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FAMILY IDENTIFICATION
Mother’s Name Age
Father’s Name
Address
Mobile No. Mother Mobile No. Father
MCTS/RCH ID (Mother)
Eligible for PMMVY Yes No
Bank & Branch Name
Account No. IFSC
PREGNANCY RECORD
No. of Pregnancies / Previous Live Births
Last Delivery Conducted at
Date of Last Menstrual Period
Expected Date of Delivery
Name of Identified Delivery Institution
Pregnancy Outcome Live Birth Still Birth
BIRTH RECORD
Child’s Name
Date of Birth Birth Weight
Current Place of Delivery
Male Female Birth Registration No.
MCTS/RCH ID (Child)
INSTITUTIONAL IDENTIFICATION
AWW LGD Code
AWC No.
Village Ward Block
Postal Account Postal Code
ASHA ANM
Hospital Phone No.
Months
Pregnancy
Test
Yes No
Date: ___/___/_____
Registration
Register with the Health Centre in the 1st trimester.
BP, Blood & Urine Have blood pressure (BP) checked and blood and
urine examined at each visit.
Weight
Have weight checkup at each visit. Gain at least
9-11 kg. during pregnancy. Gain at least 1 kg every
month during the last 6 months of pregnancy.
Iron Tablets
Take one tablet of iron folic acid a day for at least
6 months after first trimester. Take at least 180
tablets. (Fill in quantity and date issued)
Take two tablets of calcium per day for at least 6 months after 1st trimester
D. Diabetes E. Asthma F. O
thers
(Specify)
EXAMINATION
Height Heart Lungs Breasts
(cms) (check for inverted nipple)
ANTENATAL VISITS
1 2 3 4 5
(Under
PMSMA)
Date
POG (Weeks)
Weight(Kg)
Pulse Rate
Blood Pressure
Pallor
Oedema
Jaundice
Any Complaints
ABDOMINAL EXAMINATION
Fundal Height
Weeks in cm
Lie/Presentation
Fetal Movements Normal/ Normal/ Normal/ Normal/ Normal/
Reduced/ Reduced/ Reduced/ Reduced/ Reduced/
Absent Absent Absent Absent Absent
OPTIONAL INVESTIGATIONS
1. Thyroid-Stimulating Hormone Date
2. Hbs Ag. Date
3. Blood sugar Date
4. Others Date
Take one tablet of iron folic acid per day for atleast 6 months
after delivery
Take two tablets of calcium per day for atleast 6 months after
delivery
CARE OF BABY
1st 3rd 7th 6th
Day Day Day Week
Weight
Urine passed
Stool passed
Diarrhoea
Vomiting
Convulsions
Activity (Good/Lethargic)
Sucking (Good/Poor)
Breathing (Fast/Difficult)
Chest Indrawing (Present/Absent)
Temperature
Jaundice
Condition of Umbilical Stump
*(Three extra visits if birth weight < 2.5kg)
7
Care of Newborn
Please Remember:
• Keep the baby warm.
• Start breastfeeding within 1 hr of birth
• Feed the baby only mother’s milk
• Do not bathe the baby for the first 48 hours
• Keep the cord dry
• Keep the baby away from sick people
• Special care if baby < 2.5 kg at birth
Danger Signs:
Breastfeeding continued
meals
¾ to 1 cup serving at a
time, 3-4 times a day with
1-2 snacks between ×
meals
Counsel on parenting
ORS given
Treatment of Diarrhoea
Prevention of Pneumonia
Keep children covered Do not keep new born Use LPG gas stove
in warm woollen without clothes for cooking to avoid
clothes during winters smoke in the house
and do not let them
walk barefoot
Identification of Pneumonia
9
Feeding, playing and communicating with children helps them to grow and develop physically and intellectually
Birth to 6 months:
Breast milk provides all nutrients and
contains sufficient water. Do not give your Even if your baby is ill, continue breastfeeding
baby anything else to eat or drink, not even till 6 months
Consult the ANM, ASHA and AWW of your area in
10
of age. other liquids during illness baby
Talk, smile and be patient to encourage the child to eat
6 months 6–9 months 9–12 months General tips:
Continue breastfeeding
On completion of 6 months, start Continue breastfeeding Continue breastfeeding Wash your hands with soap and water before
feeding baby with 2–3 table spoons Change consistency to lumpy feeds given After 9 months, feed at least half katori of preparing food and before feeding the baby.
of soft, well-mashed foods 3–4 times a day food that requires chewing 3–4 times a day If feeding eggs, ensure they are well-cooked
2–3 times a day Feed 2–3 times and 1–2 snacks After 12 months, introduce family foods, give Thoroughly rinse raw fruits and vegetables
Introduce one food at a time, such Increase quantity and diversity of the feeds 3/4th–1 katori, 3–4 times each day along with under running water before cooking
soft foods
as a small amount of vegetables, Introduce one new food at a time such as 1–2 snacks Cook thoroughly, use safe water, discard all
followed by fruits, dal and cereals khichri, dalia Give finely chopped foods that baby can pick leftovers on children’s plates and do not save
Increase amount of the feed slowly up using thumb and fingers. Allow children to them for later
Include at least 4 food groups such as:
6 months to 2 years:
Give iron drops/syrup to maintain 1) cereals, 2) green vegetables and fruits, eat with own hands, even if they mess up Use only iodized salt for cooking; iodine
the body’s iron store for improving 3) oil, ghee; 4) mashed dal/fish/egg (only Give Vitamin A syrup for improving eyesight improves intellect
intelligence and physical strength hard-boiled) Give iron drops/syrup to maintain the body’s Give iron drops/syrup to maintain the body’s
Give iron drops/syrup to maintain the body’s iron store for improving intelligence and iron store for improving intelligence and
iron store for improving intelligence and physical strength physical strength
11
What most babies do (parents to tick as per age) Parenting tips
By
Massage gently, stretch and exercise arms and legs of
babies
Encourage babies to lie on tummy for some time every day
Move both
arms and both Cuddle and play with Hang colourful moving
2–3 months
legs, when babies daily. Cuddling or objects 30cm (1 foot)
quickly responding to each away, for babies to focus
excited
cry does not spoil babies on and follow
Keep hands Talk to babies in your Avoid use of digital media
mother tongue daily in children younger than
open and 24 months
Raise head at times, when on relaxed
tummy
12
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
3At
months
Does not startle/
wake up/ cry
Head pushed Persistently hold
in response to
back, with stiff thumb inside the
sudden loud sound
arms and legs palm, with hands
kept open or fisted
13
What most babies do (parents to tick as per age) Parenting tips
Attempt to
reach and
grasp an object Communicate with
babies; imitate their
Laugh aloud or
sounds and praise
make squealing
them when they
sounds
By
imitate yours
4–6
ah
ahee
eeoo Take children outdoors,
oo
and introduce them to the
months
outside world
Children suck on
their fingers
Put interesting things on and thumb for
Keep head steady when held upright Begin to babble “ah, ee, oo” other than the floor for babies to comfort. It is
and can sit with support when crying reach out and explore not a cause
for concern. Do
Turn head towards direction of sound Like to look at self in a mirror not stop this at an
early age
14
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
At
6 months
Does not
vocalize by Head and eyes do not
making different move to follow/track a Unable to raise head
sounds such as moving object when on tummy
“ah”, “eh”, “oo”
15
What
What most
most babies
babies do
do (parents
(parents to tick
to tick as
as per age)
per age) Parenting tips
By
Look for toys
that have
7–9 months
Grasp a toy by been hidden Play games like peek-a-boo.
using all fingers in front of Hide the children’s favourite
them Give children clean, safe toys under a cloth or box. See
Turn head to household utensils to play
visually follow Respond to if children can find it
name being and explore
familiar faces or
toys called
16
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
At
9 months
Does not utter pa.. pa..pa, ma..
ma, ba.. ba..ba, etc Tilts head always to one side each
time when looking at objects
17
What most babies do (parents to tick as per age) Parenting tips
By
picked up while using support
No!
10–12 months
While exploring, babies Tell your babies stories and
might hurt others read picture books aloud.
Use one or two commonwords in mother accidentally. Show them Show and name things in their
tongue how to touch gently. Do not environment
Respond to simple requests like “no/ come shout at them
here”
18
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
Bittoo
At
12 months
Does not search for half hidden toys that the child Does not play social games like
sees you hide peek-a-boo (jhalak/ anakh-michauli)
19
What most babies do (parents to tick as per age) Parenting tips
Stand and take Put pebbles/ Provide push toy for babies
several independent small objects in to learn walking
steps a container
By
Use a variety of
familiar gestures like
waving, clapping, etc.
18 months
Give some fruits, toys, etc. to Ask your children simple
children. Ask them to identify the questions. Encourage them
Name and identify common objects and objects, put them in and take them to talk
their pictures in a book out of containers
20
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
Babli, point
out where is
your toy
At 18 months
Does not respond to Does not use both hands Amma, Does not say single
mother’s gestures and for everyday activities words like “mama” or
seems to be in his/her (shows preference for papa, dada “dada”
own world one hand)
21
What most babies do (parents to tick as per age) Parenting tips
By
a toy chores
24
Encourage children to follow a
months
daily routine such as sleeping
Allow children to imitate and waking up at a fixed time
you and master their
skills. Be patient with Read aloud to children, often
Correctly point out and name one or more body parts repeating stories. Provide
in person or in books them if they make a mess
books and paper, chalk,
colours, etc. for scribbling
22
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
At
Pinky, show
24 months
Bye-bye me your nose Bittoo, give
Does not make me the block
appropriate response Does not seem to
to gestures such as Does not point to
body parts understand and follow
responding to bye-bye/ simple instructions
namaste
23
What most babies do (parents to tick as per age) Parenting tips
By
require movement and physical activity
3 years
Cat Dog
Bird Give variety of
materials (including
blocks, puzzles,
Climb up and rings, etc.) to
Name most familiar things consistently. children
down the stairs
Identify colours, shapes, etc.
Make a sentence by joining 3 or more words
Allow children to use their hands and fingers in
different ways to improve their skills
24
ASHA/AWW please examine and mark or on the card as per the age of the child
“Warning” signs : Contact ANM/AWW/health care provider immediately if you see any one of these
What is
your name? Your
name
At
3 years
Babloo, let’s
feed the baby Does not speak in
Continuous drooling, Mummy simple and three word
Does not play “Pretend” unclear speech sentences such as
games give milk “mummy give milk”
25
Maintaining spacing of 3 years between two children has a healthy impact on both the mother and baby’s health. If your family is complete, you/your
You can avail any spacing method from the wide basket of choices offered under the Family Planning spouse can opt for a permanent
Programme such as: method of contraception
Female Sterilization
26
of delivery
Bi-weekly Iron-Folic Acid Supplementation and bi-annual
deworming for children aged 6 months to 5 years
(Compliance Card)
Mention date Bottle 1 Bottle 2 Bottle 3 Bottle 4 Bottle 5
of provision of
IFA bottle to Bottle 6 Bottle 7 Bottle 8 Bottle 9 Bottle 10
mother
Dec
Nov
Oct
Month-wise Bi-weekly IFA syrup supplementation
Apr May Jun Mar
Feb
JanJul Aug Sep
Week
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Age
6-12 month 1-2 Year 2-3 Year 3-4 Year 4-5 Year
Dose - 2
27
GIRL: Weight-for-a
(As per WHO Child
yr.
Very Dangerous
Talk to the
AWW/ANM
immediately
Weight (kg)
Anganwadi Cent
pregnant women
integrated packa
Contact your AW
yr.
Birth
yrs. yrs.
yrs.
yrs.
Anganwadi Centre
tre of MWCD, GOI, reaches out to young children under 6 years,
n and breastfeeding mothers and women 15-45 years with an
age of services
WW for child care services at the nearest AWC
s at Anganwadi Centre
Immunization Early childhood care and
preschool education
Health check-up
Referral services
yr.
Very Dangerous
Talk to the
AWW/ANM
immediately
Weight (kg)
Anganwadi Ce
pregnant wome
integrated pack
Contact your A
yr.
Birth
yrs. yrs.
yrs.
Anganwadi Centre
entre of MWCD, GOI, reaches out to young children under 6 years,
en and breastfeeding mothers and women 15-45 years with an
kage of services
AWW for child care services at the nearest AWC
s at Anganwadi Centre
Immunization Early childhood care and
Health check-up preschool education
Referral services
32 32
3
30 30
28 2 28
26 26
1
24 24
0
22 22
20
-1 20
32
-2
(kg)
(kg)
18 18
-3
16 16
Weight
Weigh
14 14
12 12
10 10
8 8
6 6
4 4
2 2
Length/height (cm)
Length/height (cm)
33
Weight-for-length/height Boy
(As per WHO Child Growth Standards)
34 34
32 32
30 3 30
28 28
2
26 26
24
1 24
22 0 22
20 -1 20
34
-2
(kg)
18 18
-3
16 16
Weight
14 14
12 12
10 10
8 8
6 6
4 4
2 2
Length/height (cm)
35
BIRTH 1 1 / 2 MONTHS 2 1 / 2 MONTHS 3 1 / 2 MONTHS 9 MONTHS Congratulations! Your child is
vaccinated for the 1st year of life.
Date of Delivery Next Vaccination Date: Next Vaccination Date: Next Vaccination Date: Next Vaccination Date:
DATE OF VACCINATION DATE OF VACCINATION DATE OF VACCINATION DATE OF VACCINATION DATE OF VACCINATION
(mm/dd/yyyy): (mm/dd/yyyy): (mm/dd/yyyy): (mm/dd/yyyy): (mm/dd/yyyy):
Vitamin
BCG Rota-1 Rota-2 Rota-3
A-1
36
16-24 MONTHS 5-6 YEARS 10 YEARS 16 YEARS SIA / OTHER VITAMIN A
CHILD AGE DATE OF ADMINISTRATION (mm/dd/yyyy):
Next Vaccination Date: Next Vaccination Date: Next Vaccination Date: VACCINE DATE OF VACCINATION
NAME (mm/dd/yyyy): Vit-A-3 2 years
Vit-A-5 3 years
DATE OF VACCINATION DATE OF VACCINATION DATE OF VACCINATION DATE OF VACCINATION
(mm/dd/yyyy): (mm/dd/yyyy): (mm/dd/yyyy): (mm/dd/yyyy):
Vit-A-6 3.5 years
DPT DPT
TT TT Vit-A-7 4 years
Booster-1 Booster-2
Vit-A-8 4.5 years
NAME &
DATE OF
DOSE OF REASON WHY NEXT SESSION
VACCINE SIGN OF
MR-2 VACCINE DATE FOR
MISSED DOSE ANM
DOSE MISSED MISSED DOSE
MISSED
VACCINE
JE-2
37
Immunization Essentials
VACCINATION NAME BIRTH 11/
2
21/
2
31/
2
9 1 1/
2
Months Months Months Months Years
BCG
prevents tuberculosis
HepB
prevents liver disease
OPV
prevents polio
IPV
prevents polio
Penta
prevents whooping
cough, diphtheria,
tetanus Hep B and
Hib infections
PCV
prevents pneumonia
Rota
prevents
diarrhoea
MR
prevents measles,
rubella
JE
Prevents brain
fever
DPT
prevents whooping
cough, diphtheria and
tetanus
ANM Signature
39
ASHA INCENTIVE TRACKING 16-24 MONTHS 5-6 YEARS 10 YEARS 16 YEARS VITAMIN A 3–9
Full Immunization (FIC): Next Vaccination Date: Next Vaccination Date: Next Vaccination Date: DATE OF ADMINISTRATION
Completed on / / [Return Card to ANM] (mm/dd/yyyy):
OPV
Vit-A-9
Booster
40