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COMPETENCY-BASED LEARNING MATERIAL Sector: Health Qualification Title: Care giving NC II Unit of Competency: Provide Care and Support to Children Module Title: Providing Care and Support to Children

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COMPETENCY-BASED LEARNING MATERIAL

Sector: Health

Qualification Title: Care giving NC II

Unit of Competency: Provide Care and Support to Children

Module Title: Providing Care and Support to Children

GEFI COMMUNITY COLLEGE INC.3rd & 4th Floor Chiu (Rusty Lopez) Bldg.,

Rizal Avenue, Puerto Princesa CityTel No: 434 8330

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HOW TO USE THIS COMPETENCY-BASED LEARNING MATERIAL:

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MODULES OF INSTRUCTION

UNIT OF COMPETENCY: PROVIDE CARE AND SUPPORT TO CHILDREN

MODULE TITLE: PROVIDING CARE AND SUPPORT TO CHILDREN

MODULE DESCRIPTOR: This module covers the knowledge, skills, and attitudes

required to provide care and support to children from 3-12 years old.

NOMINAL DURATION: 60 HOURS

LEARNING OUTCOMES:

Upon completion of this module, the students / trainees will be able to:

LO1: Explain the importance of instilling personal hygiene practices to children

LO2: Maintain children’s paraphernalia

LO3: Prepare children

LO4: Prepare and introduce adequate nutrition and semi-solid food

LO5: Prepare infant/toddlers crib

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LEARNING OUTCOME 1 Explain the concepts and principles of caring, growth, and development of infants/toddlers

CONTENTS:1. Definition of growth and development 2. Difference/comparison between growth and development 3. Milestones of growth and development (physical/motor and sensory)4. Basic infant care5. The dependent nature of infants and toddlers6. Communication, creative and interpersonal skills 7. Empathy and ability to establish bonding with infant and toddler

ASSESSMENT CRITERIA:1. Defined growth and development 2. Recognized the difference between growth and development3. Stated the normal milestones of growth and development of infants/toddlers in

chronological order4. Recognized delayed or abnormal aspects of growth and development 5. Discussed the dependent nature of infants and toddlers6. Enumerated basic infant care procedures7. Exposed infants and toddlers to family members, relatives, and playmates for

communication and interaction purposes8. Provided infants/toddlers with manipulative or creative toys and games as needed

Gave infants and toddlers exercise or activities as required

CONDITION: Students/trainees must be provided with the following:

1. CBLM 2. Computer laboratory with Internet access 3. Fully equipped classroom conducive for learning and other activities

ASSESSMENT METHOD:1. Written test2. Interview

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Learning Experience

Learning Outcome 1: Explain the concepts and principles of caring, growth, and development of infants/toddlers

Learning Activities Special Instruction

Read Information sheet 1.1-1: Growth and Development: Definition, Difference and Comparison, and Milestones of Growth and Development

Please don’t hesitate to refer to your trainer for further discussion on the information sheets

Answer Self-check 1.1-1 Compare answer to answer keys. You should be able to get all items correctly. If not, read information sheet again, and answer afterwards.

Read Information sheet 1.1-2: Basic Infant Care

Answer Self-check 1.1-2 Perform Task Sheet 1.1-2: Methods of carrying the baby

Refer to the Performance Criteria Checklist to be guided

Read Information sheet 1.1-3: The Dependent Nature of Infants and Toddlers

Read Information sheet 1.1-4: Enhancing Physical, Social, Intellectual, Creative, and Emotional Development

Answer Self-check 1.1-4

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Information Sheet 1.1-1

GROWTH AND DEVELOPMENT

INTRODUCTION:

Growth and Development

Principles of Growth and Development

Factors influencing Growth and Development

Conception and Prenatal Development

Child development refers to how a child becomes able to do more complex things as they get older. Development is different than growth. Growth only refers to the child getting bigger in size.

When we talk about normal development, we are talking about developing skills like: Gross motor: using large groups of muscles to sit, stand, walk, run, etc., keeping

balance, and changing positions. Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other

things. Language: speaking, using body language and gestures, communicating, and

understanding what others say. Cognitive: thinking skills, including learning, understanding, problem-solving, reasoning,

and remembering. Social: interacting with others, having relationships with family, friends, and teachers,

cooperating, and responding to the feelings of others.Developmental Milestones are a set of functional skills or age- specific tasks that most children can do at a certain age range. Your pediatrician uses milestones to help check how your child is developing. Although each milestone has an age level, the actual age when a normally developing child reaches that milestone can be quite a bit. Every child is unique!

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By the end of their first month, most babies: Make jerky arm movements Bring hands near face Keep hands in tight fists Move head from side to side while lying on stomach Focused on objects 8 to 12 inches away Prefer human faces over other shapes Recognize some sounds, including parents’ voices Startle at loud noises.

By the end of their third month, most babies: Raise head and chest when lying on stomach Support head well Kick when lying on stomach or back Push down on legs when feet placed on firm surface Open and shut hands Bring hands to mouth Grab and shake hand toys Follow moving object with eyes Smile at familiar faces Begin to babble Enjoy playing with other people

By the end of their seventh month, most babies: Roll over both ways (stomach to back and back to stomach) Sit up, first with, then without, support of hands Reach for object with hand, using raking grasp Transfer objects from one hand to the other Support whole weight on legs when held up right Laugh and squeal Respond to own name Babble chains of consonants (ba-ba-ba-ba-ba) Distinguish emotions by tone of voice Explore objects with hands and by putting them in the mouth Find partially hidden objects (so enjoy playing peek- a – boo)

By their first birthday, most babies: Sit without assistance Get into hands- and- knees position Crawl Pull self up to stand Walk holding onto furniture, and possibly a few steps without support

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Use pincer grasp (thumb and forefinger) Finger- feed themselves Say “dada” and “mama” Use exclamations, such as “oh-oh!” Try to imitate words Respond to “no” and simple verbal requests Use simple gestures, such as shaking head “no” and waving bye- bye Explore objects in many ways (shaking, banging, throwing, dropping) Begin to use objects correctly (drinking from cup, brushing hair) Find hidden objects easily Look at correct picture when image is named

By their second birthday, most children: Walk alone Pull toys behind them while walking Carry large toys or several toys while walking Begin to run Kick a ball Climb on and off furniture without help Walk up and down stairs while holding on Scribble with crayon Build tower of four blocks or more Recognize names of familiar people, objects and body parts Say several single words (by 15 to 18 months) Use simple phrases (by 18 to 24 months) Use two- to four- word sentences (“want snack”) Follow simple instructions Begin to sort objects by shapes and colors Begin to play make- believe Imitate behavior of others

DEVELOPMENTAL MILESTONES

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Cognitive MilestonesA. Month 3-5: attends to and reaches for objectsB. Months 4-8: pulls string to secure a ringC. Month 8-15: imitates patting dollD. Month 14-20: finds Hidden ObjectE. Month 18-28: Completes simple puzzles

Language MilestonesA. Month 1. 5-3: squealsB. Month 3. 5-8: turns to locate a voiceC. Month 9-13: says Mama or DadaD. Month 14-24: combines two different wordsE. Month 21-36: use plurals

Social and Emotional MilestonesA. Month 1. 5-4: Smiles at othersB. Month 4-9: Seeks primary caregiverC. Month 8-15: Stranger anxietyD. Month 10-15: Displays 2 or more recognizable emotionsE. Month 11-20: Exploratory play by selfF. Month 21-36: Cooperative play in small groups

Gross Motor MilestonesA. Month 2-4.5: Rolls OverB. Month 5-8: Sits without supportC. Month 10-14: Stands AloneD. Month 14-20: Walks up stepsE. Month 21-28: Pedals TricycleF. Month 30-44: Balances on one footG. By age 6: rhythmic skippingH. By age 8.5: alternates foot-hop in placeI. By age 10: holds tandem stance for 10 sec (eyes closed)

Fine Motor MilestonesA. Month 2.5-4: Grasps rattleB. Month 4.5-7: Transfers cube hand to handC. Month 8-12: Has neat pincer graspD. Month 15-20: Builds tower of four cubesE. Month 18-24: Imitates vertical lineF. Month 28-36: Copies circle

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G. By age 5 years: Tripod pencil graspH. By age 7 years: Draws diagonal lineI. By age 9: Draws cross with same dimensionsJ. By age 12: Draws three dimensional cube

Self Testing MilestonesA. Month 4.5-8: Feeds self crackersB. Month 10-14: Drinks from cupC. Month 13-19: Removes clothesD. Month 18-28: Washes and dries handsE. Month 30-42: Dresses without supervisionF. Attained on average by age 4.5 years

1. Rides a bicycle with training wheels2. Cuts paper with scissors3. Colors inside lines

G. Attained on average by age 5.5 years1. Ties shoelaces2. Prints first and last names

H. Attained on average by age 6 years1. Rides a bicycle without training wheels

TILL PAGE 7………

SELF-CHECK 1.1-1

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ANSWER KEY

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Information Sheet 1.1-2

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BASIC INFANT CARE

INTRODUCTION: A new born genital enlarged and reddened, with male infants having an unusually large scrotum. The breasts may also be enlarged, even in male infants. This is caused by naturally- occurring maternal hormones and is a temporary condition. Females (and even males) may actually discharge milk from their nipples (sometimes called witch’s milk), and or a bloody or milky-like substance from the vagina. In either case, this is considered normal and will disappear in time.

The umbilical cord of a newborn is bluish white in color. After birth, the umbilical cord is normally cut, leaving a 1-2 inches stub. The umbilical stub will dry out, shrivel, darken, and spontaneously fall off within about 3 weeks. Occasionally, hospitals may apply triple dye to the umbilical stub to prevent infection, which may temporarily color the stub and surrounding skin purple.

Newborns lose many of the above physical characteristics quickly. Thus prototypical older babies look very different. While other babies are considered “cute”, newborns can be “unattractive” by the same criteria and first time parents may need to be educated in this regard.

As an infant’s vision develops, he or she may seem pre-occupied with watching surrounding objects and people.

Newborns can feel all different sensations, but respond most enthusiastically to soft stroking, cuddling and caressing. Gentle rocking back and forth often calms a crying infant, as do massages and warm baths. Newborns may comfort themselves by sucking their thumb, or a pacifier. The need to suckle is instinctive and allows newborns to feed.

Newborn infants have an unremarkable vision, being able to focus on objects only about 18 inches (45 cm) directly in front of their face. While this may not be much, it is all that is needed for the infant to look at the mother’s eyes or areola when breastfeeding. Generally, a newborn cries when wanting to feed. When a newborn is not sleeping, or feeding, or crying, he or she may spend a lot of time staring at random objects. Usually anything that is shiny, has sharp contrasting colors, or has complex patterns will catch an infant’s eye. However, the newborn has a preference for looking at other human faces above all else.

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While still inside the mother, the infant could hear many internal noises such as mother’s heartbeat, as well as many external noises including human voices, music and most other sounds. Therefore, although a newborns ear may have some catarrh and fluid, he or she can hear sound from before birth. Newborns usually respond to a female voice over a male voice. This may explain why people will unknowingly raise the pitch of their voice when talking to newborns. The sound of other human voices, especially the mother’s, can have a calming or soothing effect of the newborn. Conversely, loud or sudden noises will startle and scare a newborn.

Newborns can respond to different tastes, including sweet, sour, bitter, and salty substances, with a preference towards sweets.

A newborn has a develop sense of smell at birth, and within the first week of life can already distinguish the differences between the mother’s own breast milk and the breast milk of another female.

Infants cry as a form of basic instinctive communication. A crying infant may be trying to express a variety of feelings including hunger, discomfort, overstimulation, boredom or loneliness. Many caregivers employ the use of baby monitors or baby cams which enable them to hear or see an infant’s cries from another room.

Feeding is typically done by breastfeeding, which is the recommended method of feeding by all major infant health organizations including the American Academy of Pediatrics. However, if breastfeeding is not possible or desired, bottle feeding may be done with expressed breast milk or with infant formula. Infants have a sucking instinct allowing them to extract the milk from the nipples of the breasts or the nipple of the baby bottle, as well as an instinctive behavior known as rooting with which they seek out the nipple. Sometimes a wet nurse is hired to feed the infant, although this is rare, especially in developing countries.

Practitioners of these techniques assert that babies can control their bodily functions at the age of six months and that they are aware when they are urinating at an even earlier age. Babies can learn to signal to the parents when it is time to urinate or defecate by turning or making noises. Parents have to pay attention to the baby’s actions so they can learn the signals.

Children need a relatively larger amount of sleep to function correctly (up to 18 hours for newborn babies, with a declining rate as the child ages).

Babies cannot walk, although more mature infants may crawl or scoot; baby transport may be perambulator (stroller or buggy), on the back or in front of an adult in a special carrier, cloth or cradle board, or simply by being carried in the arms. Most industrialized countries have laws requiring infants to be placed in special child safety seats when in motor vehicles.

TOOLS AND EQUIPMENT USED FOR INFANT CARE

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A. ESSENTIAL MATERIALS TO INCLUDE IN A MATERNITY HOSPITAL BAG Essentials for Mom

Nursing braSupport swollen, sore breasts and keeps breast pads in place

Breast padsThese stop messy leaks by absorbing milk

Nursing pillowReduces the strain on your arms, neck, and back while nursing

Night gown and robeMore comfortable than standard hospital gowns

SlippersFor walking around the hospital during early neighbor

SocksTo keep your feet warm during delivery

Going home outfitChoose something that fit during your sixth month of pregnancy

ToiletriesToothbrush, toothpaste, deodorant, lip balm, make up, hair brush, shampoo, and soap

Sanitary padsYou’ll be more comfortable after delivery with your favorite brand

CameraFor all those important first photos

Address bookYou’ll have plenty of calls to make

Money

TOOLS AND EQUIPMENT1. Baby Clothes (0-3 months)Essentials

Coming- home outfitSomething soft, warm, and photo- friendly to welcome your baby

One- piece outfits (4-7)Snap- crotch sleepers simplify dressing (for day and night)

Stretchy pull- on pants (2-3)Pair with a snap- crotch shirt for an instant outfit

Snap- crotch T-shirts (3-6)Great for layering, and they won’t ride up

T-shirts with side snaps (4-5)A warm layer that doesn’t have to be pulled over the head

Sweater or jacket (2-3)

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For extra layering outside Footed slippers (5)

Warm, soft, and comfortable baby sleepwear (with snap crotch for easy diaper changes) Wearable blanket sleeper (2)

A cozy sleeper that’s as warm as a blanket but can’t be kicked off Hats (2-3)

For warmth and sun protection Socks or booties (4-7)

To keep your baby’s feet toasty and protectedNice Extras

Baby bunting bagKeep your baby warm without the hassle of loose blankets and bulky jackets

Dress- up outfitFor visitors, photos, and other special occasions

2. Bathing NeedsNewborn Essentials

Baby bathtubKeeps your baby face, and spares you back and knee pain

Slip- resistant bath padProtects your baby from slips and slides

Baby hooded towels (3-5)Keeps your baby’s head warm after a bath

Baby washcloths (3-5)Perfectly sized and made for your baby’s delicate skin

Floating water thermometerEliminates worries of whether the water is too hot or cold

Baby washCleanse gently, rinses off thoroughly, and doesn’t irritate skin

Baby shampooWon’t irritate eyes and leaves a great scent

Baby lotionMade for babies’ dry, delicate skin

Baby brush and combSofter and smaller than adult brushes and combs

Baby nail clippersTiny nails need small clippers to do the job safely

PAGES 9-12……….SELF-CHECK 1.1-2

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ENUMERATION:

List at least 2 infant/toddler safety measures from the ff. categories:

CRIB1.2.

CHANGE TABLE 1. 2.

CAR SAFETY 1. 2.

TOYS 1. 2.

BATHING 1. 2.

FEEDING1. 2.

ENVIRONMENT 1. 2.

ANSWER KEY

ENUMERATION: (Choose only 2 from the categories below)

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CRIB

1. Bars should be no more than 2 3/8 inches apart2. Railing should be at least 26 inches higher than the lowest level of the mattress support3. Mattress should fit snugly into the crib4. All surfaces should be smooth5. A bumper guard should be installed to protect infant from the hard railing6. Do not place the crib near a hot radiator or cold draft7. No pillow should be used on the crib

CHANGE TABLE 1. The table should be sturdy 2. It should have a strap to secure infant3. Never turn your back on the baby while changing a diaper, even if using the strap

CAR SAFETY 1. Children less than 40 pounds should be placed in a car seat2. Everyone over 40 pounds should wear a seat belt with shoulder harness

TOYS 1. Toys should always be appropriate for age 2. Avoid toys that have buttons or small objects that can easily be pulled off and swallowed 3. Don’t give a child any toy with a sharp edge4. Avoid toys that are breakable

BATHING 1. Water should be tepid. Check temperature carefully using your elbow or a bath

thermometer. 2. Never leave an infant or toddler alone in the tub3. Keep room draft-free

FEEDING1. Keep infant in an upright position to prevent choking 2. Check temperature of formula or baby food carefully before feeding3. Never prop an infant’s bottle

ENVIRONMENT 1. Remove poisonous houseplants2. Electrical outlets should be in good repair

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3. Install protective electric outlet covers to guard child if he/she is drawn to poking items into outlets

4. Instruct child never to play with matches. Keep matches and cigarette lighters well out of reach

5. Don’t expose child to second-hand smoke6. Toddlers should be instructed about an emergency fire plan7. Every home should have smoke alarms8. Every home should have a fire extinguisher9. Never leave a baby unattended on a bed or sofa 10. Never leave a child alone near a pool11. Pets should be supervised closely around children12. Handles on pots should be turned to the back of the stove to prevent a child from

pulling on it13. Keep vertical blind cords out of reach of children14. Keep all cords, ropes, and scarves away from children15. Know the Heimlich maneuver16. Keep all medicines out of reach of children17. Use safety gates to protect children from stairs18. Use a playpen or crib to protect the baby or toddler if distracted with a phone call or

some other distraction

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Task Sheet 1.1-2

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Performance Criteria Checklist

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Information Sheet 1.1-3

THE DEPENDENT NATURE OF INFANTS AND TODDLERSINTRODUCTION: An infant’s age, and their appetites grow, many parents choose from a variety of commercial Diaper BagEssentials

Diaper bagYou’ll want one big enough for everything on this and your stuff, too

Diapers (4-6)Better safe than sorry, even if you’ll only be out for an hour

WipesConsider two travel- sized packs – one for changes and one for faces, hands, spills

Diaper rash creamAn uncomfortable bottom can cut an outing short

Changing padA life saver when there is no changing table in sight

Receiving blanketFor naps or to put your baby down on less- than spotless ground

Burp clothFor spills, spit- up, and messy feedings

Change of clothes and socksConsider two changes if your baby is in the explosive poop stage

Extra layer (sweater or jacket)For sudden weather changes or cold buildings

Snack for your babyYou can’t get formula or baby food at the drive- through

Snack for youYou need fuel too, and don’t forget a bottle of water

Infant pain relieverSoothes teething pains and fevers

Hand sanitizerLets you clean up when there’s no sink nearby

Plastic zipper bags (2-3)For dirty diapers and wet clothes

Hat with brimPrevents sunburn and keeps your baby warm in cool weather

Baby- safe sunscreen

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Look for one formulated for infants

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ENHANCING PHYSICAL, SOCIAL, INTELLECTUAL, CREATIVE, AND EMOTIONAL DEVELOPMENT

INTRODUCTION:

A. AGGRESSION Aggressive behavior in 2 year- olds can include biting, scratching, hair pulling, grabbling toys, hitting, and poking at eyes. This sort of behavior is common among young humans and is part of normal developmental behavior.

All 2- year-olds are egocentric which means they think only of themselves. And things can sometimes be more important than people so that when another child grabs a toy, watch out! The child who loses the possessions will act aggressively toward the grabber.

Two- year- old children have yet to learn how to take turns. They have no manners, lack social conventions, and have not figured out why sharing is desirable. Play with other children can be hampered because these children have not developed communication skills. Peaceful interaction depends on being able to say what you want and understand the other person’s want.

Some hurtful behavior is exploratory. Young children as they are learning motor skills sometimes try out behaviors. What would it be like to bite Mommy’s nose? What happens if I scratch Grandma?

Handling hurtful behaviors like biting or scratching or hair pulling, even if it seems merely exploratory, is always the same. Say, “No! Scratching hurts!” and remove the child from the scene so the behavior cannot continue. You can hold 2- year-olds away from you so that their hands cannot reach you. You can also put them in their crib or room.

Parents tend to overreact to aggressive behavior in young children for two reasons: 1) they don’t know or fully understand that the behavior is part of normal development and 2) they worry the aggressive behavior is NOT ACCEPTABLE TODAY, TOMORROW, and OR EVER. You do this by being FIRM and CONSISTENT. You act promptly with stern firmness to remove the child from those that have been attacked or injured. You do this every time the child hits or kicks or bites. This is a NON-NEGOTIABLE matter. The lesson to teach: when you hurt people, you can’t be around people.

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In addition to ALWAYS reacting to hurtful behavior in the same way, parents can also try to PREVENT aggressive behavior in young children.

Don’t let the child get overtired or over hungry. Regular routines like naps and snacks can work wonders.

Try to avoid frustration in the child’s life. Common sources of frustration include rushing the child. Plan ahead and leave plenty of time. Give warnings.

Give children as many choices as possible. Let them decide what to wear and which cereal to eat.

Try to say, “No!” as infrequently as possible. I don’t mean you should allow kids to do what they want all the time but try to turn responses around. “we can go to the park after lunch.” Instead of “we can’t go to the park because lunch is ready.”

Work with young children on language acquisition. Name everything. Point out things in books and ask them to do the same. Be sure to give children a name for strong feelings. (“You are hungry because I said you couldn’t play with my pocketbook.”)

Yes aggression is a normal human response, but controlling our aggressive impulses is a hallmark of maturity. So help your kids grow up by teaching them this important lesson.B. REGRESSIONRegression, in psychoanalysis, is a defense mechanism leading to the reversion to an earlier stage of development in the face of unacceptable impulses.

Examples of these would be:1. When someone fails a test, they threw a temper tantrum or curl up and suck their

thumb, reverting back to how they dealt with stress in childhood.

Some people usually tend to regress themselves due to high stress and depression, while others tend to regress due to high amount of being bullied in the past.

C. HUNGERHunger is a feeling experienced when the glycogen level of the liver falls below a threshold, usually followed by a desire to eat. The usually unpleasant feeling originates in the hypothalamus and is released through receptors in the liver. Although an average nourished human can survive about 50 days without food intake, the sensation of hunger typically begins after several hours without eating.

D. FATIGUE The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work- induced burning sensation within one’s muscles.

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Physiologically, “fatigue” describes the inability to continue functioning at the level of one’s normal abilities due to an increased perception of effort.Fatigue is ubiquitous in everyday life, but usually becomes particularly noticeable during heavy exercise.

Fatigue has two known forms; one manifest as a local, muscle- specific incapacity to do work, and other manifests as an overall, bodily or systematic, sense of energy deprivation. Due to these two divergent facets of fatigue symptoms, it has been proposed to look at the causes of fatigue from “central” and “peripheral” perspectives.

Fatigue can be dangerous when performing tasks that inquire constant concentration, such as driving a vehicle. When a person is sufficiently fatigued, he or she may experience micro sleeps (loss of concentration). However, objective cognitive testing should be done to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.

E. BOREDOMBoredom is when someone perceives one’s environment as dull, tedious, and lacking stimuli. There is an intent anxiety in boredom, people will expend considerable effort to prevent or remedy it, yet in many circumstances it is accepted as an inevitable suffering to be endured. A common way to escape boredom is through creative thoughts or daydreaming.

F. LACK OF EYE CONTACTEye Contact is an event when two people look at each other’s eyes at the same time. It is a form of nonverbal communication and has a large influence on social behavior. Frequency and interpretation of eye contact vary between cultures and species. Eye aversion is the avoidance of eye contact.

G. NERVOUS TICSNervous tics are involuntary movements or twitches that most commonly occur in a person’s face, arms, or shoulders. The movements associated with nervous tics usually last for only a brief period of time and serve no purpose. Often, they are repetitive in nature. Typically, nervous tics involve twitching of the corner of the mouth, grimacing, twitching of the corner of the eye, blinking, or general repetitive movements with the arms, shoulders, or hands.

Children who develop nervous tics usually show signs of the disorder between the ages of five and ten. When nervous tics first appear, they can often be controlled, but they become automatic as the problem continues. As the child ages, nervous tics typically disappear. It is however, possible for a nervous tic to persist into adulthood.

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The decision whether or not to treat nervous tics largely depends on their underlying cause and whether or not they are interfering with the person’s life functions. If the underlying cause is a physical or mental health threat, then that cause must be addressed. Similarly, if the nervous tics are making it difficult for a person to socialize or otherwise live a normal, happy life, it may be necessary to develop a plan to control the problem.

H. CRYING

Crying is a part of life with a new baby. On average, newborns cry for about two hours each day. Although the crying is spread out through the day, all that wailing ads up to more than you probably expected. Between birth and about 6 years of age, the amount of crying typically increases to almost three hours each day, no matter what you do! After that, the fussing should eventually decrease to about an hour a day.

PAGES 20-22

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SELF-CHECK 1.1-4

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ANSWER KEY

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LEARNING OUTCOME 2 Prepare infants/toddlers for taking vital signs, bathing, and dressing

CONTENTS: 1. The tools and equipment 1.1 bathing paraphernalia 1.2 baby’s layettes 1.3 thermometer 1.4 thermometer tray 1.5 infant’s/toddler’s toys 1.6 appropriate dress 1.7 bassinet 2. Signs and Symptoms of distressed infants and toddlers 2.1 crying 2.2 appearing withdrawn 2.3 squirming 2.4 lack of eye contact 2.5 sleeping difficulties 2.6 whining 2.7 not playing or not playing creatively 2.8 repetitive display of trauma 2.9 aggression 2.10 regression 2.11 speech difficulties 2.12 toilet training difficulties 2.13 nervous tics 2.14 hunger 2.15 tiredness 2.16 discomfort 2.17 fear 2.18 anxiety 2.19 boredom 2.20 clinging behavior 3. Appropriate methods or activity 3.1 imitating baby’s vocalizations 3.2 talking 3.3 singing 3.4 laughing 3.5 rhymes 3.6 finger games 3.7 holding

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3.8 dancing 3.9 gentle bouncing 3. 10 substituting activities 3.11 playing 3.12 distraction of an activity 3.13 cuddles, comfort 3.14 listening, talking with infant or toddler quietly 3.15 use of transition object 4. Non- verbal cues 4.1 cues to indicate distress 4.2 response to an interesting activity 4.3 smiling 4.4 cues that express a desire to engage in an activity of interaction 5. Comforters 5.1 special toys 5.2 blankets 5.3 dummies 6. Pre-procedure for bathing and dressing 7. Procedure for obtaining infant and toddler vital signs

ASSESSMENT CRITERIA:1. Prepared tools and equipment according to the need of infant/toddler2. Responded to distressed infants/toddlers based on appropriate methods, activity and

non-verbal cues3. Picked up and cuddled infants and toddlers according to procedure4. Checked vital signs based on institutional standards5. Checked water quality and temperature as per requirement6. Made comforters available to infant and toddler when needed

CONDITION: Students/trainees must be provided with the following:

1. CBLM 2. Computer laboratory with Internet access 3. Fully equipped classroom/practical work area conducive for learning and other

activities 4. MATERIALS AND TOOLS

bathing paraphernalia baby’s layettes Thermometer thermometer tray infant’s/toddler’s toys appropriate dress

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stethoscope cotton and alcohol blankets baby bottles/pacifier

5. EQUIPMENT bassinet/crib baby bath tub infant dummy

ASSESSMENT METHOD:1. Written test2. Interview3. Demonstration with oral questioning

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Learning Experience

Learning Outcome 2: Prepare infants/toddlers for taking vital signs, bathing, and dressing

Learning Activities Special Instruction

Read Information sheet 1.2-1: Tools and equipment used in caring for baby

Please don’t hesitate to refer to your trainer for further discussion on the information sheets

Answer Self-Check 1.2-1 Compare answers to answer key. You should be able to get all answers correctly. If not, go back to the information sheet and try to answer again

Read Information sheet 1.2-2: Distress Signs of Infants and Toddlers; Appropriate methods and activities to address distress signs; and Non-Verbal Cues

Answer Self-Check 1.2-2

Perform Task Sheet 1.2-2: Responding effectively to distress signs of infants and toddlers

Refer to the Performance Criteria Checklist to be guided

Read Information sheet 1.2-3: Comforters

Answer Self-Check 1.2-3

Read Information sheet 1.2-4: Procedures on bathing and dressing, and taking the vital signs

Answer Self-Check 1.2-4

Perform Job Sheet 1.2-4: Taking the Vital Signs, and Bathing and Dressing infant/toddler

Refer to the Performance Criteria Checklist to be guided

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Information Sheet 1.2-1

TOOLS AND EQUIPMENT USED IN CARING FOR BABY

INTRODUCTION: An infant is defined as a human child at the youngest stage of life, especially before they can walk and generally before the age of one.

A human infant less than a month old is a newborn infant or a neonate.

Upon reaching the age of one or beginning to work, infants are subsequently referred to as “toddlers” (generally 12-36 months). Day cares with an “infant room” often call all children in it “infants” even if they are older than a year and/ or walking; they sometimes use the term “walking infant”.

A newborn’s shoulders and hips are narrow, the abdomen protrudes slightly, and the arms and legs are relatively short. The average birth weight of a full- term newborn is approximately 7 ½ lbs. (3.2 kg), but is typically in the range of 5.5- 10 pounds (2.7- 4.6 kg). the average total body length is 14-20 inches (35.6- 50.8 cm), although premature newborns maybe much smaller. The Apgar score is a measure of a newborn’s transition from the uterus during the first minutes of life.

A newborn’s head is very large in proportion to the rest of the body, and the cranium is enormous relative to his or her face. While the adult human skull is about 1/8 of the total body length, the newborn’s is about ¼. At birth, many regions of the newborn’s skull have not yet been converted to born, leaving “soft spots” known as fontanels. The two largest are the diamond- shaped anterior fontanel, located on the top front portion of the head. And the smaller triangular- shaped posterior fontanel, which lies at the back of the head. Later in the child’s life, these bones will fuse together in a natural process. A protein called noggin is responsible for the delay in an infant’s skull fusion.

During labor and birth, the infant’s skull changes shape to fit through the birth canal, sometimes causing the child to be born with a misshapen or elongated head. It will usually return to normal on its own within a few days or weeks. Special exercises sometimes advised by physicians may assist the process.

Some newborns have a fine, downy body called Lanugo. It may be particularly noticeable on the back, shoulders, forehead, ears and face of premature infants. Lanugo disappears within a few weeks. Likewise, not all infants are born with lush heads of hair. Some may be nearly bald while others may have very fine, almost invisible hair. Some babies are even born with a full heads of hair. Amongst fair- skinned parents, this fine hair may be blond, even if the parents are not. The

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scalp may also be temporarily bruised or swollen, especially in hairless newborns, and the area around the eyes may be puffy.

Immediately after birth, a newborn’s skin is often grayish to dusky blue in color. As soon as the newborn begins to breathe, usually within a minute or two, the skin’s color returns to its normal tone. Newborns are wet, covered in streaks of blood, and coated with a white substance known as vertex caseosa, which is hypothesized to act as an antibacterial barrier. The newborn may also have Mongolian spots, various other birthmarks, or peeling skin, particularly on the wrists, hands, ankles and feet.

PAGE 8……

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SELF-CHECK 1.2-1

ENUMERATION:

1. Name at least 5 tools and equipment used in caring for baby a. b. c. d. e.

2. List 3 clothing that is part of the infant’s layette a. b. c.

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ANSWER KEY

ENUMERATION:

1. Name at least 5 tools and equipment used in caring for baby a. infant’s bed/crib i. thermometerb. blanket/comforters j. thermometer trayc. infant carrier k. sterilizerd. stroller l. infant/toddler’s formula e. bassinet m. bibsf. bathing paraphernalia n. nursery rhymesg. layettes o. toys for the cribh. feeding bottles with cap, ring, and nipple p. infant’s/toddler’s toys

2. List 3 clothing that is part of the infant’s layette a. onesies- little undershirts with snaps at the bottom b. sleepers or nightgowns c. baby socks d. newborn hats or capse. gloves f. diapers

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Information Sheet 1.2-2

DISTRESS SIGNS OF INFANTS AND TODDLERS

4. Diapering at Home

Essentials Disposable or reusable diapers

Start with 150 for the first two weeks and buy more as needed Wipes

To clean your baby’s bottom without irritation Diaper rash cream

Creates a moisture barrier to help prevent diaper rash Portable changing pad

Provides a clean, dry changing spot n any location Burp cloths

To protect your clothing from baby’s spit- up Diaper disposal system

A convenient place to toss dirty diapers that helps contain odor Diaper disposal liner refills (2)

Replacements for the plastic liners used with disposal systems

If you use cloth diapers, you’ll need the following: Pre- folded cloth diapers (3 or 4 dozen to start)

If you’re not using a diaper service, stock up on these Diaper wraps (5 to 10 newborn size)

With Velcro or snap fasteners so you don’t have to use pins Diaper pail

To store (and soak) dirty diapers before laundering them

Nice Extras Changing table

Prevents back strain, has a strap for safety, and stores your supplies Changing pad for table

Cushions your baby during diaper changes Changing pad cover (2)

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Soft cloth makes the plastic- coated pad more comfortable Diaper wipe warmer

A warm wipe feels so much better to your baby’s bottom Mobile

Distracts and entertains squirmy babies at changing time Deodorizers

Air purifiers and other odor attackers for a sweet- smelling nursery

5. Feeding Needs

Breastfeeding Essentials Nursing bras(3-5)

Easy access for your baby and plenty of support for you Breast pads (2-4 pairs of washable or 1 box of disposable)

To prevent leaks from soaking through to your clothes Breast pump

Lets your pump and save breast milk for those times when you’re not around Disposable freezer bags

To store breast milk and protect nutrients for up to six months Nipple cream

Heals sore, cracked nipples and helps prevent chafing

Nice Extras Nipple shells

To protect tender nipples by holding cloth away from skin Nursing stool

Lifts your feet, raising your lap to the best position for feedings Nursing pillow

Reduces the strain in your arms and shoulders Bottle warmer

The fastest and safest way to take the chill out Bottle drying rack

A convenient way to let your bottles and nipples air dry Bottle sterilizer

Keeps germs from accumulating on bottles and nipples Glider rocking chair

Safer and more comfy than a rocker, it soothes your baby with gentle motion Receiving blankets (5-7)

Great for swaddling, mopping up spills, and protecting clothes from spit-up6. Medicine Chest

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Essentials Digital thermometer

A fast, safe way to take your baby’s temperature Petroleum jelly

Soothes minor skin irritations Diaper rash cream

Treats and prevents diaper rash Infant’s acetaminophen

For low- grade fevers, aches, and pains Saline nose drops

To help clear stuffy noses Bulb syringe

Because babies can’t blow their own noses Antibacterial ointment

Prevents infection of minor cuts and scrapes Tweezers

For removing splinters and ticks Baby nail clippers

For trimming tiny nails to prevent face- scratching Rubbing alcohol

Cleans thermometers, tweezers, and scissors Baby- safe sunscreen

To protect your baby’s delicate skin Baby- safe insect repellant

Made especially for babies under age 1 Children’s liquid decongestant

Check with your child’s doctor before choosing or using one Mild liquid soap

Antibacterial and deodorant soaps may be too strong for babies’ sensitive skin A medicine dropper, oral syringe, or calibrated cup or spoon

An easy, accurate way to give your baby the right dose of medicine Calamine lotion or hydrocortisone cream (1/2 percent solution)

For rashes, insect bites, and minor sunburn Infant gas relief drops

To quickly and safely relieve the discomfort of infant gas Electrolyte solution

Quickly replaces fluids lost through vomiting or diarrhea Cotton- tipped swabs

For cleaning delicate or hard- to- reach places

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Nice Extras Humidifier

Creates soothing, moist air for stuffy noses Small flashlight

To check ears, nose, throat, and eyes Hand Sanitizer

Kills germs on hands and thermometers

7. Sleeping Needs

Essentials Crib

A safe place for your baby to sleep up to age 2 or 3 Crib mattress

Pick one that’s firm and fits snugly into the crib Crib sheets (2-3)

Gives your baby a comfortable surface to sleep on Waterproof mattress protector

Keeps crib mattress dry and odor- free Bumper

Cushions and blocks railings so your baby can’t wedge an arm or leg between them Monitor

Lets you keep tabs on your baby sleepwear Wearable blanket sleepers (2)

A cozy sleeper that’s as warm as a blanket but can’t be kicked off Footed sleepers (5)

Warm, soft, and comfortable baby sleepwear Receiving blankets (4-6)

Perfect for swaddling, which helps many newborns sleep better

Nice Extras Bassinet Keeps your baby conveniently close for nighttime feedings Moses basket A wicker basket that allows your newborn to sleep in any part of the house Sleep positioned Keeps babies sleeping in their back to reduce the risk of SIDS Mobile Hung over the crib, it’s a soothing distraction for a wakeful baby Glider or rocking chair Back and forth movement is a time-tested way to send your baby to dreamland

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Swing The gentle motion and music puts some baby’s right to sleep Soothing crib accessories Designed to relax your baby with heartbeat sounds, music, and more

8. Feeding Solids

Essentials Highchair Secure seating that lets your baby join you at the table Spoons (3-5) Plastic or rubber- tipped spoons protect tender gums Bowls (3-5) Unbreakable for your baby, dishwasher and microwave safe for you Bibs (5-7) Plastic ones can be wiped off easily Sippy cups (5-7) To help kids drink from a cup without spills

Nice Extras Plastic splat mat

To protect your floors from food, art supplies, and more Portable booster chair

Provides a clean, safe seat for your child wherever you go To- go bowls with lids (3-5)

Great for snacks in the park or when visiting friends Food grinder or miniature food processor

Instantly turns your meal into baby food Plastic table toppers

To create a clean place for your baby at dirty restaurant tables Forks (3-5)

Baby- safe forks have dull, flat tines to prevent injuries Ice cube tray

For freezing homemade baby food Disposable cups, plates, and utensils

Always clean and ready to use Recipe books

Great ideas for homemade baby food

9. Bathing Needs

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Newborn Essentials Baby bathtub

Keeps your baby safe, and spares you back and knee pain Slip- resistant bath pad

Protects your baby from slips and slides Baby hooded towels (3-5)

Keeps your baby’s head warm after a bath Baby washcloths (3-5)

Perfectly sized and made for your baby’s delicate skin Floating water thermometer

Eliminates worries of whether the water is too hot or cold Baby wash

Cleans gently, rinses off thoroughly, and doesn’t irritate skin Baby shampoo

Won’t irritate eyes and leaves a great scent Baby lotion

Made for babies’ dry, delicate skin Baby brush and comb

Softer and smaller than adult brushes and combs Baby nail clippers

Tiny nails need small clippers to do the job safely.

Nice Extras Floating tub toys (3-5)

To keep your baby occupied while you gentle scrub Bath books (2-4)

Waterproof books occupy your baby and promote early learning Playful bath mitt

Hand- puppet washcloths make a good scrub less scary Terry robe

Keeps your baby warm and looks adorable Bubbles (nontoxic)

Nontoxic bubbles can keep your baby happy at bath time Padded faucet guard

Avoids nasty bumps

Others Toys Books Traveling and safety materials

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Storage and cabinets

PAGES 14- 20….SELF-CHECK 1.2-2

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ANSWER KEY

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Task Sheet 1.2-2

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Performance Criteria Checklist

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Information Sheet 1.2-3

COMFORTERS COMFORTERS

Comforters (or pacifiers, or attachment objects) include dummies, blankets, soft toys or thumbs that help children relax. Sucking is pleasant and calming for babies. Sucking or holding comforters helps very young children to feel safe when they are not with their parents or other family members, until they are old enough to feel OK by themselves.

Not all children have comforters. Children who sleep with their parents or a sibling at night, and who are cared for during the day by a parent or other close family member seem less likely to need a comforter. But they are very important for the children who do use them. Parents can encourage a child to use a particular comforter (such as a teddy or soft toy) by leaving it with the child at bedtime, but it is not possible to make a child choose what parents want. It has to be something that is so special for the child.

Why children use comforters? Comforters have a special meaning for the infant and young child. The child develops a

strong attachment to, and need for, the object to feel safe when alone. The object is reminder of the special close times that infants have with their parents and

becomes a stand- in for that closeness. They are a kind of bridge to help children move from the safety of being with their family to the big world around them.

Children usually have a strong need for the object at times of stress or change or separation, such as bedtime or when in child care, and studies have found that comforters help children to deal better with times of stress or anxiety.

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The comforter can also help the child to express her emotions. Children can fight, cuddle or be angry with their teddy, dummy or blanket.

As the child gets older and she is able to feel more secure inside herself, she will need the comforter less and it will gradually fall into disuse. It is important to the child to have control over this.

If a child uses a comforter, the comforter can make a positive contribution to her healthy emotional development.

At what age do children use comforters? Many babies get attached to a special toy or dummy at about 6 months of age (although

they may have it before) From 8 to 9 months on, the need for the comforter may be strong, especially at times

when the child is not with a parent, such as at bed time. Children need the comforter most between about 1 and 3 years of age, before they

have learned to feel safe when their parent is not there. Children are usually ready to give them up between 3 or 4 years of age- at least in the

day time. If a child still clings to the comforter by school age, it is important to ask what it is that is

making the child worried, rather than to take the comforter away.

When do children need comforters? Children use comforters most when they are worried, or afraid, or tired. They are usually needed at times such as bedtime or when staying with someone else

(e.g. child care). When children start preschool, some still want the comforter while they are there, but

they might not want the other children to know. In this case, sometimes a dummy or piece of blanket can be pinned hidden in a pocket so the child can touch it when he needs to. Sometimes a special place to o when the comforter is needed may be helpful, as long as the child knows that he can go there whenever he wishes.

Helping other children to learn that the comforter is special and not to be shared can protect the child’s rights to his special object.

Sometimes, however, if the child needs the comforter a lot, this will interfere with his opportunity to play.

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Dummies

Dummies (or pacifiers) are commonly used comforters. Dummies should not be used with glycerin or anything sweet such as honey on them,

because this can damage the child’s teeth. One of the things about a dummy is that you can easily replace it if it gets lost or

damaged. It is important not to let dummies get too worn before you replace them. Dummies should be tied on short cords which cannot go around a child’s neck and cause

strangling (no longer than 10 cm). Sucking on a dummy or fingers by a young child does not usually affect permanent tooth

position, but they can cause problems if they are not given up before the permanent teeth come through (by about 5 or 6 years of age).

Sometimes a child may develop a speech problem, such as lips, if the child has a dummy in her mouth when she is talking.

The effect dummies have on breastfeeding is still not fully clear. If dummies are used with very young babies before breastfeeding really gets going well,

the babies may not suck on the nipple as well as is needed to keep up the milk supply. Dummies should not be used to make breast- fed babies wait for a feed when they are

hungry, unless your doctor or child health nurse suggests it to make the time between feeds longer (space the feeds).

Babies use a different kind of sucking on the dummy from the breast, so it is advised by breastfeeding g organizations not to use a dummy until a breastfeeding is going well.

There have been quite a few claims that dummies can have bad effects on the health or development of children. These claims have generally been shown to be untrue. For example, research has shown that:

Children who use dummies are not likely to be less intelligent than other children. (Some research with tiny premature babies has shown that those who are given special dummies do better developmentally than those who do not get these dummies.)

Children who use dummies are not more likely to get ear infections

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Dummies reduce the risk of SIDS (see the topic ‘SIDS’).Thumbs and Fingers

Sometimes children will not take any comforter but their thumbs or fingers. Thumbs and finger are harder to give up than dummies or other comforters because

they are there all the time. Try to encourage your toddler or preschool child not to talk with her thumb or fingers in

her mouth. Past the age of 7, thumb and finger sucking can cause dental problems. If this is

happening for your child, you could think about whether her life is stressful, or whether this is a habit. Also talk to a dentist about it. Telling the child to stop is not usually helpful.

Many children go on sucking their thumbs into their teens, although this is something they tend to only do when they are embarrassed by it.

BottlesSome children use their bottle for a comforter.

If a baby chooses the bottle as a comforter, it is best to help the child get used to having water in it between feeds from an early age. Perhaps use a bottle that looks and feels different for milk feeds.

Continually sucking milk or juice can damage teeth.

Soft toys and Blankets Because children really get attached to their comforter, they can get very upset if it gets

lost or falls to pieces- which sometimes happen with blankets or soft toys. If you see that your child is choosing a blanket or soft toy to be special, you could buy

another one like it, so that they can both wear out at the same pace and can be changed when one needs washing.

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Babies should not have soft toys or a loose blanket in their cot or bassinette while they are asleep. It is possible that the toys or a loose blanket might cover the baby’s face. See the topic ‘Safe Sleep’.

Giving up ComfortersIt is best for children if they can give up their comforter when they are ready, not when other people think they should.

Children do this when the comforter loses its special meaning for them and when they feel confident trying new things (usually between 3 and 5 years of age).

1 and 2 year olds may agree to give their dummy to the fairies, but they do not understand that they can’t have it back when they need it. The child may be distraught when he later needs it and it is gone.

Nagging about it will make the child more worried and need the comforter more.When you can see that your child needs it less, you can put the comforter on a shelf when he is playing happily.

You can tell the child where the comforter is so he can get it when he needs to, but it won’t just be in his mouth or hand when he doesn’t need it.

Make sure the child is not lonely and bored during the day so he is less likely to think about the comforter.

If a child still needs a comforter a great deal after 5 or 6 years of age, or if a younger child is unable to enjoy play without the comforter being there, it is important to try to find out what is happening in his life and to deal with any underlying stresses.

PAGES 47-48…..

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Information Sheet 1.2-4

PROCEDURES ON BATHING AND DRESSING, AND TAKING THE VITAL SIGNS

INTRODUCTION:

A. HOW TO BATH AN INFANTSteps1. Get everything ready in advance. Once the baby’s in the bath, you will never leave him or

her for even a moment. (See “things you need” below). This is will also alleviate the need to run around with a wet baby in a towel while gathering all the gear together once you are done.

2. Be sure you’re dressed in appropriate clothes- you will get splashed and/ or soapy. Roll up long sleeves; remove jewelry like watches, rings, and bracelets. Many caregivers like wearing a terrycloth bathrobe while bathing a baby.

3. If you will be in kneeling position, you may like to use a folded towel to cushion your knees.4. You can use a special tub, or your clean kitchen sink until your newborn is several months

old (depending on the size of your sink).5. Run the water and check the temperature. You can use your elbow, wrist or special bath

thermometer available in many places. Always test before placing baby in the tub. The water should be comfortably warm to touch but not hot enough to scald a baby.

6. Line the sink or bath (if necessary- many baby tubs are already lined). If using the sink, place a towel or washcloth in the bottom. This keeps baby from slipping around. It is also handy to do this in a bath if it is slippery. Have a cup handy so that you can have something to rinse of any soap.

7. Keep your baby’s out of the water. If you has a child that cannot hold up his or her own head, place your left hand on baby’s back and gently use this hand to grasp the baby’s left

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upper arm to keep him/ her steady. Babies can be wriggly and slippery. Use a cup or your cupped hands to get baby wet.

8. Use a soft washcloth and begin washing a baby. If you wish, you can use a safe baby soap that is very neutral, but it isn’t necessary; a gentle scrub and wash down are adequate to keep babies clean. Don’t forget to get between all the little creases and behind the ears and under the neck where spit-up and moisture seem to collect. Don’t forget to gently clean the genitalia, too.

9. Wash the hair. If washing, lean baby back and gently massage water into hair and scalp. Use cup to pour water over baby’s head. You can use baby shampoo if desired but there is really no need. Baby is born with all the natural oils needed to keep the scalp beautiful and shampoos can easily spoil this balance.

10. If you use a baby shampoo, use your hand to create a ‘visor’ to protect the baby’s eyes form the soap.

11. Before rinsing, be certain that the temperature of the incoming water is not too hot!12. Make sure any soap use if off baby before finishing the bath. Place baby in a towel being

careful to cover baby’s head. When drying, make sure to dry gently behind the ears and in the skin folds, so that no excess moisture is left there.

Use a secure hold

A secure hold will help your baby feel comfortable and stay safe in the tub. Support your baby’s back, grasping your baby firmly under the armpit.

Washing baby’s back

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When you clean your baby’s back and buttocks, lean him or her forward on your arm. Continue to grasp your baby under the armpit.

Remember the creases

As you did during sponge baths, pay special attention to creases under the arms, behind the ears, around the neck and in the diaper area. Also wash between your baby’s fingers and toes.

13. Towel- dries the hair as much as possible. The fine hair of a baby will dry quickly. Do not use a hairdryer, as it is unnecessary and potentially dangerous.

14. Only apply creams, lotions, powders, or oils if directed by a doctor.15. Replace diaper (nappy) and dress baby in clean clothes.16. Cuddle your nice clean baby!

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TYPES OF FEEDING BOTTLESInfant formula is an artificial substitute for human breast milk. Formulas are designed for infant consumption, and usually are mostly either cow milk or soy milk.

Infant formula is necessarily an imperfect approximation since: The exact chemical properties of breast milk are still unknown. A mother’s breast milk changes in response to the feeding habits of her baby and over

time, thus adjusting to the infant’s individual growth and development. Breast milk includes a mother’s white blood cells that help the baby avoid or fight off

infections and give his immature immune system the benefit of his mother’s immune system that has many years of experience with the germs common in their environment.

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A baby bottle is a bottle with a teat (also called a nipple in the US) to drink directly from. It is typically used if someone cannot (as conveniently) drink from a cup, for feeding oneself or being fed.In particular it is used to feed an infant with infant formula, expressed breast milk or pediatric electrolyte solution.

Dimensions and designA large- sized bottle typically holds 270ml; the small size 150ml. it is composed of a bottle itself, a teat, a ring to seal the teat to the bottle, a cap to cover the teat and optionally a disposable liner.The height-to-width ration of bottles is high (relative to adult cups) because it is needed to ensure the contents flood the teat when used a normal angles; otherwise the baby will drink air. However, if the bottle is too tall, it easily tips. There are asymmetric bottles that ensure the contents flood the teat if the bottle is held at a certain direction.

Teats (or nipples)

The teat itself is typically slimmer and more flexible than the mother’s nipple. Babies can find feeding from the bottle easier than breastfeeding. Specialized teats that mimic the shape of the breast exist to allow babies to switch back and forth between bottle feeding and breast feeding for cases where “teat confusion” occurs. Teats come in a selection of flow rates.

Different flow rate teats either have more holes or larger holes. The correct flow rate needs to select based on the age of the infant. Variable flow rate teats are available for older infants. The hole is asymmetric so that by turning the bottle/ teat, different flows can occur. Specialized teats are available for infants with cleft palate.

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Vented bottles

“Vented” bottles allow air to enter the bottle while the baby is drinking without the need to break the baby’s suction during feeding. Alternatively a bottle liner can be used to enclose the formula instead of directly in the bottle. The liner collapses as the formula is drained.

Vented bottles work by allowing air to enter while preventing the liquid inside form escaping. A vent is the most popular brand in this category. It works by an “anti-vacuum skirt” in the base of the teat, where it forms a seal with the bottle. The skirt acts as a one way valve, allowing air to enter the bottle but not liquids to leave. If he sealing ring is tightened too much, the skirt is compressed too tightly to allow it to open and the bottle will not vent. If the sealing ring is too loose, liquid leaks from the bottle.

There are multiple patents for technologies in this area. Initial designs called for a complex spring and valve system that was impossible to clean and sterilize. Current research is in specialized materials with microscopic pores that allow the entry of air without the escape of liquids. This avoids the caregiver having to get the sealing ring tension just right. It remains to be seen whether these materials can withstand the rigors of daily cleaning and sterilization. Another competitor, Dr. Brown’s, offers a system whereby the vented air is conducted through a tube to the bottom of the bottle where the airspace is when the bottle is in use. This avoids the vented air from bubbling through the liquid and unnecessarily aerating the liquid.

Variations and accessoriesBottles may be designed to attach directly to a breast pump for a complete “feeding system” that maximizes the reuse of the components. Such systems include a variety of drinking spouts for when the child is older. This converts the bottle into a zippy cup, a cup with lid and spout for toddlers, which is intermediate between a baby bottle and an open top cup.

Bottles that are part of the feeding system may include handles that can be attached. The ring and teat may be replaced by a storage lid.

Accessories for bottles include cleaning brushes and drying racks. Brushes may be specially designed for a specific manufacturer’s bottles and teats. Bottle warmers warm previously made

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and refrigerated formula. Cooler designed to fit a specific manufacturer’s bottles are available to store pre-measured amounts of formula so that caregivers can pre-fill bottles with sterile water and mix in the powder easily. The containers are typically designed to stack together so that multiple pre- measured amounts of formula powder may be transported as a unit.

Specialty, “designer” bottles are now quite common as novelty gifts for parents or just something interesting for the child. They either have special logos or are of special shapes (e.g. animals). Some even have a hole in the middle. Depending on the shape, these bottles can be quite difficult to clean. Another specialty bottle is made from heat sensitive materials that act as a built- in thermometer. If the contents are too hot, the bottle changes color.

Institutions can purchase ready-to0 feed formula in containers that can be used as baby bottles. The lid screws off and is replaced by a disposable teat when the formula is ready toe used. This avoids storing the formula with the teat and possibly clogging the teat holes when formula is splashed within the bottle and dries.

TOOLS AND MAREIALS FOR CLEANING

You will need a few items to get started:1. All of the bottles you are going to sterilize2. A large pot filled ½ to ¾ of the way with water3. Dish soap4. Warm water5. A bottle brush6. A set of tongs or something similar to remove the bottles from the boiling water.7. Dish drainer or clean towels/ cloth laid on clean table top8. Storage/ container

PROCEDURE FOR CLEANING

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A new baby means a lot of new stress for parents. Feeding your baby can be a big trigger of that stress. Picking the right bottle, the right formula, and making sure your baby eats enough are just some of the worries new parents might face. But it’s good to know that you can easily clean your baby’s bottle nipples without adding unnecessary stress to your home.Instructions for cleaning

A. Before the first use1. Remove the bottles and nipples from the original packaging. Make sure there are no

decals or other unnecessary items stuck to the bottles or the nipples.2. Add water to a pot and bring to a boil. The pot should be big enough to hold all of your

bottles and accessories. And there should be enough water so that all of these items can be submerged.

3. Boil the bottles, nipples and all accessories for at least 5 minutes. If you have too much to fit in one pot, it may be necessary to repeat this step several times. You can use the same boiling water for this.

4. Allow bottles and nipples to air dry on a clean towel. It’s important that everything has cooled to room temperature before you try to use it.

B. In the dishwasher

1. Separate all bottle parts, making sure especially that the nipples and rings are apart from each other.

2. Rinse each part under warm water, removing any caked on debris.3. Place all small objects in dishwasher rack that’s designed for bottles and other small

items. These racks are made to fit on the top rack of the dishwasher. Bottles and other accessories that are too big for the rack are able to run through the dishwasher on the top rack.

4. Run your dishwasher like normal.

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C. By hand

1. Fill a sink with hot, soapy water. Some people choose a soap that comes with bleach to ensure the bottles are clean and sterile.

2. Place the bottles and nipples in the water and allow them to soak that come with bleach to ensure the bottles are clean and sterile.

3. Rinse everything under hot water, and allow drying on a towel.

Sterilization

If necessary, bottles can be sterilized by boiling in hot water, in a specialized bottle sterilization appliance (which typically uses steam) or in a specialized sterilization container that is micro waved. Modern bottles are difficult to sterilize in boiling water because they tend to float. Bottles were originally composed of glass which was dangerous when babies learned to feed themselves and held the bottle. For mainly cost reasons, modern bottles are unbreakable plastic. Since bottles have to be made to withstand the heat of sterilization, the bottle can also withstand the heat of dishwashers and are dishwasher- safe.

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There is some concern about BPA leakage on poly carbonate bottles due to extended dishwasher or boiling. However, unless there are infant healths concerns, or concerns about water contamination, baby bottle sterilization can be replaced by cleaning with hot soapy water.

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SELF-CHECK 1.2-4

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ANSWER KEY

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Job Sheet 1.2-4

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Performance Criteria Checklist

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LEARNING OUTCOME 3 Clean, sterilize feeding bottles and prepare milk formula

CONTENTS:1. Types of feeding bottles 2. Tools and materials for cleaning and sterilizing 2.1 feeding bottles 2.2 bottle brush 2.3 liquid soap 2.4 sterilizer (pot, or electric, or for microwaves) 2.5 stove or microwave 2.6 tongs 2.7 timer, watch or clock 2.8 small towel or cloth 2.9 storage for clean bottles 2.10 tap water3. Procedure for cleaning and sterilizing baby bottles4. Breastfeeding importance and procedures5. Types of milk for infants and toddlers6. Procedures for preparing milk formula 7. Normal prescription of milk appropriate to child’s age8. Basic measurement techniques

ASSESSMENT CRITERIA:1. Identified cleaning and sterilizing materials/tools2. Cleaned and sterilized infants and toddlers’ feeding bottles as needed3. Prepared the prescribed milk formula

CONDITION: Students/trainees must be provided with the following:

1. CBLM 2. Computer laboratory with Internet access 3. Fully equipped classroom/practical work area conducive for learning and other

activities 4. SUPPLIES AND MATERIALS:

feeding bottles bottle brush liquid soap

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small towel or cloth tap water milk formula

5. EQUIPMENT sterilizer (pot, or electric, or for microwaves) stove or microwave tongs timer, watch or clock storage for clean bottles

ASSESSMENT METHOD:1. Written test2. Demonstration with oral questioning

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Learning Experience

Learning Outcome 3: Clean, sterilize feeding bottles and Prepare milk formula

Learning Activities Special Instruction

Read Information sheet 1.3-1: Breastfeeding Please don’t hesitate to refer to your trainer for further discussion on the information sheets

Answer Self-check 1.3-1 Compare answer to answer keys. You should be able to get all items correctly. If not, read information sheet again, and answer afterwards.

Perform Task Sheet 1.3-1: Breastfeeding the Baby

Refer to the Performance Criteria Checklist to be guided.

Read Information sheet 1.3-2: Feeding Infant Formula

Answer Self-check 1.3-2

Perform Job Sheet 1.3-2: Sterilizing bottles, Preparing milk formula, Feeding and Burping

Refer to the Performance Criteria Checklists to be guided.

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Information Sheet 1.3-1BREASTFEEDING

BREASTFEEDING PROCEDURECross- cradle hold

Breast- feeding is a natural process. But your first few attempts to breast-feed your baby may feel awkward at best. Experiment with various positions until you feel comfortable.The cross-cradle hold is ideal for early breast-feeding, when you and your newborn are getting used to the process. Sit up straight in a comfortable chair with armrests. Hold your baby crosswise in the crook of the arm opposite the breast you’re feeding from- left arm for right breast, right arm for left. Support the baby’s trunk and head with your forearm and palm. Place your other hand beneath your breast in a U-shaped hold. This will help you guide the baby’s mouth to your breast and make it easier for the baby to latch on properly.Don’t bend over or lean forward to bring your breast to your baby. Instead, cradle your baby close to your breast.

Cradle hold

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The cradle hold is similar to the cross- cradle hold, but you support the baby with the arm on the same side as the nursing breast, rather than the opposite arm. As with the cross- cradle hold, sit up straight- preferably in a chair with armrests. Cradle your baby and rest his or her head in the crook of your elbow while he or she faces your breast. For extra support, place a pillow on your lap.

Football hold

Another option is the football hold. This position is especially popular among mothers who: Are recovering from caesarian births Have large breasts Are nursing a premature baby or two babies at once Need to encourage a baby to take more of the nipple into his or her mouth

Hold your baby at your side, with your elbow bent. With your open hand, support your baby’s head and face him or her toward your breast. Your baby’s back will rest on your forearm. For comfort, put a pillow at your side and use a chair with broad, low arms.

Side-lying hold

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A lying position may help your baby latch on to your breast correctly in the early days of breast- feeding. It’s also a good choice when you’re tired. If you’re recuperating from a Caesarian birth, reclining may be your only option for the first few days.

Lie on your side and face your baby toward your breast, supporting him or her with the hand of the arm you’re resting on. With your other arm and hand, grasp your beast and then touch your nipple to your baby’s lips. Once your baby latches on, use the bottom arm to support your own head and your top hand and arm to help support the baby.

Breastfeeding is the feeding of an infant or young child with milk from a woman’s breasts. Babies have a sucking reflex that enables them to suck and swallow milk.

With few exceptions, human breast milk is the best source of nourishment for human infants. However, experts disagree about how long to breastfeed to gain the greatest benefit, and how much more risk in involved in using artificial formulas.

A mother may breastfeed her infant, or another infant, e.g. as a wet nurse. While there are conflicting studies about the relative value of artificial feeding, including infant formula, it is acknowledged to be inferior to breastfeeding for both full term and premature infants. In many countries, including the First World, artificial feeding is associated with more deaths from diarrhea in infants.

Lactation The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.

Breast milkNot all the properties of breast milk are understood, but its nutrient content is relatively stable.Brest milk is made from the nutrients in the mother’s bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infants exclusively uses 400-600 extra calories a day in producing a milk. The composition of breast milk and amount of water, fat and other nutrients varies depending on the manner in which the baby nurses and the mother’s food consumption and environment.

Foremilk, released at the beginning of a feed, is watery, low in fat and high in carbohydrates. Hind milk, released as the feed progresses, is creamier. There is no sharp distinction between foremilk and hind milk and the transition from one to the other is very gradual. The fat content of the milk is primarily determined by the emptiness of the breast- the less milk in the breast, the higher the fat content. The breast can never be truly “emptied” since milk production is continuous.

Benefits for the infantThe benefits of breastfeeding babies are well documented. The American Academy of Pediatrics states;

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Breastfeeding is associated with a lower risk for the following diseases: Atopic disease\autoimmune thyroid diseases Bacterial meningitis Celiac disease Diabetes Diarrhea Eczema Necrotizing enter colitis Obesity Otitis media (ear infection) Respiratory infection and wheezing Urinary tract infection

Breast milk has several anti- infective factors, including the anti- amoebic factor BSSL, (Rodriguez- Palmero, Koletzko, Kunz, & Jensen, 1999), lactoferrin, the second most common protein in human milk that binds to iron and inhibits the growth of intestinal bacteria like E. coli and Salmonella, and IgA’ which protects breastfeeding infant’s from microbial infection.

Breast milk contains the right amount of the amino acids cystine, methionine, and taurine that are essential for neuronal (brain and nerve) development. A New Zealand study took 280 infants and assessed them at the 7-8 years of age on their verbal and performance IQ.

Researchers also asked the mothers if they had breastfed or not and for how long. 37% of the mother’s had breastfed for 4 months or longer. Children who were breastfed for 8 months or longer had meant verbal IQ scores that were 10.2 points higher and performance IQ scores that were 6.2 higher than children who were not breastfed. Their data suggests that breastfeeding may have long term effects on children’s cognitive development.

Exclusive breastfeeding may reduce the risk of HIV transmission from mother to child. A case- control study was done on HIV infected Tanzanian women and their children to determine the effects of breastfeeding on transmitting the disease from mother to child.

Benefits for the mother Breastfeeding is the most cost effective. It provides the best nourishment for a child with a little extra food for the mother; infant formulas are not as good and cost much more.

Breastfeeding releases the hormones oxytocin and prolactin which relax the mother and make her feel more nurturing toward her baby. Breastfeeding soon after giving birth increases the mother’s oxytocin levels, making her uterus contract more quickly in reducing bleeding bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.

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As fat accumulated during pregnancy is used to produce milk, breastfeeding can help mothers lose weight. Frequent and exclusive breastfeeding can delay the return of ovulation, and therefore fertility. Ovulation returns before menstruation does, and women can become pregnant before menstruation returns. Therefore, breastfeeding cannot be used as the only form of fertility regulation without careful and skillful observation of a combination of other fertility signs, such as cervical position and texture, basal body temperature, and commercial predictor’s kit.

Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point during the pregnancy.

Breastfeeding mothers have less risk of breast, ovarian, and endometrial cancer, and less risk of osteoporosis. Mother who breastfeed longer than eight months have better bone re- mineralization. Breastfeeding diabetic mothers require less insulin. Breastfeeding helps stabilize maternal endometriosis; there is less risk of post- partum hemorrhage, and less risk and beneficial effects on insulin levels of mothers with polycystic ovary syndrome.

Some breastfeeding women have pain from thrush or staph infections of the nipple. With continued breast feeding and treatment these can be easily managed and be of little concern for mother and child.

BondingThe hormones released during breastfeeding strengthen the maternal bond, the nurturing feelings the mother has towards her child. This is very important as up to 80% of mothers suffer from some form of postpartum depression, though most cases are very mild. The woman’s partner and other caregivers can support here in a variety of ways and this support is an important factor in successful breastfeeding rates.

Breastfeeding can affect family relationships. While some partners may feel left out when the mother is feeding the baby, others find breastfeeding strengthens family bonds. Looking after a new baby and breastfeeding take time. This can add pressure to the family, as the partner has to care for the mother as well as doing tasks she would otherwise do. However, as a partner is often very willing to give this support, this pressure can help to strengthen the couple’s pair bond and also to build the paternal bond to the new member of the family.

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk (EBM). The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. However, the mother must produce and store enough milk to feed the child for the time she is away and this may not always be practical. Also, the other caregiver must be comfortable in handling breast milk. These two factors may prompt the mother- perhaps against her wishes- to give up breastfeeding.

Time and place for breastfeeding

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Breastfeeding at least once every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high. Newborn babies may feel more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day. Feeding a baby on demand (sometimes referred to as “on cue”), may mean breastfeeding much more than the recommended minimum. Feeding when the baby shows early signs of hunger is the best way to maintain milk production and ensure the baby’s needs for milk and comfort are being met. However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hind milk, potentially creating problems.

Babies usually show they are hungry by waking up (newborns), mouthing their fists, moaning or fussing. Crying is a late indicator of hunger. When a baby’s cheeks are stroked, the rooting instinct makes it move its face towards the stroking and open its mouth.

Breastfeeding can make mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions can last for an hour or more (there is no time limit for breastfeeding). Having water readily available helps mothers maintain proper hydration.

Most states now have breastfeeding laws which allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming- in care is used for breastfeeding. There are breastfeeding rooms in some places, including hypermarkets.

Latching on, feeding and positioningWhen the nipple strokes the baby’s cheek will open its mouth and turn towards the nipple. To help the baby latch on well, push the nipple into its mouth so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby’s throat, with the baby’s tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto.

Many women wearing nursing brassieres for easier access to the breast, but these are not always necessary and certainly not required. In the very early days, wearing a nursing bra can make breastfeeding complicated and uncomfortable. Wearing a bra at anytime afterbirth will not affect how the breast changes with pregnancy and breastfeeding. Many women find that the size of their breasts change dramatically and so fitting a bra is better done after childbirth rather than before. An ill- fitting bra, whether designed for nursing or otherwise, can cause plugged ducts or mastitis.

Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.

The baby may full away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or

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even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.

The length of feeds varies a lot. Regardless of the time taken, the breastfeeding mother should be comfortable.

Upright: the sitting position with the back straight and leaning back comfortably. Mobile: the mother carries her nursing in a sling or other baby carrier while

breastfeeding. Doing so permits the mother to incorporate breastfeeding into the varied work of daily life.

Lying down: good for night feeds and for those who have had caesarian section On her back: mother is usually sitting slightly upright; particularly useful for

tandem breastfeeding (nursing more than one child) On her side: the mother and baby lie on their sides

Hand and Knees: the mother is on all fours with the baby underneath her ( not usually recommended)

While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child’s comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but thew mother should offer both breasts at every nursing with her newborn.

Cradling positions: Cradle hold: the baby is held with its head in the woman’s elbow horizontally

across the abdomen, “tummy to tummy”, with the woman in an upright and supported position image

Cross- cradle hold: as above but the baby is held with its head in the woman’s hand

Football hold: the woman is upright and the baby is held securely under the mother’s arm with the head cradled in her hands. This position especially useful for feeding twins simultaneously image

Feeding up hill: the baby lies stomach to stomach with the mother who is lying on her back; this is helpful for babies finding it difficult to feed.

Lying down: On its side: the mother and baby lie on their sides On its back: the baby is lying on its back (cushioned by something soft) with the

mother on her hands and knees above the child (not usually recommended)When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows. Favored positions include:

Double cradle hold Double clutch hold

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One clutched baby and one cradled baby Lying down

Expressing breast milk

Manual Breast MilkWhen direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use.

Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen from up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.

Expressing breast milk can maintain a mother’s supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother’s reaction-‘a jump and cry of pain’ is usually enough to discourage the child from biting again. (Another possibility is responding to the bite by drawing the baby so close that is nose is covered and he cannot breathe without releasing. Babies or toddlers that are truly feeding cannot physically bite the nipple.

“Exclusively Expressing”, “Exclusively Pumping” and “EPing” are terms for a mother who feeds her baby exclusively on her breast milk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes.

It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4-6 weeks old and is good at sucking directly from the breast. Because it takes less effort to suck from a bottle, a baby might lose its desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4-6 weeks of age, it is recommended that breast milk be given by the other means such as feeding spoons or

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feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse) and associate bottle feeding with other people.

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman’s milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk- either from donors or the baby’s own mother- is the feeding method of choice for premature babies.

PAGES 49- 54…..

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SELF- CHECK 1.3-1

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ANSWER KEY

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Information Sheet 1.3-2

FEEDING INFANT FORMULA Mixed feeding

Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle. Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle feeding (or using a pacifier) before the baby us used to feeding form its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mother supplement feed with a small syringe with a flexible cup to reduce the risk of artificial nipple preference.

Tandem Breastfeeding

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Feeding two children at the same time is called tandem breastfeeding. The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.

In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully.

Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrums, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.

Extended breastfeedingBreastfeeding past two years is called extended breastfeeding or “sustained breastfeeding” by supporters and those outside the U.S. some women breastfeed a child until the age of 3 or more. Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional; continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother.

Shared breastfeedingIn developing nations in Africa, it is sometimes common for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants. A woman who is engaged to breastfeed another’s baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry.

WeaningWeaning is the process of introducing the infant to ordinary food and reducing the supply of breast milk. The infant is fully weaned once it relies on ordinary food for all its nutrition and it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and drink milk- usually cow or goat milk- well beyond the age of weaning.

In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this

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medication poses serious risks to women, such as stroke, and the U.S. FDA withdrew this indication for the drug in 1994.

TYPES OF MILK

What are the main types of infant formula?All commercial infant formulas are nutritionally sound and designed to support your baby’s growth and development. Most babies thrive on cow’s milk formula, but some babies fare better with other types of infant formula.

Cow’s milk formula. Most infant formula is made with cow’s milk that has been altered to resemble breast milk. The alteration gives the formula the right amount of carbohydrates and the right percentages of protein and fat. The alteration also makes the formula easier to digest. Remember the regular cow’s milk isn’t a substitute for infant formula. Pasteurized goat’s milk and evaporated milk aren’t either.

Soy- based formula. Soy- based formula may be an alternative for babies who are allergic to the proteins in cow’s milk formula or who can’t tolerate lactose, a sugar naturally present in cow’s milk. If you choose to use soy products, be sure to use a soy- based infant formula- not soy milk.

Protein hydrolysate formula. This type of formula is meant for babies who have a family history of milk allergies. It’s easier to digest and less likely to cause allergic reactions than are other types of formula.

More specialized infant formulas are available for premature infants and babies who have specific medical conditions.

What are the various forms of infant formula?Infant formula is available in three forms: ready-to-feed, concentrated liquid and powder. Ready-to-feed is used “as is”. Concentrated liquid (the only liquid that comes in a 13 ounce can) and powder must be diluted with water according to instructions on the label. Ready-to-feed and concentrated liquid infant formulas are commercially sterile. Powdered formulas are not sterile. Preparation of any form of infant formula (especially powdered products) requires careful handling to prevent contamination and minimize growth of microorganisms. Manufacturer’s instructions should be followed in all cases.A graphic depicting the addition of water and the statement “add water” are found on concentrated formula containers. Because ready-to-feed and concentrated formulas are both liquids, anyone caring for your child should be made fully aware of what form of formula you use, and whether or not water must be added. (Powdered infant formula containers also provide a graphic depicting the major preparation steps for the formula.)

What is the difference between milk- based and soy- based infant formulas?

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The protein in milk-based formulas came from cow’s milk which has been heat treated, making it easy for a baby to digest. The sugar in milk- based formulas is lactose, unless specifically manufactured as lactose- free. Soy- based formulas are milk- free and lactose- free; the protein in these formulas comes from a soybean source that also is easy for a baby to digest. If a baby exhibits signs of lactose intolerance or certain allergic reactions to milk protein, the physician may recommended a soy-based formula to help treat these conditions. A baby with confirmed milk protein- induced colitis could also be sensitive to soy protein so might be given an extensively hydrolyzed sate formula, one in which the protein has been predigested so it will decrease the likelihood of a reaction. Parents who seek a vegetarian- based diet for their healthy infant may want to discuss the use of soy- based formula with the pediatrician.

What nutrients are present in infant formula and why are they included?Infant formulas contain energy- providing nutrients (protein, carbohydrate and fat) as well as water (an essential nutrient) and appropriate vitamins and minerals. The energy nutrients provide the calories necessary to maintain bodily functions, support activity, and promote growth. They also support desirable immune functions as an outcome of overall nutrition. Protein provides the building blocks necessary to form and repair tissue. Vitamins and minerals are essential in the metabolism of energy nutrients. Minerals play an important part in bone structure, regulate certain body functions and together with water, help maintain the body’s water balance.

Standard iron- fortified formulas are naturally complete foods for normal infants. When a physician recommends a formula not fortified with iron, another source of iron should also be recommended. A physician may recommend fluoride supplementation to infants at least 6 months of age only if the water supply is severely depleted of fluoride.U.S. manufacturers of infant formulas currently offer infant formulas containing docosahezanoic acid (DHA) and arachidonic acid (ARA), two nutritional fatty acids considered to be “building blocks” for the development of brain and eye tissue. Formulas containing DHA and ARA have been shown to provide visual and mental development similar to the breastfed infant.

MILK PREPARATIONYou can choose between powdered, concentrated liquid and ready- to- use infant formulas.Which is best depends on your budget and lifestyle.

Powdered formula. Powdered formula is the least expensive type of infant formula. Each scoop of powdered formula must be mixed with a specific amount of water.

Concentrated liquid formula. Some parents prefer concentrated liquid formula. It must also be mixed with a specific amount of water.

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Ready- to- use formula. As the name implies, ready-to-use formula doesn’t need to be mixed with water. It’s the most convenient type of formula, but also the most expensive- especially when packaged in disposable bottles.

Whichever type of infant formula you choose, proper preparation and refrigeration are essential. Follow these steps:

Wash your hands and utensils. Before preparing formula, wash your hands with soap and water. Be sure all the utensils you’ll use are clean, too, including bottles and nipples. You may want to sterilize bottles and nipples before using them for the first time. After that, cleaning them in a dishwasher or washing them by hand with soapy water is enough. If you’re opening a new can of formula, wipe the top of the can with a clean towel or napkin before you puncture it.

Measure the formula. Don’t take shortcuts in measuring. First, use water and a measuring cup to make sure the measurements printed on the bottle are accurate. If the bottle measurements are off, mark the bottle appropriately. If you’re using powdered formula, fill the scoop provided and shave off any excess formula with the flat side of a knife. Don’t use a spoon or any other curved surface. Pour liquid concentrate directly into a measuring cup or bottle. Make sure that the quantity is level with the correct measurement mark.

Mix the formula. Powdered and concentrated liquids formulas must be mixed with water. Use the exact amount of water the manufacturer specifies on the label. If the formula is too diluted or too concentrated, you may upset your baby’s electrolyte balance and your baby’s nutritional needs won’t be met. Never dilute formula to make it last longer.

Keep in mind that exposure to fluoride during infancy helps prevent tooth decay during childhood and beyond. But it’s possible to have too much of a good thing.

Regularly mixing a baby’s formula with fluoridated tap water can provide enough fluoride exposure to cause white streaks on the teeth. These streaks, which affect both baby and permanent teeth, are a mild sign of a condition known as flourosis. In more severe cases, flourosis can cause pitting or staining of tooth enamel.

The American Dental Association suggests that fluoridated tap water not to be used to prepare infant formula. Some amount of fluoride is still important, however. If you use only nonflouridated water- such as purified, de-ionized or distilled bottled water- to prepare your baby’s formula, your baby’s doctor may recommend fluoride supplements beginning at age 6 months.

After age 1- when infant formula is typically replaced by milk and other foods- excessive exposure to fluoride through fluoridated tap water is no longer a concern. In fact, in the

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doctor prescribes fluoride supplements, they may only be needed until your child stops drinking formula and begins to drink fluoridated water as part of a balanced diet.

Warm the formula, if needed. It’s fine to give your baby room temperature or even cold formula. If your baby prefers warm formula, place a filled bottle in a bowl or pan of hot water and let it stand for a few minutes. Shake the bottle after warming it. Then turn it upside down and allow a drop or two of formula to fall on your wrist to test the temperature. It should be lukewarm- not hot. Don’t warm bottles in the microwave. The formula may heat unevenly, creating hot spots that could burn your baby’s mouth.

Refrigerated extra bottles. If you prepare and fill several bottles at once, refrigerate the extra bottles until you need them. Discard any prepared formula that’s been in the refrigerator more than 24 hours- or any formula that remains in the bottle after a feeding.

When might I need to try a different infant formula?Fussing, crying and spitting up rarely indicate a baby’s tolerance to infant formula. But a few babies don’t respond well to certain formulas. Report any of these signs to your baby’s doctor:

Diarrhea Persistent or increasingly forceful vomiting Unusual fatigue or weakness Dry, red, scaly skin Gas

If your baby’s doctor suspects a reaction to the formula you are using, he or she may suggest switching brands or trying another type of formula.

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INFANT/ TODDLER DIET AND FEEDING PROCEDURESA. INFANT FEEDING GUIDELINES

Stages of an infant development and introduction to solidsThere are many cues that your infant gives to let you know she’s hungry. You may be surprised at how many there are in a newborn baby. When your newborn is hungry she may open her mouth, put her hand in her mouth, make sucking noises and, of course, cry.

The sole diet of an infant from birth to at least 4 months should be only breast milk or iron- fortified formula. Any other forms of milk or solids should not be introduced. These foods or milks can cause problems for the developing infant. It is much safer to wait until your infant is at least 4 months and only if she is developmentally ready!

AGE GROWTH STAGESADDITIONAL NUTRIENT

NEEDSFOODS TO OFFER

Birth to 6 months

SucklesRoots for nipple

Only breast milk or iron- fortified formula

None

5- 7 months

Sits with supportFollows food with eyesBegins to swallow thickened food

Iron fortified infant cereal:-rice-oats(feed with spoon)

6- 8 months

Hand to mouth movementMoves tongue to sideControls position of food in the mouthControls swallowUp and down chew

Vitamin A andVitamin C

Strained or mashed:-vegetables-fruits-infant juice (diluted with water. Begin teaching baby to drink from a cup.)

7- 10 months

BitesRotary chewMoves food from side to side in mouthForms lips to cupGrasp develops

B vitaminsVariety diet( allow baby to feed self with hands)

Finger foods-dry cereal-toast squaresCrackers-soft tortilla-cooked vegetables-soft fruit wedges

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8- 10 months

Sociable:Greater interest in solid foodsDrinking from cup improvesThumb and fingers (pincer grasp) develops

ProteinTrace elements(allow baby to feed self with spoon)Gradually decrease number of feedings from breast or bottle as baby eats more solid foods

Mashed or chopped foods from the family meal; ground or finely chopped meats, fish or poultry; cottage cheese; egg yolk (whole egg at one year)

Caution: babies can easily choke on nuts, seeds, popcorn, raw vegetables, peanut butter and hotdogs. Young children should be watched carefully while they are eating.

What are Some Good Table Foods to Start With?1. Start with small bits of soft fruit such as bananas or vegetables2. Mashed potatoes3. Well- cooked mashed vegetables4. Yogurt5. Canned, drained tuna or salmon (no bones)6. Mashed or refried beans7. Mashed egg yolk (wait until at least a year of age before introducing egg whites- baby

may have an allergy to egg white)

When a Cup Should Be IntroducedYour baby maybe ready to start drinking from a cup between 6- 8 months. The 6 month old who is sitting up unsupported and is using both hands for play is developmentally ready to begin learning to drink from a cup. Start with a small amount of breast milk or a formula in the cup, hold the baby in your lap and show him how to drink. Small amounts of apple, pear or other juice may be offered in the cup. Infants do not need more than 4 ounces of juice a day. This is also a good time to introduce plain water.

Infant Weight GainBreastfed infants generally gain weight according to the following guidelines:0-4 months: 170 grams per week4-6 months: 113-142 grams per week6-12 months: 57-113 grams per week

It is acceptable for some babies to gain 113- 142 grams (4-5 ounces) per week. This average is taken from the lowest weight, not the birth weight.

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The average breastfed baby doubles birth weight in 5-6 months. By one year, the typical breastfed baby will weigh about 2 ½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies. By two years, differences in weight gain and growth between breastfed and formula- fed babies are no longer evident.

B. FEEDING THE TODDLEROnly fight battles you can win. You can stop a toddler from doing what you don’t want her to do, but you can’t get her to do what you want her to do. You can get her to come to the table, but you can’t make her eat.

Simple things to make mealtimes better: Have regular meals and snacks Feed a toddler every 2 to 3 hours Snacks should be planned, not just handouts. A good snack contains 2 of the 5 food groups. At least some of the meals should include everyone in the household as a family meal. Turn off the TV so everyone can pay attention to each other at meal time. Don’t allow toys or other distractions at the table- keep the meal social Respect a child’s speed at meals Sit at the table with your toddler as he eats. Talk and pay attention to your child, but don’t overwhelm her with attention. Enjoy your own meals and help your toddler enjoy mealtimes with you.

Parents are responsible for: Selecting and buying foods Making and presenting meals Regulating timing of meals and snacks Presenting food in a form a child can handle Allowing eating methods a child can master Making family mealtimes pleasant Helping the child to participate in family meals Helping the child to attend to his eating Maintaining standards of behavior at the table

The parent is NOT responsible for: How much a child eats Whether he eats How is or her body turns out

Foods to avoid: 12 to 24 months

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Low- fat milk: Your toddler still needs the fat and calories of whole milk for growth and development. Once he turns 2 (and if he doesn’t have any growth problems), you can start giving him lower- fat milk if you like.

Large chunks: Pea- size pieces of food are safest- they won’t get stuck in your child’s throat. Vegetables like carrots, celery, and green beans should be diced, shredded, or cooked and cut up. Fruits like grapes, cherry tomatoes, and melon balls should be cut into quarters before serving, and meats and cheeses should be cut into very small pieces or shredded.

Small, hard foods: Nuts, popcorn, cough drops, hand candies, raisins, and other small dried fruit and seeds are potential choking hazards. Also avoid chewing gum and soft foods like marshmallows and jelly candies that might get lodged in your child’s throat.

Peanut butter: Be careful not to give your toddler large dollops of peanut butter, which can be difficult to swallow. Instead, spread peanut butter thinly on bread or crackers. You might want t try thinning it with some apple sauce before spreading it.More choking prevention:

Avoid letting your child eat in the car since it’s hard to supervise while driving. If you’re using a rub- on teething medication, keep an even closer eye on your toddler as

it can numb his throat and interfere with swallowing.

Highly allergenic foods: Most kids can handle common allergens by their first birthday. But if you’re concerned about allergies, experts suggest delaying the introduction of egg whites until age 2, and holding off on shellfish, tree nuts, and peanuts (including peanut butter) until your child is at least 3.

Foods to avoid: 24 to 36 monthsChoking hazards: Even though your child is becoming a more competent eater, there’s still a chance he could choke on his food. Continue to avoid the choking hazards listed above, and discourage your child from eating while talking, watching TV, or doing anything else that might distract him from his meal.

Highly allergenic foods: By age 1, most children can handle most foods. However, in families that are prone to allergies, it’s better to wait until after age 3 to introduce highly allergenic foods such as nuts and shellfish.

Foods to avoid: age 3 and upChoking hazards: Your child is a very competent eater now, but you should still be on the lookout for pieces of food that he could choke on. Keep cutting his food into small pieces, especially things like grapes and pieces of hot dog that could completely block his airway if inhaled. Continue to avoid popcorn, whole nuts, and chewing gum, and discourage your child from eating when distracted.

Allergens: Most children outgrow food allergies by age 3, so your preschooler can now safely eat a wide variety of foods. (Note: Allergies to some foods, like nuts and shellfish, can persist for years, so you may need to steer clear of them for some time to come. Talk to your doctor if you have questions about these foods.)

Avoid common mistakes, such as:

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Drinking more than 16- 24 ounces of milk each day. Drinking more than 4- 6 ounces of juice each day. Letting your child fill up on sweets and snacks. Forcing your child to eat when he isn’t hungry. Giving servings that are too big. The average toddler serving is going to be about ¼ of an

adult serving size. Don’t go by the serving size listed on nutrition labels, as these are mainly for elder children and adults.

Toddler Food PyramidWell, there isn’t a toddler food pyramid. The Kid’s Food Pyramid is for children aged 2- 6 years, but you can still use it to guide what your younger toddler eats, including 6 servings of grains, 3 servings of vegetables, 2 servings of fruits, 2 servings from the milk/ dairy group, 2 servings from the meat and protein group, and a limited amount of fats and sweets. Just remember that the servings sizes will be smaller for younger toddlers and are equal to about ¼ an adult’s serving size.

The Basics of a Toddler’s DietAlthough you shouldn’t usually count calories, knowing how many calories your toddler needs can help when planning his diet and can also help reassure you that your child is getting enough to eat.

The average toddler needs about 1300 calories each day. Bigger kids will need a little more and smaller kid a little less. A good rule of thumb is that your toddler will need 40 calories each day for each inch of his height.If he is following AAP recommendations as to how much milk and juice he drinks, that will take care of:

300- 455 calories (about 19 calories per ounce) from whole cow’s milk (or a similar amount from breast milk if you are breastfeeding your toddler 2- 3 times a day) if he is drinking 16-24 ounces a day. Remember to not give low fat milk until your child is 2- 3 years old and don’t overdo it on milk. If he gets up to 48 ounces of milk a day, then he is getting over 900 calories he needs all day.

60-90 calories (about 15 calories per ounce) from juice. Don’t overdo it on juice either. If your child is drinking 2- 3 10 ounce sappy cups of juice, that is giving him 300-450 extra calories.

A common problem scenario we see in kids who don’t eat much, is a toddler who drinks 4 cups of milk and 3 cups of juice each day. That can add up to 1350 calories, which is probably more than he needs all day, so it is not surprising that this child wouldn’t be hungry for other foods.

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So you now have only another 550- 950 calories to get in him, divided between three meals and two snacks. That usually isn’t very hard if you look at the number of calories in foods kids usually eat (although you should be choosing more healthy alternatives for many of these foods):

A sample breakfast, with ½ cup ( 4 ounces) of cereal, ¼ cup of milk and 4 ounces of orange juice would give about 230 calories. If you instead gave a slice of bread with 1 tablespoon of peanut butter and jelly and 4 ounces of orange juice, your toddler would get over 250 calories.

For lunch, consider a 1/2 sandwich (one slice of bread), with 1 slice of lean luncheon meat (90 calories) and cheese (45 calories). Or a tuna fish sandwich (add 1/2 tablespoon of mayo to the tuna to get 50 extra calories); sliced and quartered hotdog and water, juice or milk.

Dinner might include 1- 2 ounces of chicken (75-100 calories) or beef (120-165 calories), 2- 3 tablespoons of vegetables (50- 75 calories), some whole meat bread (40 calories) and 1/2 cup of milk (76 calories).

Plus, your child will likely need a couple of small snacks mid- morning and in the early afternoon. These might include ½ cup of milk (76 calories) or juice (60 calories). Alternatives might include some jelly, pudding, or yogurt.

American cheese (one slice) = 45 calories

Apple (1/2 small apple) = 40 calories Banana (1/2) = 50 calories Beef, ground (ounces) = 85 calories Bologna (1 slice) = 90 calories Bread (1/2- 1 slice) = 20- 40 calories Breakfast cereal (1/4 -1/2 cup) = 40-

80 calories Chicken nuggets (3- 6 pieces) = 105-

210 calories Eggs (1/2- 1 egg) = 35- 70 calories French fries (7-15 steak fries) = 60-

120 calories French fries (8-17 Funky Fires) = 150-

300 calories Fruit cocktail, canned (1/4 ounce) =

calories Graham Crackers (1- 2 sheets) = 60-

120 calories

Grape jelly ( 1 tablespoon) = 50 calories Hot dog ( ½- 1 hotdog) = 60- 120

calories Ice cream (1/2 cup) = 135 calories Macaroni & Cheese (2 ½ ounces) = 260

calories Mozzarella cheese ( 1 ounce) = 80

calories Pancakes (1) = 60 calories Peanut butter (1 tablespoon smooth

and thinly spread) = 95 calories Pizza, cheese (1/2 – 1 slice) = 140- 290

calories Pop tart (1/2- 1 pastry) = 1- 200 calories Popsicle (1) = 70 calories Pudding (1/2 cup) = 110 calories Vegetables (1 tablespoon per year of

age) = 25 calories/ tablespoon Yogurt (1/3 cup) = 50 calories

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This sample diet outlined above will give your child well over 1000 calories. In reality, he may not eat 3 full meals each day though. Many toddlers just eat one good meal a day and it is usually still fine. If he eats a good breakfast (250 calories), a small lunch and dinner (100 calories each), has a couple of snacks (150 calories each), 16 ounces of milk (300 calories), and 6 ounces of juice (90 calories),

SELF-CHECK 1.3-2

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ANSWER KEY

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Job Sheet 1.3-2

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Performance Criteria Checklist

LEARNING OUTCOME 4 Prepare and introduce adequate nutrition and semi-solid food

CONTENTS: 1. Infant/toddler diet i. daily dietary requirement guide for infants and toddlers ii. food pyramid for infants and toddlers 2. Table etiquette 3. Procedures in feeding 4. Hand washing procedures

ASSESSMENT CRITERIA: 1. Identified appropriate food for infant and toddlers as prescribed 2. Ensured tools, materials and equipment used for making infant and toddlers’ food are

clean and functional 3. Ensured that personal hygiene practices are undertaken prior to food preparation 4. Adequately prepared food as prescribed 5. Demonstrated ability to determine the nutrients present in food per serving

CONDITION: Students/trainees must be provided with the following:

1. CBLM 2. Computer laboratory with Internet access 3. Fully equipped classroom/practical work area conducive for learning and other

activities 4. SUPPLIES AND MATERIALS

Feeding utensils (plastic cups, spoons, bowls/plates, Appropriate food, water Bibs

5. EQUIPMENT High chair Tables Equipment for food preparation (knives, etc.)

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ASSESSMENT METHOD:1. Written test2. Demonstration with oral questioning

Learning Experience

Learning Outcome 4: Prepare and Introduce adequate nutrition and semi-solid food

Learning Activities Special Instruction

Read Information sheet 1.4-1: Infant/Toddler Diet

Please don’t hesitate to refer to your trainer for further discussion on the information sheets

Answer Self-Check 1.4-1 Compare answers to answer key. You should be able to get all items correctly. If not, go back to the information sheet, and answer again afterwards

Perform Task Sheet 1.4-1: Menu Preparation for Toddler

Refer to the Performance Criteria Checklist to be guided

Read Information sheet 1.4-2: Table Etiquette for Toddlers

Read Information sheet 1.4-3: Procedures in Feeding

Perform Task Sheet 1.4-3: Feeding the Toddler Refer to the Performance Criteria Checklist to be guided

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Information Sheet 1.4-1

INFANT/TODDLER DIET

III. DEALING WITH PICKY EATERS

When our first few children were toddlers, we dreaded dinner time. We would prefer all kinds of sensible meals composed of what we thought were healthy, appealing foods. Most of these offerings would end up splattering the high- chair tray and carpeting the floor. To make matters worse, we took our kids’ rejection of our cuisine personally, sure that this was a sign of parental lapse on our part. What was wrong? Why were these kids such picky eaters?

NUTRITIP: 1. Good Grazing- Good Behavior

A child’s demeanor often parallels her eating patterns. Parents often notice that a toddler’s behavior deteriorates toward the end of the morning or mid- afternoon. Notice the connection? Behavior is at its worst the longer they go without food. Grazing minimizes blood sugar swings and lessens the resulting undesirable behavior.

2. Dip it.Young children think that immersing foods in a tasty dip is pure fun (and delightfully messy). Some possibilities to dip into:

Cottage cheese or tofu dip Cream cheese Fruit juice- sweetened preserves Guacamole Peanut butter, thinly spread Pureed fruits or vegetables Yogurt, plain or sweetened with juice concentrate

Those dips serve equally well as spreads on apple or pear slices, bell- pepper strips, rice cakes, bagels, toast, or other nutritious platforms.3. Spread it. Toddlers like spreading, or more accurately, smearing. Show them how to use a table knife to spread cheese, peanut butter, and fruit concentrate onto crackers, toast, or rice cakes.4. Top it.

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Toddlers are not into toppings. Putting nutritious, familiar favorites on top of new and less- desirable foods is a way to broaden the finicky toddler’s menu. Favorite toppings are yogurt, cream cheese, melted cheese, guacamole, tomato sauce, apple sauce, and peanut butter.5. Drink it.If your youngster would rather drink than eat, don’t despair. Make a smoothie- together. Milk and fruit- along with supplements such as juice, egg powder, wheat germ, yogurt, honey, and peanut butter- can be the basis of very healthy meals. So what if they are consumed through a straw? One note of caution: Avoid any drinks with raw eggs or you’ll risk salmonella poisoning.6. Cup it up.How much a child will eat often depends on how you cut it. Cut sandwiches, pancakes, waffles, and pizza into various shapes using cookie cutters.7. Package it. Appearance is important. For something new and different, why not use your child’s own toy plates for dishing out a snack? Our kids enjoy the unexpected and fanciful when it comes to serving dishes- anything from plastic measuring cups to ice cream cones.You can also try the scaled- down approach. Either serve pint- size portions or, when they’re available, buy munchkin- size foodstuffs, such as mini bagels, mini quiches, chicken drumbeats (the meat part of the wing), and tiny muffins.8. Become a veggie vendor. I must have heard, “Doctor, he won’t eat his vegetables” a thousand times. Yet, the child keeps right on growing. Vegetables require some creative marketing, as they seem to be the most contested food in households with young children. How much vegetable do toddlers need? Although kids should be offered three to five servings of veggies a day, for children under five, each serving need to be only a tablespoon for each year of age. In other words, a two- year- old should ideally consume two tablespoons of vegetables three to five times a day. So if you aren’t the proud parent of a veggie lover, try the following tricks:

Plant a garden with your child. Let her help care for the plants, harvest the ripe vegetables, and wash and prepare them. She will probably be much more interested in eating what she has helped to grow.

Slip grated or diced vegetables into favorite foods. Try adding them to rice, cottage cheese, cream cheese, guacamole, or even macaroni and cheese. Zucchini pancakes are a big hit at our house, as are carrot muffins.

Camouflage vegetables with a favorite sauce. Use vegetables as finger foods and dip them in a favorite sauce or dip. Using a small cookie cutter, cut the vegetables into interesting shapes. Steam your greens. They are much more flavorful and usually sweeter than when raw. Make veggie art. Create colorful faces with olive- slice eyes, tomato ears, mushroom

noses, bell- pepper mustaches, and any other playful features you can think of. Our eight child, Lauren, love to put olives on the tip of each finger. “Olive fingers” would

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then nibble this nutritious and nutrient- dense food off her fingertips. Zucchini pancakes make a terrific face which you can add pea eyes, a carrot nose, and cheese hair.

Concoct creative camouflages. There are all kinds of possible variations on the old standby “cheese in the trees” (cheese melted on steamed broccoli florets). Or, you can all enjoy the pleasure of veggies topped with peanut- butter sauce, a specialty of Asian cuisines.

9. Share it. If your child is going through a picky- eater stage, invite over a friend who is the same age or slightly older whom you know “like to eat”. Your child will catch on. Group feeding lets the other kids set the example.10. Respect tiny tummies. Keep food servings small. Wondering how much to offer? Here’s rule of thumb- or, rather, of hand. A young child’s stomach is approximately the size of his fist. So dole out small portions at first and refill the plate when your child asks for more. This less- is- more meal plan is not only more successful with picky eaters, it also has the added benefit of stabilizing blood- sugar levels, which in turn minimizes mood swings. As most parents know, a hungry kid is generally not a happy kid.Use what we call “the bite rule” to encourage the reluctant eater: “Take one bite, two bites…” (However far from you think you can push it without force- feeding). The bite rule at least gets your child to taste a new food, while giving her some control over the feeding. As much as you possibly can, let your child- and his appetite- set the face for meals. But if you want your child to eat dinner at the same time you do, try to time his snack-meals so that they are at least two hours before dinner.11. Make it accessible. Give your toddler shelf space. Reserve a low shelf in the refrigerator for a variety of your toddler’s favorite (nutritious) foods and drinks. Whenever she wants a snack, open the door for her and let her choose one. This tactic also enables children to eat when they are hungry, an important step in acquiring a healthy attitude about food.12. Use sit- still strategies. One reason why toddlers don’t like to sit still at the family table is that their feet dangle. Try sitting on a stool while eating. You naturally begin to squirm and want to get up and move around. Children are likely to sit and eat longer at a child- size table and chair where their feet touch the ground.13. Turn meals upside down. The distinctions between breakfast, lunch, and dinner have little meaning to a child. If your youngster insists on eating pizza in the morning or fruit and cereal in the evening, go with it- better than her not eating at all. This is not to say that you should become a short- order cook, filling lots of special requests, but why not let your toddler set the menu sometimes? Other family members will probably enjoy the novelty of waffles and hash browns for dinner.

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14. Let them cook. Children are more likely to eat their own creations, so, when appropriate, let your child help prepare the food. Use cookie cutters to create edible designs out of foods like cheese, bread, thin meat slices, or cooked lasagna noodles. Give your assistant such jobs as tearing and washing lettuce, scrubbing potatoes, or stirring batter. Put pancake batter in a squeeze bottle and let your child supervise as you squeeze the batter onto the hot griddle in fun shapes, such as hearts, numbers, letters, or even spell the child’s name.15. Make every calorie count. Offer your child foods that pack lots of nutrition into small doses. This is particularly important for toddlers who are often as active as rabbits, but who seem to eat like mice.

Nutrient- dense foods that most children are willing to eat include:

16. Count on inconsistency. For young children, what and how much they are willing to eat may vary daily. This capriciousness is due in large part to their ambivalence about independence, and eating is an area where they can act out this confusion. So don’t be surprised if your child eats a heaping plateful of food one day and practically nothing the next, adores broccoli on Tuesday and refuses it on Thursday, wants to feed herself at one meal and be totally catered to at another. As a parent in our practice said, “The only thing consistent about toddler feeding is inconsistency.” Try to simply roll with these mood swings, and don’t take them personally.

17. Relax. Sometimes between her second and third birthday, you can expect your child to become set in her ideas on just about everything- including the way food is prepared. Expect food fixations. If the peanut butter must be on top of the jelly and you put the jelly on top of the peanut butter, be prepared for a protest. It’s not easy to reason with an opinionated two- year- old. Better to learn to make the sandwich the child’s way. Don’t interpret this as being stubborn. Toddlers have a mindset about the order of things in their world. Any alternative is unacceptable. This is a passing stage.

PAGES 69- 71, 74 (FOOD GUIDE PYRAMID)- 76The Pyramid calls for eating a variety of foods to get the nutrients you need and at the same time the right amount of calories to maintain healthy weight.

Avocados Pasta Brown rice and other grains Potatoes Cheese Poultry Eggs squash

Broccoli Peanut butter Fish Sweet potatoes Kidney beans Tofu yogurt

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Use the Pyramid to help you eat better every day...the Dietary Guidelines way. Start with plenty of breads, cereals, rice, pasta, vegetables, and fruits. Add 2-3 servings from the milk group and 2-3 servings from the meat group. Remember to go easy on fats, oils, and sweets, the foods in the small tip of the Pyramid. What Counts as One Serving?

The amount of food that counts as one serving is listed below. If you eat a larger portion, count it as more than 1 serving. For example, a dinner portion of spaghetti would count as 2 or 3 servings of pasta.

Be sure to eat at least the lowest number of servings from the five major food groups listed below. You need them for the vitamins, minerals, carbohydrates, and protein they provide. Just try to pick the lowest fat choices from the food groups. No specific serving size is given for the fats, oils, and sweets group because the message is USE SPARINGLY.

Milk, Yogurt, and Cheese

1 cup of milk or yogurt 1 1/2 ounces of natural cheese 2 ounces of process cheese

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

2-3 ounces of cooked lean meat, poultry, or fish

1/2 cup of cooked dry beans, 1 egg, or 2 tablespoons of peanut butter count as 1 ounce of lean meat

Vegetable

1 cup of raw leafy vegetables

1/2 cup of other vegetables, cooked or chopped raw

3/4 cup of vegetable juice

Fruit

1 medium apple, banana, orange

1/2 cup of chopped, cooked, or canned fruit

3/4 cup of fruit juice

Bread, Cereal, Rice, and Pasta

1 slice of bread 1 ounce of ready-to-eat cereal 1/2 cup of cooked cereal, rice, or pasta

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SELF-CHECK 1.4-1

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ANSWER KEY

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Task Sheet 1.4-1

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Performance Criteria Checklist

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Information Sheet 1.4-2

TABLE ETIQUETTE of Toddlers

II. TABLE ETIQUETTE

Toddler Dining EtiquetteQ: my two- year- old daughter will sit with us at the table and eat- usually. My question is- should I have her eat if she doesn’t want to? Should I force her to try new foods? Should I make her sit there until her plate is clean or until she’s eaten two bites of peas? If she asks to leave the table before her father and I are finished eating, do I let her?

A. Trying to get a two- year- old to sit still is like trying to keep water in a sieve. Toddlers are not fans of the niceties of dining.

Don’t force her to eat. You want her learn to eat only what she needs; forcing her to eat now could lead to weight problems later because she’ll have no idea how gauge her real food needs. Have her stay at the table until she’s finished, and encourage her to try new foods, but don’t make it a fight. When she’s done, let her excuse herself and leave the table.

Most toddlers eat only one good meal a day and that’s usually breakfast or lunch. Unfortunately for them, and us, we focus on the evening meal. Relax and make mealtime pleasant for her. Understand that, at age two, sitting through a whole adult meal is simply beyond her capabilities.

Table Manners for Kids

Youngsters Can Learn Proper Table Manners that DazzleYour youngsters may know how to sit still, use napkin, and how to cut with a knife and fork, but do they really know proper table manners? The holidays, weddings, anniversary celebrations, school dances, and other social events are prime occasions for kids to demonstrate appropriate table manners. However, far too many parents somehow assume that their kids will know how to act, what to do (and not to do), and how to exhibit proper table manners- only to be embarrassed b a youngster’s double- dipping, slurping, or demonstration of finger- lickin’ good! You’ve taught them most everything they know up to now, so take time and teach them table manners basics that will dazzle at the next occasion. Here’s how to get started:

Teach kids how to greet relatives and guests. Many kids simply don’t know what to say or appropriate action to take. If the occasion is at your home or you’re serving as host, instruct your kids about properly opening the door and taking any coats. (Show them how to hold them and not to roll them up in a wad.)Teach them how to properly shake hands and how to appropriately hug relatives, especially elderly or individuals with disabilities.

If you are serving appetizers, ask your youngsters to act as a host/ hostess. Instruct them what to ask, how to not interrupt conversations, and to tell them what the choice is. If they are on the receiving end of an offering of hors d’ oeuvres, be sure to tell them

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how to say hors du’ oeuvres and what it means to avoid the normal kid reaction of “what’s that?” instruct them how to take one or how to gracious refuse. If it is an item that sounds unappetizing to a kid’s palate (and many do), tell them to simply decline without offering any commentary about how it looks, smells, or seems to taste.

At the table, show them how to pull out a seat for a guest and to hold it and help them scoot to the table. Boys can do this for ladies or girls, and boys or girls can do the same for older guests as a sign of respect.

Teach kids how to place the napkin in the lap and how to sit up straight and near the table. Be sure to let youngsters know not to plop their elbows on the table.

Practice table manners such as passing food, asking for something rather than reaching across the table to get it (and risk spilling a drink or worse), and to take only as much as they know they’ll eat. The proper table manners protocol is to pass food from left to right (counterclockwise).

Talk with kids about how tables are set up, where forks, knives and spoons go, why sometimes there are utensils about the plates and what particular order means (using the outside utensil first). Emphasize the proper table manners are for everyone to be served and the host/ hostess to pick up a fork to begin eating.

Talk about the no-no’s of “double-dipping”, slurping, licking fingers, or the ever- tempting dragging a finger across the side of an item to taste it (i.e. icing on the cake).

Practice sitting up straight and not hunched over, and remind them to bring food from their plate to their mouth and not hunker down over it.

Explain bread etiquette and how bread plates positioned to the upper left of a dinner plate. Kids need to learn not to butter the entire piece of bread; rather, butter is placed on the bread place, and then a bite-sized piece to be buttered only. Explain how some bread is to be “torn off” with your hands while other types may need to be cut. Younger kids won’t be apt to understand the differences, but older ones should be able to make a distinction.

Practice napkin use about how they should wipe their mouth appropriately, and where to put the napkin if they need to get up or go to the bathroom.

Offer your kids some conversation ideas, and be sure to emphasize that they are not to talk with their mouths full or too stuff too much in their mouth, or chomp with their mouths open, or other disgusting kid habits. Kids should be reminded to eat slowly and not gobble down their food.

Use utensils and only eat with fingers if it is meant to be eaten with fingers. Explain to youngsters the difference, and how French fries are even meant to be eaten with a fork and dipped into ketchup rather than with hands during certain occasions.

Tell kids to always thank the cook for the delicious meal- even if it wasn’t to your youngsters. Someone put forth an effort, and kids should be taught to find at least one or two things they did like, and to praise those items in particular.

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Kids should stay seated until there becomes an obvious point where kids are being excused and going elsewhere so that adults can linger.

Adults should set the stage for success through practice. A “fancy table” can be set up at home and kids can ask questions and practice so that they are comfortable and familiar enough to wow everyone with their great table manners when it truly counts!

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Information Sheet 1.4-3

PROCEDURES IN PREPARING FOOD, FEEDING, AND STORAGE PAGES 78-80, 71-74 (FEEDING DOS AND DONTS)

Feeding Do’s and Don’ts

DO wait 3-7 days to add each new food to your baby’s diet

DON’T put your baby to bed with a bottle. This can promote baby bottle tooth decay.

DO learn to recognize your baby’s signals.Never force food on your baby’s if they don’t want to eat.

DON’T feed cereals or other solids through the bottle. Your baby may gag or choke.

Do let your infant pace the feeding.DON’T put your baby in a reclining position while feeding (such as an infant carrier). The baby may choke or gag.

DO be patient with yourself and your baby.Remember if it doesn’t work today it may work tomorrow.

DON’T season baby food that you buy.Babies don’t need added salt or sugar.

DO keep a sense of humour. Easy feedings can be unproductive, messy, frustrating and often very funny.

DON’T feed directly from the baby food jar. Saliva from the baby’s mouth can contaminate the remainder of the food in the jar.

DO offer food that baby has refused 7- 10 days later. It may take 8- 10 times before a new food is accepted.

DON’T serve any food from the microwave without first stirring gently and then testing the temperature.

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Task Sheet 1.4-3

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Performance Criteria Checklist

LEARNING OUTCOME 5 Prepare Infant/Toddlers’ Crib

CONTENTS: 1. Sleep and Rest 1.1 from crib to bed 1.2 bedtime routines 1.3 bedtime conflicts 1.4 nighttime fear 1.5 fear of monsters 1.6 sleep patterns at different age levels

ASSESSMENT CRITERIA: 1. Prepared crib based on procedure 2. Put infants and toddlers to sleep based on procedures

CONDITION: Students/trainees must be provided with the following:

1. Computer laboratory with Internet access 2. Fully equipped classroom/practical work area conducive for learning and other

activities 3. CBLM 4. SUPPLIES AND MATERIALS

Appropriate dress Layette

5. EQUIPMENT Crib Bassinet

ASSESSMENT METHOD:1. Written test2. Oral questioning

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Learning Experience

Learning Outcome 5: Prepare infant/toddlers’ crib

Learning Activities Special Instruction

Read Information sheet 1.5-1: Conditioning Baby to fall asleep

Please don’t hesitate to refer to your trainer for further discussion on the information sheets

Answer Self-Check 1.5-1 Compare answers to answer key. You should be able to get all items correctly. If not, go back to the information sheet, and answer again afterwards

Information Sheet 1.5-1

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CONDITIONING BABY TO FALL ASLEEP CONDITIONING BABY TO FALL ASLEEP

Sleep in not a state you can force your baby into. Sleep must naturally overtake your baby. Your nighttime parenting role is to set the conditions that make sleep attractive and to present cues that suggest babying that sleep is expected. Try the following sleep tight tips, which may vary at different stages in your baby’s development. What doesn’t work one week may work the next.

Get baby use to a variety of sleep associations. The way an infant goes to sleep at night is the way she expects to go back to sleep when she awakens. So, if your infant is always rocked or nursed to sleep, she will expect to be rocked or nursed back to sleep. Sometimes nurse her off to sleep, sometimes rock her off to sleep, sometimes sing her off to sleep, and sometimes use tape recordings, and switch off with your spouse on putting her to bed. There are two schools of thought on the best way to put babies to sleep: the parent- soothing method and the self- soothing method. Both have advantages and possible disadvantages.

1. Parent- soothing method.

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When baby is ready to sleep, a parent or other caregiver helps baby make a comfortable transition from being awake to falling asleep, usually by nursing, rocking, singing, or whatever comforting techniques work.

Advantages: Baby learns a healthy sleep attitude- that sleep is a pleasant state to enter and a

secure state to remain in. Creates fond memories about being parented to sleep. Builds parent- infant trustSo- called “Disadvantages”: because of the concept of sleep associations, baby learns to rely on an outside prop to get to sleep, so- as the theory goes- when baby awakens he will expect help to get back to sleep. This may exhaust the parents.

2. Self- soothing method:

Baby is put down awake and goes to sleep by himself. Parents offer intermittent comforting, but are not there when baby drifts off to sleep.

So- called “Advantages”: if baby learns to go to sleep by himself, he may be better able to put himself back to sleep without parental help, because he doesn’t associate going to sleep with parents comforting. Maybe tough on baby, but eventually less exhausting for parents.

Disadvantages: Involves a few nights of let- baby- cry- it- out Risks baby losing trust Seldom works for high- need babies with persistent personalities

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Overlooks medical reasons for night waking Risks parents becoming less sensitive to baby’s cries

Remember, in working out your own parenting- to- sleep techniques and rituals, be sensitive to the night time needs of your individual baby and remember your ultimate goal: to create a healthy sleep attitude in your baby and to get all family members a restful night’s sleep. Daytime mellowing. A peaceful daytime is likely to lead to a restful night. The more

attached you are to your baby during the day and the more baby is held and calmed during the day, the more likely this peacefulness is to carry through into the night. If your baby has a restless night, take inventory of unsettling circumstances that may occur during the day: Are you too busy? Are the daycare and the daycare provider the right match for your baby? Does your baby spend a lot of time being held and in- arms by a nurturing caregiver, or is he more of a, “crib baby” during the day? We have noticed babies who are carried in baby slings for several hours a day settle better at night. Baby wearing mellows the infant during the day, behavior that carries over into restfulness at night.

Set predictable and consistent nap routines. Pick out the times of the day that you are most tired, for example 11:00 am and 4:00 pm. Lie down with your baby at these times every day for about a week to get your baby used to a daytime nap routine. This also sets you up to get some much- needed daytime rest rather than be tempted to “finally get something done” while baby is napping. Babies who have consistent nap routines during the day are more likely to sleep longer stretches at night.

Consistent bedtimes and rituals. Babies who enjoy consistent bedtimes and familiar going- to- sleep rituals usually go to sleep easier and stay asleep longer. Yet, because of modern lifestyles, consistent and early bedtimes are not as common, or realistic, as they used to be. Busy two- income parents often don’t get home until six or seven o’clock in the evening, so it’s common for older babies and toddlers to procrastinate the bedtime ritual. This is prime time with their parents and they are going to milk it for all they can get. In some families, a later afternoon nap and a later bedtime is more practical. Familiar bedtime rituals set the baby up for sleep. The sequence of a warm bath, rocking, nursing, lullabies, etc. set the baby up to feel that sleep is association. Babies developing brain is like a computer, storing thousands of sequences that become patterns. When baby clicks into the early part of the bedtime ritual, he is programmed for the whole pattern that results in drifting off to sleep.

Calming down. Give baby a warm bath followed by a soothing massage to relax tense muscles and busy minds. Be careful, though, because this will stimulate some babies.

Tank up your baby during the day. Babies need to learn that daytime is for eating and nighttime is mostly for sleeping. Some older babies and toddlers are so busy playing during the day that they forget to eat and make up for it during the night by waking frequently to feed. To reverse this habit, feed your baby at least every three hours during the day to cluster the baby’s feedings during the waking hours. Upon baby’s first night waking, attempt a full feeding, otherwise some babies, especially breastfed infants, get in the habit of nibbling all night.

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SELF-CHECK 1.5-1

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ANSWER KEY

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