Provide Care and Support Tro Children

ST.
P AU L SU RI G AO UNI VERSI TY HO S P I T AL
National Highway, Km. 4, Brgy. Luna, Surigao 0
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
ST. PAUL SURIGAO UNIVERSITY HOSPITAL
CBLMs on Document No. AC-CGV0216671921104

CAREGIVING NC II Issued by:
Provide care and Date Developed:
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NOVEMBER 7, 2019 St.Paul Surigao University Hospital
infants/toddlers
ST. P AU L SU RI G AO UNI VERSI TY HO S P I T AL
ACKNOWLEDGEMENT
I would like to express my profound gratitude and deepest appreciation to the following persons and
institution that have great contribution to the realization of this Trainer’s Methodology 1 – CBLM for the
CAREGIVING NC II.
To our facilitators Mrs. LILIAN C. GARCES, JULIAN T. SALAO JR. for their patience, professional
guidance, understanding and untiring support during the conduct of training;
To the TESDA Provincial Director, Mr. ALLAN S. MILLAN Maed and MR. JAMES A. TABADA
Tesda Focal SDN for their encouragement, support and guidance to pursue this Trainer’s Methodology Level I;
To my St. PAUL SURIGAO UNIVERSITY HOSPITAL headed by SR. NORMA PATRICIA
MANZANO,SPC Hospital Administrator and SR. MELANIE GUZMAN,SPC. Human Resource Director for their
encouragement, inspiration, prayers and financial support.
To the head AC MANAGER OF LGU ALEGRIA, MR. GILBERT MARTINEZ for the wholehearted
assistance and for facilitating me in this TM training;
To LGU ALEGRIA as the home and the center of the TM training and for providing us the training
facilities we need.
To my Parents, Mr. And Mrs. Sergio T. Mazuela, SR. to my husband Albert B. Sebial and childrends
Alhrich Kozier M. Sebial and Sweet Marry Gold M. Sebial , for their unconditional love, unending support and
prayers;
Finally, my ultimate to Almighty God the Father, the kings and my Creator for giving the gift of
wisdom and courage to give me that fighting spirit to fight and overcome those hurdles that I encounter in my
way up. Thank you for hearing and granting my desire all the time. I really can’t imagine life without Him. Who
showed his abundant blessings for the completion of this TM Level 1- CBLM.
“ALL FOR THE GREATER GLORY OF GOD”

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COMPETENCY- BASED LEARNING MATERIALS

Provide care and support to infants/toddlers
Printed by:
ST.PAUL SURIGAO UNIVERSITY HOSPITAL
National Highway, KM. 4, Brgy. Luna, Surigao City
November 2019
All rights reserved
These Competency-Based Learning Materials

Are properties of SPUSH , AND
Duplication and/ or use of the CBLMs for
Commercial purposes require prior written
Approval from ST. Paul SURIGAO UNIVERSITY HOSPITAL
For further information, please contact:
RECHEL O. MAZUELA
Trainer
Surigao City
Mobile # 09461338052
r.mazuela@yahoo.com

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HOW TO USE THIS COMPETENCY-BASED LEARNING MATERIALS (CBLM)

WELCOME!
The unit of Competency, “Provide care and support to infants/toddlers
“is one major core competencies in the CAREGIVING NC II a competency you must have to accomplished for
you to become more equipped and knowledgeable.
The “module” Assisting in patient Mobility “contains training materials and activities. It will provide you
the process; discussion and necessary information’s that will lead you to a better understanding.
This learning material covers the knowledge , skills and attitudes in which you are required to go
through the series of learning , activities in order for you to complete the training outcomes , The learning
outcomes includes Informative Sheets for facts, self -checks and Task sheets for evaluation. If you have
clarifications, do not hesitate to ask assistance from your facilitator.
RECOGNITION OF PRIOR LEARNING (RPL)
You may have some or most of the knowledge and skills that are included in this learner’s guide
because you have:
 Been working in the same industry for some time.
 Already completed training this area.
If that were so, as soon as you can demonstrate a particular skills to your trainer; you don’t have to such
training again.
If you feel that you have some skills, talk to your trainer to recognized them formally. If you have a
qualification or certificate of competence from various trainings, present it to your trainer. If the skills you
acquired are still current and relevant to the unit of competency, they may become part of evidence you can
present for RPL. If you are not sure about the currency of your skills, discuss this with your trainer.
A trainee Record Book (TRB) will be given to you to record important dates, jobs undertaken and other
workplace events that will assist you in providing further details to your trainer/assessor. A record for
Achievement/Progress Chart is also provided to your trainer to complete/accomplish once you have completed
the module. This will show your progress.
REMEMBER TO:
Work through all the information and complete the activities in each section
Read the Information sheet and complete the Self-checks suggested references are included to supplement
the materials provided in this module.
Most probably, your trainer will also be your supervisor or manager or who will be there to support you and
show you the correct way to do things.
You will be given plenty of opportunities to ask question and practice on the job. Make sure you practice new
skills during actual exercises. This way, you will improve your speed and memory and confidence.

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Used the self-checks and task sheets at the end of each section to test your progress. Use the performance
Criteria/Evaluation Checklist located after Task Sheet to check your own performance.
When you feel confident that you have sufficiently practiced, ask your trainer to evaluate you. The result of
your assessment will be recorded in the
Progress chart and Accomplishment Chart it will justify that you are ready for assessment.
If you have complete the required competencies, and as soon as you have master /completed this, ask your
trainer to arrange an appointment to asses /evaluate you with the qualified trainer. The result of the
assessment/evaluate will appear to your in COMPETENCY ACHIEVEMENT RECORD

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CAREGIVING NC II
COMPETENCY-BASED LEARNING MATERIALS
List of Competencies
No. Unit of Competency Module Title Code
Provide care and support to 1.1 Providing care and support to HCS323301
1 infants/toddlers infants/toddlers
2 children children
Foster social, intellectual, 3.1 Fostering social, intellectual, HCS323303
3 creative and emotional creative and emotional
development of children development of children
Foster the physical 4.1 Fostering the physical HCS323304
4 development of children development of children
Provide care and support to 5.1. Providing care and support to HCS323305
5 elderly elderly
6 people with special needs people with special needs
Maintain a healthy and safe 7.1 Maintaining a healthy and safe HCS323307
7 environment environment
Respond to emergency 8.1 Responding to emergency HCS323308
8
Clean living room, dining room, 9.1 Cleaning living room, dining room, HCS323309
9 bedrooms, toilet and bedrooms, toilet and bathroom
bathroom
Wash and iron clothes, linen 10.1 Washing and iron clothes, linen HCS323310
10 and fabric and fabric
Prepare hot and cold meals 11.1 Preparing hot and cold meals HCS323311
11

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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 care
5. The dependent nature of infants and toddlers
6. 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 development
3. Stated the normal milestones of growth and development of infants/toddlers in
chronological order
4. Recognized delayed or abnormal aspects of growth and development
5. Discussed the dependent nature of infants and toddlers
6. Enumerated basic infant care procedures
7. Exposed infants and toddlers to family members, relatives, and playmates for
communication and interaction purposes
8. 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 test
2. 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 Please don’t hesitate to refer to your trainer for
Development: Definition, Difference and further discussion on the information sheets
Comparison, and Milestones of Growth and
Development
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 Refer to the Performance Criteria Checklist to be
baby 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

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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.
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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!
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

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 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

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DEVELOPMENTAL MILESTONES
 Cognitive Milestones
A. Month 3-5: attends to and reaches for objects
B. Months 4-8: pulls string to secure a ring
C. Month 8-15: imitates patting doll
D. Month 14-20: finds Hidden Object
E. Month 18-28: Completes simple puzzles
 Language Milestones
A. Month 1. 5-3: squeals
B. Month 3. 5-8: turns to locate a voice
C. Month 9-13: says Mama or Dada
D. Month 14-24: combines two different words
E. Month 21-36: use plurals
 Social and Emotional Milestones

A. Month 1. 5-4: Smiles at others
B. Month 4-9: Seeks primary caregiver
C. Month 8-15: Stranger anxiety
D. Month 10-15: Displays 2 or more recognizable emotions
E. Month 11-20: Exploratory play by self
F. Month 21-36: Cooperative play in small groups
 Gross Motor Milestones

A. Month 2-4.5: Rolls Over
B. Month 5-8: Sits without support
C. Month 10-14: Stands Alone
D. Month 14-20: Walks up steps
E. Month 21-28: Pedals Tricycle
F. Month 30-44: Balances on one foot
G. By age 6: rhythmic skipping
H. By age 8.5: alternates foot-hop in place
I. By age 10: holds tandem stance for 10 sec (eyes closed)
 Fine Motor Milestones

A. Month 2.5-4: Grasps rattle
B. Month 4.5-7: Transfers cube hand to hand
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C. Month 8-12: Has neat pincer grasp

D. Month 15-20: Builds tower of four cubes
E. Month 18-24: Imitates vertical line
F. Month 28-36: Copies circle
G. By age 5 years: Tripod pencil grasp
H. By age 7 years: Draws diagonal line
I. By age 9: Draws cross with same dimensions
J. By age 12: Draws three dimensional cube
 Self Testing Milestones

A. Month 4.5-8: Feeds self crackers
B. Month 10-14: Drinks from cup
C. Month 13-19: Removes clothes
D. Month 18-28: Washes and dries hands
E. Month 30-42: Dresses without supervision
F. Attained on average by age 4.5 years
1. Rides a bicycle with training wheels
2. Cuts paper with scissors
3. Colors inside lines
G. Attained on average by age 5.5 years
1. Ties shoelaces
2. Prints first and last names
H. Attained on average by age 6 years
1. Rides a bicycle without training wheel

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SELF-CHECK 1.1-1

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ANSWER KEY

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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
forthe infant to look at the mother’s eyes orareola 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.

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TOOLS AND EQUIPMENT USED FOR INFANT CARE

A. ESSENTIAL MATERIALS TO INCLUDE IN A MATERNITY HOSPITAL
BAG Essentials for Mom
 Nursing bra
Support swollen, sore breasts and keeps breast pads in place
 Breast pads
These stop messy leaks by absorbing milk
 Nursing pillow
Reduces the strain on your arms, neck, and back while nursing
 Night gown and robe
More comfortable than standard hospital gowns
 Slippers
For walking around the hospital during early neighbor
 Socks
To keep your feet warm during delivery
 Going home outfit
Choose something that fit during your sixth month of pregnancy
 Toiletries
Toothbrush, toothpaste, deodorant, lip balm, make up, hair brush, shampoo, and soap
 Sanitary pads
You’ll be more comfortable after delivery with your favorite brand
 Camera
For all those important first photos
 Address book
You’ll have plenty of calls to make
 Money
TOOLS AND EQUIPMENT

1. Baby Clothes (0-3 months)
Essentials
 Coming- home outfit
Something 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)

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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) 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
protected Nice Extras
 Baby bunting bag
Keep your baby warm without the hassle of loose blankets and bulky jackets
 Dress- up outfit
For visitors, photos, and other special occasions
2. Bathing Needs
Newborn Essentials
 Baby bathtub
Keeps your baby face, 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
Cleanse gently, rinses off thoroughly, and doesn’t irritate skin

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 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

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SELF-CHECK 1.1-2
ENUMERATION:
List at least 2 infant/toddler safety measures from the ff. categories:
CRIB
1.
2.
CHANGE TABLE
1.
2.
CAR SAFETY
1.
2.
TOYS
1.
2.
BATHING
1.
2.
FEEDING
1.
2.
ENVIRONMENT
1.
2.

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ANSWER KEY
ENUMERATION: (Choose only 2 from the categories below)
CRIB
1. Bars should be no more than 2 3/8 inches apart

2. Railing should be at least 26 inches higher than the lowest level of the mattress support
3. Mattress should fit snugly into the crib
4. All surfaces should be smooth
5. A bumper guard should be installed to protect infant from the hard railing
6. Do not place the crib near a hot radiator or cold draft
7. No pillow should be used on the crib
CHANGE TABLE
1. The table should be sturdy
2. It should have a strap to secure infant
3. 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 seat
2. 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 edge
4. 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 tub
3. Keep room draft-free
FEEDING
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1. Keep infant in an upright position to prevent choking

2. Check temperature of formula or baby food carefully before feeding
3. Never prop an infant’s bottle
ENVIRONMENT
1. Remove poisonous houseplants
2. Electrical outlets should be in good repair
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 smoke
6. Toddlers should be instructed about an emergency fire plan
7. Every home should have smoke alarms
8. Every home should have a fire extinguisher
9. Never leave a baby unattended on a bed or sofa
10. Never leave a child alone near a pool
11. Pets should be supervised closely around children
12.Handles on pots should be turned to the back of the stove to prevent a child from
pulling on it
13. Keep vertical blind cords out of reach of children
14. Keep all cords, ropes, and scarves away from children
15. Know the Heimlich maneuver
16. Keep all medicines out of reach of children
17. Use safety gates to protect children from stairs
18.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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THE DEPENDENT NATURE OF INFANTS AND TODDLERS
INTRODUCTION:
An infant’s age, and their appetites grow, many parents choose from a variety of commercial
Diaper Bag
Essentials
 Diaper bag
You’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
 Wipes
Consider two travel- sized packs – one for changes and one for faces, hands, spills
 Diaper rash cream
An uncomfortable bottom can cut an outing short
 Changing pad
A life saver when there is no changing table in sight
 Receiving blanket
For naps or to put your baby down on less- than spotless ground
 Burp cloth
For spills, spit- up, and messy feedings
 Change of clothes and socks
Consider 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 baby
You can’t get formula or baby food at the drive- through
 Snack for you
You need fuel too, and don’t forget a bottle of water
 Infant pain reliever
Soothes teething pains and fevers
 Hand sanitizer
Lets you clean up when there’s no sink nearby
 Plastic zipper bags (2-3)
For dirty diapers and wet clothes
 Hat with brim
Prevents sunburn and keeps your baby warm in cool weather
 Baby- safe sunscreen
 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. REGRESSION
Regression, 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. HUNGER
Hunger 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. BOREDOM
Boredom 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 CONTACT

Eye 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 TICS
Nervous 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

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nervous tic to persist into adulthood.
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.

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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
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3.7 holding
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
Procedure for obtaining infant and toddler vital signs
1. Prepared tools and equipment according to the need of infant/toddler
2. Responded to distressed infants/toddlers based on appropriate methods, activity and
non-verbal cues
3. Picked up and cuddled infants and toddlers according to procedure
4. Checked vital signs based on institutional standards
5. Checked water quality and temperature as per requirement
Made comforters available to infant and toddler when needed
CONDITION:
1. CBLM
3. Fully equipped classroom/practical work area conducive for learning and other
activities
4. MATERIALS AND TOOLS
 bathing paraphernalia
 baby’s layettes
Thermometer

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 thermometer tray
 infant’s/toddler’s toys
 appropriate dress
 stethoscope
 cotton and alcohol
 blankets
 baby bottles/pacifier
5. EQUIPMENT
 bassinet/crib
 baby bath tub
 infant dummy
ASSESSMENT METHOD:
1. Written test
2. Interview
3. Demonstration with oral questioning

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Learning Experience
Learning Outcome 2: Prepare infants/toddlers for taking vital signs, bathing, and dressing
Read Information sheet 1.2-1: Tools and equipment Please don’t hesitate to refer to your trainer for
used in caring for baby 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 Refer to the Performance Criteria Checklist to be
effectively to distress signs of infants and guided
toddlers
Read Information sheet 1.2-3: Comforters
Read Information sheet 1.2-4: Procedures on

bathing and dressing, and taking the vital signs
Perform Job Sheet 1.2-4: Taking the Vital Refer to the Performance Criteria Checklist to
Signs, and Bathing and Dressing infant/toddler be guided

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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 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.

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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. thermometer
b. blanket/comforters j. thermometer tray
c. infant carrier k. sterilizer
d. stroller l. infant/toddler’s formula
e. bassinet m. bibs
f. bathing paraphernalia n. nursery rhymes
g. layettes o. toys for the crib
h. 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 caps
e. gloves
f. diapers

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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
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

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 Changing pad cover (2)

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
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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-up
6. Medicine Chest
Essentials
 Digital thermometer
A fast, safe way to take your baby’s temperature
 Petroleum jelly
Soothes minor skin irritations
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
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
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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
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
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 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
 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

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 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
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

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Made for babies’ dry, delicate skin

 Baby brush and comb
Softer and smaller than adult brushes and combs
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
 Storage and cabinets

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SELF-CHECK 1.2-2

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ANSWER KEY

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Task Sheet 1.2-2

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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.

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 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.
 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 breastfed 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:

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 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
 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.
Bottles
Some 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.

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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.
 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 Comforters
It 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.

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PROCEDURES ON BATHING AND DRESSING, AND TAKING THE VITAL

SIGNS
INTRODUCTION:
A. HOW TO BATH AN INFANT

Steps
1. 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.

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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 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.

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Washing baby’s back
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 BOTTLES

Infant 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.
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 design

A 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)

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The teaitself 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.
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.
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Variations and accessories

Bottles 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 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 sterilize
2. A large pot filled ½ to ¾ of the way with water
3. Dish soap
4. Warm water
5. A bottle brush
6. 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 top
8. 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 use

1. 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.

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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.
C. By hand
1. Fill a sink with hot, soapy water. Some people choose a soap that comes with bleach to

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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.
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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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 water
3. Procedure for cleaning and sterilizing baby bottles
4. Breastfeeding importance and procedures
5. Types of milk for infants and toddlers
6. Procedures for preparing milk formula
7. Normal prescription of milk appropriate to child’s age
8. Basic measurement techniques
1. Identified cleaning and sterilizing materials/tools
2. Cleaned and sterilized infants and toddlers’ feeding bottles as needed
3. Prepared the prescribed milk formula
CONDITION:
1. CBLM
Fully equipped classroom/practical work area conducive for learning and other activities

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4. SUPPLIES AND MATERIALS:

 feeding bottles
 bottle brush
 liquid soap
 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 test

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Learning Experience
Learning Outcome 3: Clean, sterilize feeding bottles and Prepare milk formula
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 Refer to the Performance Criteria Checklist to be
Baby guided.
Read Information sheet 1.3-2: Feeding Infant

Formula
Perform Job Sheet 1.3-2: Sterilizing bottles, Refer to the Performance Criteria Checklists to be
Preparing milk formula, Feeding and Burping guided.

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BREASTFEEDING
BREASTFEEDING PROCEDURE
Cross- 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 milk
Not 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 infant

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The benefits of breastfeeding babies are well documented. The American Academy of Pediatrics
states;
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.
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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.
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 postpartum 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.
Bonding
The 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
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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

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 positioning

When 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
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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 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)
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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
 One clutched baby and one cradled baby
 Lying down
Expressing breast milk
Manual Breast
Milk
When 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.

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“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 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.

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SELF- CHECK 1.3-1

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ANSWER KEY

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Mixed feeding
FEEDING INFANT FORMULA
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 breastfeeding
Breastfeeding 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 breastfeeding
In 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.
Weaning
Weaning 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
medication poses serious risks to women, such as stroke, and the U.S. FDA withdrew this indication
for the drug in 1994.

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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.Ifyouchoosetousesoyproducts,besuretouseasoy- 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 PREPARATION
You 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’lluse 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

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exposure to fluoride through fluoridated tap water is no longer a concern. In fact, in the
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.
INFANT/ TODDLER DIET AND FEEDING PROCEDURES

A. INFANT FEEDING GUIDELINES
Stages of an infant development and introduction to solids

There 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!

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ADDITIONAL
AGE GROWTH STAGES NUTRIENT FOODS TO OFFER
NEEDS
Only breast milk or

Birth to Suckles None
iron- fortified
6 Roots for nipple
formula
months
Iron fortified infant
Sits with support
cereal:
Follows food with eyes
5- 7 months -rice
Begins to swallow
-oats
thickened food
(feed with spoon)
Hand to mouth movement Strained or mashed:
Moves tongue to side -vegetables
Controls position of food in Vitamin A -fruits
6- 8 months
the mouth and Vitamin -infant juice (diluted with
Controls swallow C water. Begin teaching
Up and down chew baby to drink from a cup.)
Bites B vitamins Finger foods
Rotary chew Variety -dry cereal
7- 10 months
Moves food from side to diet -toast squares
side in mouth ( allow baby to feed Crackers
Forms lips to cup Grasp self with hands) soft tortilla
develops -cooked vegetables
-soft fruit wedges
Protein
Trace elements Mashed or chopped foods
Sociable:
(allow baby to feed from the family meal;
Greater interest in solid
self with spoon) ground or finely chopped
foods
8- 10 months Gradually decrease meats, fish or poultry;
Drinking from cup improves
number of feedings cottage cheese; egg yolk
Thumb and fingers (pincer
from breast or (whole egg at one year)
grasp) develops
bottle as baby eats
more solid foods
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.

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What are Some Good Table Foods to Start With?

1. Start with small bits of soft fruit such as bananas or vegetables
2. Mashed potatoes
3. Well- cooked mashed vegetables
4. Yogurt
5. Canned, drained tuna or salmon (no bones)
6. Mashed or refried beans
7. 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 Introduced

Your 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 Gain

Breastfed infants generally gain weight according to the following guidelines: 0-4 months: 170
grams per week
4-6 months: 113-142 grams per week
6-12 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.
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 TODDLER

Only 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.

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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

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.

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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 months

Choking 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 up

Choking 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:
 Drinking more than 16- 24 ounces of milk each day.

 Drinking more than 4- 6 ounces of juice each day.

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 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 Pyramid

Well, 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 Diet

Although 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):
 American cheese (one slice) = 45  Grape jelly ( 1 tablespoon) = 50 calories

calories  Hot dog ( ½- 1 hotdog) = 60- 120
 Apple (1/2 small apple) = 40 calories calories
 Banana (1/2) = 50 calories  Ice cream (1/2 cup) = 135 calories
 Beef, ground (ounces) = 85 calories  Macaroni & Cheese (2 ½ ounces) = 260
 Bologna (1 slice) = 90 calories calories
 Bread (1/2- 1 slice) = 20- 40 calories  Mozzarella cheese ( 1 ounce) = 80
 Breakfast cereal (1/4 -1/2 cup) = 40- calories
80 calories  Pancakes (1) = 60 calories
 Chicken nuggets (3- 6 pieces) = 105-  Peanut butter (1 tablespoon smooth
210 calories and thinly spread) = 95 calories
 Eggs (1/2- 1 egg) = 35- 70 calories  Pizza, cheese (1/2 – 1 slice) = 140- 290
 French fries (7-15 steak fries) = 60- calories
120 calories  Pop tart (1/2- 1 pastry) = 1- 200 calories
 French fries (8-17 Funky Fires) = 150-  Popsicle (1) = 70 calories
300 calories  Pudding (1/2 cup) = 110 calories
 Fruit cocktail, canned (1/4 ounce) =  Vegetables (1 tablespoon per year of
calories age) = 25 calories/ tablespoon
 Graham Crackers (1- 2 sheets) = 60-  Yogurt (1/3 cup) = 50 calories
120 calories
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).

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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.
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),

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SELF-CHECK 1.3-2

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ANSWER KEY

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Job Sheet 1.3-2

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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
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:
1. CBLM
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.)
ASSESSMENT METHOD:
1. Written test

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

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 Refer to the Performance Criteria Checklist to be
Toddler 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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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 highchair tray and carpeting the floor. To make matters
worse, we tookour kids’ rejection of ourcuisine personally, sure that thiswas 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.
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.
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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.

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“Olive fingers” would 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.
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
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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:
 Avocados  Broccoli
 Pasta  Peanut butter
 Brown rice and other  Fish
grains  Sweet potatoes
 Potatoes  Kidney beans
 Cheese  Tofu
 Poultry  yogurt
 Eggs
 squash
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.
The 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.

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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 1/2 cup of cooked dry beans, 1 egg, or 2 tablespoons of peanut butter
meat, poultry, or fish count as 1 ounce of lean meat
Vegetable
1 cup of raw leafy 1/2 cup of other vegetables, cooked or 3/4 cup of vegetable
vegetables chopped raw juice
Fruit
1 medium apple, banana, 1/2 cup of chopped, cooked, or canned 3/4 cup of fruit
orange 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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TABLE ETIQUETTE of Toddlers
II. TABLE ETIQUETTE

Toddler Dining Etiquette
Q: 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 Dazzle

Your 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.

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 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 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.

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 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.
 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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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 DON’T put your baby to bed with a bottle. This can
baby’s diet promote baby bottle tooth decay.
DO learn to recognize your baby’s signals. Never

DON’T feed cereals or other solids through the bottle.
force food on your baby’s if they don’t want to eat.
Your baby may gag or choke.
DON’T put your baby in a reclining position while

Do let your infant pace the feeding. feeding (such as an infant carrier).
The baby may choke or gag.
DO be patient with yourself and your baby.

DON’T season baby food that you buy.
Remember if it doesn’t work today it may work
Babies don’t need added salt or sugar.
tomorrow.
DO keep a sense of humour. Easy feedings can be DON’T feed directly from the baby food jar. Saliva
unproductive, messy, frustrating and often very from the baby’s mouth can contaminate the
funny. remainder of the food in the jar.
DO offer food that baby has refused 7- 10 days DON’T serve any food from the microwave without
later. It may take 8- 10 times before a new food is first stirring gently and then testing the temperature.
accepted.

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Task Sheet 1.4-3
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
1. Prepared crib based on procedure
2. Put infants and toddlers to sleep based on procedures
CONDITION:
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
ASSESMENT METHOD:
1. Written test
2. Oral questioning

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Learning Experience
Learning Outcome 5: Prepare infant/toddlers’ crib
Read Information sheet 1.5-1: Conditioning Baby to Please don’t hesitate to refer to your trainer for
fall asleep further discussion on the information
sheets

able to get all items correctly. If not, go back to the
information sheet, and answer again afterwards

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CONDITIONING BABY TO FALL ASLEEPCONDITIONING 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.

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1. Parent- soothing method.
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 trust
So- 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:

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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
 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.
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infants/toddlers
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.

support to
infants/toddlers
SELF-CHECK 1.5-1

support to
infants/toddlers
ANSWER KEY

support to
infants/toddlers

support to
infants/toddlers

Provide Care and Support Tro Children

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Provide Care and Support Tro Children

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ST.

COMPETENCY-BASED LEARNING MATERIAL

Qualification Title: Care giving NC II

Unit of Competency: Provide Care and Support to Children

Module Title: Providing Care and Support to Children

ST. PAUL SURIGAO UNIVERSITY HOSPITAL

CBLMs on Document No. AC-CGV0216671921104

“ALL FOR THE GREATER GLORY OF GOD”

CBLMs on Document No. AC-CGV0216671921104

COMPETENCY- BASED LEARNING MATERIALS

All rights reserved

These Competency-Based Learning Materials

For further information, please contact:

CBLMs on Document No. AC-CGV0216671921104

HOW TO USE THIS COMPETENCY-BASED LEARNING MATERIALS (CBLM)

CBLMs on Document No. AC-CGV0216671921104

CBLMs on Document No. AC-CGV0216671921104

CBLMs on Document No. AC-CGV0216671921104

UNIT OF COMPETENCY: PROVIDE CARE AND SUPPORT TO CHILDREN

MODULE TITLE: PROVIDING CARE AND SUPPORT TO CHILDREN

NOMINAL DURATION: 60 HOURS

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

CBLMs on Document No. AC-CGV0216671921104

LEARNING OUTCOME 1 Explain the concepts and principles of caring,

CBLMs on Document No. AC-CGV0216671921104

Learning Activities Special Instruction

Answer Self-check 1.1-1 Compare answer to answer keys. You should be

Read Information sheet 1.1-2: Basic Infant Care

Answer Self-check 1.1-2

Read Information sheet 1.1-3: The Dependent

Read Information sheet 1.1-4: Enhancing

Answer Self-check 1.1-4

CBLMs on Document No. AC-CGV0216671921104

Information Sheet 1.1-1

GROWTH AND DEVELOPMENT

Growth and Development

Principles of Growth and Development

Factors influencing Growth and

Development Conception and Prenatal

CBLMs on Document No. AC-CGV0216671921104

 Find partially hidden objects (so enjoy playing peek- a –boo)

CBLMs on Document No. AC-CGV0216671921104

 Use pincer grasp (thumb and forefinger)

CBLMs on Document No. AC-CGV0216671921104

 Social and Emotional Milestones

 Gross Motor Milestones

 Fine Motor Milestones

C. Month 8-12: Has neat pincer grasp

 Self Testing Milestones

CBLMs on Document No. AC-CGV0216671921104

CBLMs on Document No. AC-CGV0216671921104

CBLMs on Document No. AC-CGV0216671921104

Information Sheet 1.1-2

CBLMs on Document No. AC-CGV0216671921104

CBLMs on Document No. AC-CGV0216671921104

TOOLS AND EQUIPMENT USED FOR INFANT CARE

TOOLS AND EQUIPMENT

CBLMs on Document No. AC-CGV0216671921104

Pair with a snap- crotch shirt for an instant outfit