materials also warrant
acknowledgement for their contributions. The package was reviewed by WHO headquarters colleagues: Carmen Casanovas (Technical Officer), Constanza
Vallenas (Medical Officer) and the HIV component by Nigel Rollins (Scientist). External reviewers also included Facility Savage and Rukhsana Haider, and
comments were received from Holly Blanchard (Maternal Child Health Integrated Program) The contributions of the Ministry of Health, UNICEF-Zambia, staff
from various partners agencies and the health workers who participated in the field tested of the package in August 2010 in Lusaka, Zambia, is also
acknowledged.
Although each of these materials have been copy righted and co-branded by UNICEF and URC/CHS. Any part of this package may be printed, copied and/or
adapted to meet local needs without express written permission. Requests to reproduce the materials may be directed to [email protected]. In addition, 1) the
source of the original materials should be fully acknowledged; 2) the parts of the package that are printed, copied and/or adapted should be distributed free
or at cost (not for profit); and 3) credit must be given to both UNICEF and URC/CHS.

Positive counselling skills

This set of cards was developed for you to help counsel
mothers and other caregivers about maternal, infant and
young child nutrition (MIYCN). Positive counselling skills
are important for your success. Some basic counseling
skills presented below include Listening and Learning, as
well as Building Confidence and Giving Support.

If one or more feeding difficulty is present, or the

condition or health of the child or mother (or
caregiver) is poor, prioritize the difficulties.
Answer the mothers (or caregivers) questions if
any.
Step 3: Act: discuss, suggest a small amount of
relevant information, agree on doable action
Depending on the factors analyzed above, select a
small amount of information to share with the
mother or caregiver that is most relevant to her or
his situation.

Listening and Learning skills

Use helpful non-verbal communication
Keep your head level with the mother (or caregiver)
Pay attention
Reduce physical barriers

Be sure to praise the mother or caregiver for what

she or he is doing well.

Take time
Touch appropriately
Ask open questions
Use responses and gestures that show interest
Reflect back what the mother (or caregiver) says
Avoid using judging words
Building Confidence and Giving Support skills
1. Accept what a mother (or caregiver) thinks and feels.
Let the mother (or caregiver) talk through her or his
concerns before correcting any wrong ideas or
misinformation. This helps to establish confidence.
2. Listen carefully to the mothers (or caregivers)
concerns.
3. Recognize and praise what a mother (or caregiver)
and child are doing correctly.
4. Give practical help.
5. Give a little, relevant information at a time.
6. Use simple language that the mother or caregiver will
understand.
7. Use appropriate Counselling Card(s) or Take-Home
Brochure(s).
8. Make one or two suggestions, not commands

IYCF 3-Counselling:
The following 3-Step Counseling will help you to
counsel, problem solve and reach an agreement with
mothers (or caregiver) about infant and young child
feeding. The 3-Steps are Assess, Analyze and Act.

Present options for addressing the feeding difficulty

or condition of health of the child or caregiver in
terms of small do-able actions. These actions
should be time-bound (within the next few days or
weeks).

Step 1: Assess: ask, listen and observe

Greet the mother (or caregiver), using friendly
language and gestures.

Share key information with the mother or caregiver,

using the appropriate Counselling Cards or
Takehome Brochures and answering questions as
needed.

Ask some initial questions that encourage her (or

him) to talk.
Listen to what is being said and observe what is
going on using your Listening and Learning, and
Building Confidence and Giving Support skills.
Assess the age appropriate feeding practice(s) and
the condition or health of the child and mother (or
caregiver).
Step 2: Analyze: identify difficulty and if there is
more than one prioritize the difficulties
Decide if the feeding you observe is age
appropriate and if the condition or health of the
child and mother (or caregiver) is good.
If there are no apparent difficulties, praise the
mother (or caregiver) and focus on providing
information needed for the next stage of the childs
development.

Help the mother or caregiver select one option that

she or he agrees to try, in order to address or
overcome the difficulty or condition that has been
identified. This is called reaching-an-agreement.
Suggest where the mother or caregiver can find
additional support. Refer to the nearest health
facility if appropriate and/or encourage
participation in educational talks or IYCF Support
Groups in the community.
Confirm that the mother or caregiver knows where
to find a community volunteer and/or other health
worker.
Thank the mother or caregiver for her or his time.
Agree on when you will meet again, if appropriate.

Nutrition for pregnant and breastfeeding woman

Card 1

Immediate breastfeeding after birth

Card 2

During the first 6 months, give ONLY breast milk

Card 3

Exclusive breastfeeding during the first 6 months

+
+
+

Card 4

Breastfeed on demand, both day and night

Card 5

There are many breastfeeding positions

Card 6

Good attachment is important

Card 7

Care and feeding of a low birth weight baby

Card 8

How to hand express and cup feed

Card 9

Give breast milk, even when away from home

Card 10

Good hygiene practices prevent disease

Card 11

Use safe water and ensure good compound hygiene

Card 12

Start complementary feeding at 6 months

Card 13

Give complementary feeding from 6 up to 9 months

Card 14

Give complementary feeding from 9 up to 12 months

Card 15

Give complementary feeding from 12 up to 24 months

Card 16

Feed your baby a variety of foods

Card 17

When your baby is sick, seek advice

Card 18

When to bring your child to the health facility

Refusal to feed

Vomiting

Diarrhoea

Convulsions

Card 19

Fever

Respiratory infection

Malnutrition

Feeding your sick baby less than 6 months of age

Card 20

Feeding your sick baby more than 6 months of age

6 up to
9 months

9 up to
12 months

12 up to
24 months

Card 21

How to feed a baby above 6 months with poor appetite

Card 22

Regular growth monitoring and promotion

Card 23

Family planning improves health and survival

LAM
(Exclusive breastfeeding)

Male & Female Condom

Abstinence
(Avoiding intercourse)

Injectables
(Depro - Provera)

Oral Contraceptives

Norplant

Tubal Ligation

Vasectomy

IUD

Card 24

Create a kitchen garden and plant fruit trees

Card 25

Small animal breeding

Card 26

Risks for babies born to HIV-infected mothers...

When NO Preventive actions are taken?

If both mother and baby take ARVs and practise

exclusive breastfeeding during the first 6 months?

Out of 100 babies born to HIV infected women:

Out of 100 babies born to HIV infected women who take ARVs:

The majority of babies

(about 65) are not
infected with HIV,
but should be protected

Card 27

Most babies (about 25)

become infected with HIV
during pregnancy, labour
and birth.

Other babies (about 10)

are infected with HIV
through breastfeeding

The majority of babies

(95 or more) are not
infected with HIV

Most of these babies

(less than 2) become
infected with HIV during
pregnancy, labour
and birth.

Protect your baby - get tested and know your HIV status!

Breastfeeding babies
(less than 3) can become
infected. Exclusive and
safer breastfeeding
reduces the risk.

Exclusively breastfeed and take ARVs

Only Breast Milk

Use expressed breast milk

when away from baby
ARVs for the mother

ARVs for the baby

Card 28

Do not give any other liquids (even water) or foods to breastfeeding babies
before 6 months

If using infant formula, avoid all breastfeeding

Special Circumstance Card 1

Continuing to breastfeed is dangerous for your baby

conditions needed to avoid all breastfeeding if

animal milk is choosen

Special Circumstance Card 2

Conditions needed to avoid all breastfeeding if the mother

chooses infant formula or animal milk

Special Circumstance Card 3

Non-breastfed child from six (6) up to 24 months

6 up to
9 months

Each day add

Special Circumstance Card 4

9 up to
12 months

Each day add

12 up to
24 months

Each day add