TABLE OF CONTENTS

Page

Title Page………………………………………………………… i

Table of Contents……………………………………………….. ii

Session 1: Opening Program 1

Session 2: Getting Ready for Pregnancy and Proper Care During Pregnancy 4

Session 3: Proper Nutrition and Healthy Lifestyle for Pregnant Women 5

Session 4: Physical Activity and Exercise for Pregnant and Postpartum Women 6

Session 5: Postpartum Services and Proper Nutrition for Lactating Women 12

Session 6: Caring for Newborn: Introduction to Breastfeeding 21

Session 7: Introduction of Complementary Feeding with Return Cooking

Demonstration

Session 8: Psychosocial Stimulation

Session 9: Closing Activity/ Culminating Activity

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ANNEXES

Annex A. The Pinggang Pinoy for Pregnant Women from DOST-FNRI 1

Annex B. Sample Menu for Pregnant Women 4

Annex C. The Different Breastfeeding Positions 5

Annex D. Common Breastfeeding Problem 6

Annex E. Return Cooking Demonstration on Complementary Feeding 12

21
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Introduction

“Malnutrisyon ay Iwasan, First 1000 Days ay Tutukan” is an initiative focused on the

most critical period in the child’s life which is the first 1000 days. The program is a lifestyle

health program that aims to reduce malnutrition among children 0-23 months through the

application of lifestyle medicine elements and intervention modalities such as physical activity,

emotional wellness, sleep, avoidance of smoking and alcohol, and proper nutrition from

pregnancy until the first two years of the child. The program aims to address the knowledge,

attitude, and lifestyle practices of the mother and other family members to achieve the

necessary learnings they need to make important decisions about their children's nutrition. The

learning sessions will lead participants to examine their existing feeding and caring behaviors,

as well as identify which practices should be kept, enhanced, or changed and techniques in

doing it.

“Malnutrisyon ay Iwasan, First 1000 Days ay Tutukan” program will be conducted in

nine sessions, including opening and closing programs, health and nutrition assessment,

lectures, lifestyle coaching, and a cooking demonstration. The program is to be implemented in

4- 5 weeks depending on the availability of the participants.

The initial session will deal with preliminary activities such as getting to know, sharing

expectations for the program, visioning exercises, health, and nutritional assessment, and pre-

test. The second to the fourth sessions of the module session will focus on the period of

conception. During these sessions, the participants will be given information on the importance

of planning for pregnancy and proper caring practices during pregnancy, the importance of
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healthy weight on pregnancy outcomes, and the preparations needed for pregnancy.

Additionally, pregnant mothers will learn about the importance of good nutrition using

Pinggang Pinoy. The next session will cover the topics of the benefits of physical activity

among pregnant and postpartum women and what moderate physical activity can pregnant

women do safely.

For session five, the discussion will highlight the health services for a postpartum

woman, the importance of follow-up visits after delivery, and the proper nutrition for a

lactating mother.

The sixth session up to the eighth session will focus on the lifestyle intervention in the

first two years of the child’s life. The sessions are designed to educate mothers on the essential

health services for newborns including the importance and benefits of breastfeeding and child

growth monitoring, the importance of giving complementary feeding, and its characteristics

and psychosocial stimulation. A participatory cooking demonstration will be conducted in the

seventh session to capacitate mothers on preparing complementary foods and enriching them

with locally available foods. The psychosocial stimulation topic in the eighth session tries to

address the problem of long screen time with children by educating mothers on the importance

of providing psychosocial stimulation and care to their children. Moreover, the discussion will

also include the importance of giving age-appropriate toys in the development of the child and

the characteristics of safe toys for young children. The last session will be the closing

ceremonies, giving of post-test, and recognizing the exemplary performance of participants in

the program.
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A post-test is administered to participants to evaluate their knowledge, behavior, and

practices about a change in lifestyle to determine the program's effectiveness. The result will be

compared with the pre-test that was administered at the start of the program.

Target Audience

This program is designed for expectant mothers to offer early intervention during the

most crucial years of the child's life. The module aims to improve maternal health and infant

and small child feeding practices. Each learning session will be informative, educational,

scientific, and entertaining. Table 2 provides a summary of the program.

Program Overview

Session 1 Opening Program

Session 2 Getting Ready for Pregnancy and Proper Care During Pregnancy
Session 3 Proper Nutrition and Healthy Lifestyle for Pregnant Women
Session 4 Physical Activity and Exercise for Pregnant and Postpartum Women
Session 5 Postpartum Services and Proper Nutrition for Lactating Women
Session 6 Caring for Newborn: Introduction to Breastfeeding
Session 7 Introduction of Complementary Feeding with Return Cooking
Demonstration
Session 8 Psychosocial Stimulation
Session 9 Closing Activity/ Culminating Activity

Statement of Goal and Objectives

The goal of this community-based health program is to reduce malnutrition among

preschool children aged 0-23 months in the Municipality of Candelaria. The following are the

objectives of the program.

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The Program Objectives

Session Topic Objectives

Session 1 Opening Program
Session 2 Getting Ready for Pregnancy and
Proper Care During Pregnancy
Session 3 Proper Nutrition and Healthy
Lifestyle for Pregnant Women
 80 % of the participants can
state their expectations in the
class and how their
expectations can be met by
the objectives of the
program.
 80% of the mothers can state
the importance of the first
1000 days in ensuring
optimum growth and
development of their child.
 80% of the mothers can state
the importance of preparing
for pregnancy.
 80% of the mothers can
identify the relationship
between nutritional status
and pre-pregnancy outcomes.
 80% of the participants can
identify the preparations
needed for pregnancy.
 80% of the participants can
determine what foods to eat
during pregnancy.
 80% of the participants can
prepare a menu appropriate
for pregnant women using
Pinggang Pinoy.

Session 4 Physical Activity and Exercise
for Pregnant and Postpartum
Women
Session 5 Postpartum Services and Proper
Nutrition for Lactating Women
Session 6 Caring for Newborn:
Introduction to Breastfeeding
5
 80% of the mothers can
follow a healthy lifestyle
 80 % of the participants can
enumerate the benefits of
physical activity during
pregnancy
 80% of the participants can
identify safe exercise for
pregnant women
 80% of the participants can
identify warning signs when
to stop exercising
 80% of the participants
enumerate the importance of
follow-up visits and health
services for postpartum
women
 80% of the participants can
determine the proper foods
during postpartum and
lactation.
 80% of the participants can
a. determine the benefits of
breastfeeding
b. identify the correct
attachment and different
breastfeeding positions
c. identify the common
problems; their causes,
and ways to address
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Session 7 Introduction of Complementary
Feeding with Return Cooking
Demonstration
Session 8 Psychosocial Stimulation
them.
 80% of the participants can
a. explain the importance of
complementary feeding
and its characteristics
b. demonstrate how to
prepare appropriate
complementary foods for
their babies.
 80% of the participants can
explain the importance of
providing psychosocial
stimulation and care to the
child.
 80% can describe the
characteristics of appropriate
and safe toys for infants and
young children.

Session 9 Closing Ceremony  80% of the participants can

discuss their learning and
share the actions that they
will do after the program.
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SESSION 1
INTRODUCTION AND VISIONING EXERCISE

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Understand the concept of the first 1000 days and its importance;

2. Know about the co-participants.

3. Discuss their expectations for the program and how these can be met by the

objectives, and

4. Agree on the schedule of the program’s next sessions.

METHODS:

Game, group discussion, lecture discussion, audio-visual presentation

MATERIALS:

Crayons, manila paper, marking pens, laptop, projector, cartolina, video of

“Ningning” from the National Nutrition Council

TIME: 2 hours- 2 ½ hours

ACTIVITY 1: Getting to Know You Activity

Procedure:

Welcome everyone and thank them for coming. Invite everyone to sit in a circle. One

individual introduces herself first. The next participant after her reiterates what she said and

introduces herself. The third person then repeats the first two names, adds her response, and so
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on around the circle. If one of the participants cannot remember a name or something that was

said about them simply ask the co-participant for their answers.

The following are the questions that the participants can use to introduce themselves.

1. What is the mother’s name and nickname?

2. If your baby can grow up to be anyone in the world, who will you want him or her

to be? Why?

ACTIVITY 2: Sharing of Expectations

Procedure:

Give each participant a meta-card and ask them to put down their expectations for each

program session. Ask the participants to put their responses on the wall or board and then discuss

their answers after five (5) minutes. Ask the audience what they had in common before the

presentation and what further expectations they would want to add. After the discussion, give the

list of learning session goals and have the participants compare it to their expectations.

ACTIVITY 3: Setting up Schedule and Norms

Procedure:

Refer to the activity completed regarding the defined learning expectations and

objectives. Highlight that to achieve the goals of the sessions, a considerable amount of time is

needed from the participants. Get from the participants what time of day and duration they would

find most convenient for them to attend each session. Set the dates and times that the class will

meet. Talk about the norms and how important they are for attaining each session's objectives.

Ask the participants, "What should we do to make our class productive and orderly?"
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ACTIVITY 4: Visioning Exercise

Procedure:

Give each participant crayons, a marking pen, and a blank sheet of paper. Ask the

participants to draw their dream for their child. Allow the participants five to ten minutes to do

the activity. Reassure them that their drawings are acceptable even if they do not have any

drawing skills. Request that selected participants present their drawings. Once the presentation of

the participants is done, ask the attendees "What do you think is needed to be able to achieve

your dream for your child? "

ACTIVITY 5: Pre-Test and Introduction on First 1000 Days

Procedure:

To gauge their level of familiarity with the topics covered in the learning sessions, all

participants should complete the pre-test. Following the pre-test, participants will view the

"Ningning" movie produced by the National Nutrition Council (NNC) and the United Nations

Food Programme (WFP).

After the video presentation, an overview of the program's different sessions will be

discussed. Following the presentation, the participants will be asked what they would do if

Ningning were their child. Then, share the takeaway message to wrap up the session.

KEY MESSAGES FOR DISCUSSION

● The first 1000 days of life start from conception until the child reaches his/her second

birthday

270 days pregnancy + 365 days (0-12 months) + 365 days (13-23 months) = 1000 days
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● It is regarded as the "golden window of opportunity" for a child to realize his or her

greatest potential. Important health, nutrition, early learning, and associated services

should be provided during this time to safeguard a child's optimum physical and mental

development.

● Strong foundations for a child's physical growth, mental development, health, nutrition,

and future economic production are laid by good maternal nutrition throughout

pregnancy and after birth, along with appropriate newborn, infant, and young child

feeding practices.
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SESSION 2
GETTING READY FOR PREGNANCY AND PROPER CARE
DURING PREGNANCY

The life cycle approach underpins prenatal and postpartum care, where the mother's

health is highly dependent on her nutrition and general health throughout the prenatal period, and

her prenatal health is influenced by her childhood health. This is referred to as preconception or

pre-pregnancy care. Therefore, prenatal care must concentrate on preventing the

intergenerational repercussions of malnutrition and poor health. Pregnancy care should be seen

as a continuum from adolescence to motherhood, focusing on being healthy and nourishing in

case of pregnancy and childbirth.

Session two will focus on the significance of mothers' nutritional status and what they

should do to get ready for pregnancy.

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Recognize the significance of preparing for pregnancy;

2. Identify the association between nutritional status and pre-pregnancy outcomes;

3. Discuss the preparations required for pregnancy.

4. Discuss what is a healthy pregnancy, and

5. Identify the danger signs of pregnancy.

METHODS:

Group-discussion, lecture-discussion
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MATERIALS:

Laptop, projector, marking pen, meta card

TIME: 2- 2 ½ hours

ACTIVITY 1: Importance of Preparing for Pregnancy and Healthy Signs of Pregnancy

Before conducting this session, ask the mothers to bring their mother and

baby book from the barangay health center.

Procedure:

Before the activity, the participants will be grouped into 3-4 members using The Boat is

Sinking. The session will start with a “Battle of the Brain” game to determine the knowledge of

the participants on the importance of preparing for pregnancy. The facilitators will give questions

that will be answered by the representative of each group. Seven questions will be given, and the

team with the highest score will win the game. Below are the guide questions.

1. Ano ang tamang bilang ng anak upang masiguro ang kalusugan ng ina at sanggol?

a. tatlo

b. lima

c. apartpat

d. dalawa

2. Ilan taon ang dapat pagitan ng pagbubuntis ng isang ina upang maging ligtas ang kanyang

pagbubuntis para sa kanya at sa kanyang sanggol?

a. dalawang taon

b. tatlong taon

c. limang taon
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d. isang taon

3. Alin ang hindi masamang epekto sa pagbubuntis ng isang ina na labis ang timbang sa

kanyang pagbubuntis?

a. Maari siya magkaroon ng diabetes.

b. Maaring tumaas ang kanyang presyon.

c. Wala at mas maging malusog ang sanggol na ipinagbubuntis.

d. Maaring magkasakit sa puso ang isang ina na labis ang timbang

4. Ano ang tamang pagtaas ng timbang ng isang ina sa ikalawa at ikatlong trimester ng

pagbubuntis kung nasa tamang timbang ang nanay bago sa pagbubuntis?

a. 400 gramo kada linggo

b. 200 gramo kada linggo

c. 500 gramo kada linggo

d. 100 gramo kada linggo

5. Ang mga sumusunod ay mga panganib sa pagbubuntis maliban sa_______.

a. mabilis o hirap na paghinga

b. malalang pagsakit ng ulo

c. magana sa pagkain

d. sobrang pagsakit ng tiyan

6. Ang isang inang nagbubuntis ay hinihikayat na bumisita sa health center, klinika o ospital ng

buwan-buwan. Sa pagkakataon na hindi posible ang buwanan, ang isang buntis ay dapat

magkaroon ng ilan beses na pagkonsulta?

a. 4

b. 3
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c. 1

d. 2

7. Ang mga sumusunod ay mga serbisyong pangkalusugan na binibigay sa mga health center

maliban sa_______ .

a. pagsukat ng timbang at taas ni nanay

b. pagbibigay ng folic acid

c. counseling o pagtuturo sa mga nanay tungkol sa kalusugan at nutrisyon ni mommy at

baby

d. libreng Philhealth sa mga buntis

After the game, the facilitator will lead the discussion on the important messages for

discussion.

KEY MESSAGES FOR DISCUSSION

 Pregnancy refers to the time leading up to a woman’s first pregnancy as well as the

interval between subsequent pregnancies.

 As pregnancies are often confirmed at three to four months, the woman may not

know when she will get pregnant. Pregnancy, therefore, must be wanted and

planned.

 The age and nutritional status of a woman before conception may have an impact

on both her and her unborn child. The reproductive years of a woman range from

15 to 44. Pregnancy during the teenage period, which is between the ages of 15

and 18, carries a greater risk of difficulties since the body is still growing. These

complications include premature delivery, low birth weight, and neonatal

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mortality. Contrarily, getting pregnant after age 40 may result in pregnancy

complications due to the co-existence of other health issues, such as heart disease,

diabetes, and reproductive issues. Additionally, the risk for genetic abnormalities

increases with maternal age, having an impact on both the mother and the unborn

child.

 A woman must prepare herself physically and psychologically for this significant stage of

her life since pregnancy is a special moment for her.

 To cope with pregnancy, labor, and delivery challenges, the woman should be in

good physical and nutritional condition. This is significant for both her and her

unborn child.

 The first four months are crucial for the developing fetus, therefore missing any

healthcare interventions like iron-folic acid supplements at this time may have

negative health effects on both the mother and the child.

 A mother who is underweight increases the chance of giving birth to an

underweight child.

 A pregnant obese woman is more likely to produce an oversized fetus with

potential birth abnormalities, as well as hypertension, diabetes, and heart disease.

 Having sufficient iron levels can lower the chance of anemia during pregnancy

and taking folic acid supplements in the first few weeks of pregnancy can lower

the risk of having a baby with a brain abnormality.

 For adolescents and non-pregnant women of reproductive age, health facilities in

the community offer interventions and services such as immunization, the

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distribution of iron supplements, counseling services, and reproductive health

care.

 The lack of menstruation is the sole early indication of pregnancy. Although

nausea, vomiting, and dizziness can happen during pregnancy, these symptoms

can also be brought on by other medical issues. When the monthly period is

absent, consult a doctor to determine if you are pregnant or not. The positive and

negative pregnancy symptoms are listed below. For adolescents and non-pregnant

women of reproductive age, health facilities in the community offer interventions

and services such as immunization, the distribution of iron supplements,

counseling services, and reproductive health care.

 The lack of menstruation is the sole early indication of pregnancy. Although

nausea, vomiting, and dizziness can happen during pregnancy, these symptoms

can also be brought on by other medical issues. When the monthly period is

absent, consult a doctor to determine if you are pregnant or not. The positive and

negative pregnancy symptoms are listed below.

HEALTHY SIGNS OF PREGNANCY DANGER SIGNS OF PREGNANCY

● Normal increase in weight according ● Swelling of legs, hands, and/or face

to the month of pregnancy
First trimester:
1-2 kg (regardless of pre-pregnancy BMI)
Second and third trimesters:
● Severe headache, dizziness
● Fever and chills
● Severe abdominal pain
● Watery vaginal discharge or bleeding
● Painful urination
● Fast or difficult breathing

Pre-pregnancy Normal weight

BMI increase

< 18.5 ½ kg (500g)/ week

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18.5-24.9 400 g/ week

> 25 < 300 g/ week

(The total increase in body weight during the

entire course of pregnancy should be 20% of
pre-pregnancy weight)

● Absence of illness
● Absence of paleness
● Physically active
● Normal urination
● Absence of body pain

At this point, check the participants’ weight, height, and BMI from their Mother
and Child Book. Emphasize the significance of healthy weight during the period
of pregnancy for both mother and baby.

ACTIVITY 2: Care During Pregnancy

Procedure:

To introduce the topic of care during pregnancy, the participants will be asked to pass a

paper cabbage while the music is playing. When the music stops, the person holding the paper

cabbage will peel off one sheet and answer the question written on the paper. Every participant

will be given the chance to answer the question written on the paper cabbage.

After all the questions have been answered, synthesize the activity by reviewing the

answers of the participants. Below is the table which can serve as the facilitator’s guide.

Topic Answers
Health services available for pregnant women  Tetanus-diphtheria immunization and
in the health facility iron-folic acid supplementation

 Weight and height measurement,

assessment of body mass index

 Abdominal check-up
 Counseling on lactation amenorrhea,
breastfeeding, nutrition, healthy lifestyle,

Danger signs a pregnant woman might
encounter that needs urgent care in a health
facility
Vaccine given to a pregnais givenman
Important micronutrients for a pregnant
woman
Number of visits of a pregnant woman to the
health facility
Record needed in each antenatal visit
Place a woman should give birth
Screening needed by a pregnant woman
18
exercise, responsible parenthood, and birth
spacing
 Swelling of legs, hands, and/or face
 Severe headache, dizziness
 Fast or difficult breathing
 Fever and chills
 Severe abdominal pain
 Watery vaginal discharge or bleeding
 Painful urination
 Tetanus-diphtheria immunization helps in
preventing tetanus and diphtheria for both
mother and infant. A woman needs five
doses for lifetime protection against
tetanus for her and her future babies.
 Iron with folic acid to prevent anemia and
folic acid deficiency
 A pregnant woman should go for prenatal
visits monthly. If not possible, she must
have at least four (4) visits once during the
first and second trimesters and twice in the
third trimester.
 Mother and Child Book which should be
brought every check-up and given at the
prenatal checkup
 All mothers must give birth in a health
facility and assist by a trained health
professional (doctor, nurse, midwife)
 Pregnancy test
 STI/HIV testing
 Routine laboratory such as Complete
Blood Count (CBC), blood typing,
urinalysis, fecalysis, hepatitis B surface
antigen test
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SESSION 3

PROPER NUTRITION AND HEALTHY LIFESTYLE FOR

PREGNANT WOMEN

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Recognize the significance of a healthy diet during pregnancy;

2. Identify the foods to eat while pregnant; and

3. Use the Pinggang Pinoy to create example dinners fit for a pregnant woman.

METHODS:

Group-discussion, lecture-discussion

MATERIALS:

Laptop, projector, Pinggang Pinoy brochures for pregnant women, paper plates,

pictures of different food items, paper, pencils, scissors, masking tape

TIME: 1 ½ - 2 hours

ACTIVITY 1: Nutrition During Pregnancy

Procedure:

Introduce the session by discussing the importance of good nutrition in this period.

KEY MESSAGES FOR DISCUSSION

 A woman's nutritional requirements increase during pregnancy and lactation. The

pregnant woman needs to eat more for both herself and her developing child.
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 A healthy diet during pregnancy will assist in the baby's proper growth inside the womb.

Additionally, this will give the strength and stamina needed for labor and delivery.

 The appropriate amount of weight increase during pregnancy depends on the woman's

diet. Throughout the entire pregnancy, the total weight gain should not exceed 20% of the

pre-pregnancy weight.

 A baby born to a malnourished mother may experience complications like low birth

weight, anemia, birth defects, and brain damage. It could potentially result in the mother's

and the infant's deaths.

Ask the participants about their cravings and dietary taboos while pregnant. Discuss and

decide whether the practice or food choice is appropriate or inappropriate. The table can serve as

a reference point for organizing the activity.

Food cravings Food Taboos

Sweet foods (chocolates, cake, etc) Kambal na Saging (pregnant woman may
give birth to a twin)

The facilitator will distribute Pinggang Pinoy pamphlets (see Annex A) to the participants

when the group discussion on food desires and taboos is complete. The facilitator will explain to

the mothers what Pinggang Pinoy is, and how to prepare meals using this food guide.

Paper plates will be provided to the participants after the discussion, and they will be

asked to fill the plate with a suitable menu for a pregnant woman using cutout images. A prize

will be given to the participants who produced the best results.

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ACTIVITY 2: Healthy Lifestyle During Pregnancy

Procedure:

A group-sharing activity will be used to start the second activity of Session 3. To select

the mother who will do the sharing, a paper ball will be passed to the participants. With the cue

of the music, the mother holding the paper ball after the music stops will do her sharing as

guided by the following questions.

1. What are the different changes in your lifestyle have you changed or changed

because of pregnancy?

2. Is there anything in your lifestyle that you still want to change? If yes, what is it and

why?

After the group sharing lead the discussion with the key points for discussion.

KEY MESSAGES FOR DISCUSSION

 Adequate and good quality sleep are essential for both the mother's health and the

development of the fetus during pregnancy. According to National Sleep Foundation, the

recommended hours of sleep at the age most women are becoming pregnant is between 7

and 9 hours.

 Poor sleep during pregnancy, both in terms of quantity and quality, may increase the risk

of undesirable pregnancy outcomes, such as postpartum depression and fetal growth

restriction, and gestational diabetes. However, cardiovascular conditions are linked to

prolonged periods of sleep. 

 Some factors may affect sleep during pregnancy such as

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Hormonal Changes: Blood pressure and blood sugar levels drop during the first. The

increased progesterone level at this time can also result in pregnant women wanting more

sleep. 

Restless leg syndrome. The rise in estrogen levels or lack of folic acid and iron among

pregnant women may result in restless syndrome.

Gastroesophageal reflux disease (GERD). Pregnancy can lead to GERS as the extra

pressure on the stomach area hinders the muscular ring at the bottom of the esophagus to

close.

Insomnia. Pregnancy-related aches and pains are one cause of sleeplessness.

The increased stress and anxiety related to childbirth and parenting during pregnancy can

lead to women being up long past the usual bedtime. 

Sleep apnea. Some pregnant women experience sleep apnea, possibly as a result of

hormonal and physiological changes.

Frequent Urination. This is the result of the growing baby that puts extra pressure on

the mother’s bladder.

 To improve sleep during pregnancy, the following can be done to assist pregnant women

to have good quality sleep.

o Consider using a pregnancy pillow

o Address underlying problems which means addressing any issues that are keeping the

mind racing.

o Exercise daily to improve sleep. Touch may be really calming anul for falling asleep. 

It can also lessen some of the aches and pains related to pregnancy and lift your mood.
 23

o Get a massage. Touch can be very soothing and beneficial to sleep! It can also relieve

some of the aches and pains associated with pregnancy and improve your mood.

o Establish good sleep habits. Going to bed at regular times following predictable

patterns of activity might assist create the right environment for a good night's sleep.

o Make the ideal sleeping environment. Keep electronics out of your bedroom, invest

in a new mattress, check that your space is clear of clutter, or even set the thermostat to

the ideal temperature before bed.

 Preterm birth, low birth weight, and birth defects of the mouth and lip are just a few of

the health issues that smoking during pregnancy increases the risk of for unborn children.

Smoking before, during, and after pregnancy also raises the risk of sudden infant death

syndrome (SIDS).

 Alcohol in the mother’s blood passes to the baby through the umbilical cord. Alcohol use

during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical,

behavioral, and intellectual disabilities. These disabilities are known as fetal alcohol

spectrum disorders (FASDs). Children with FASDs might have the following

characteristics and behaviors:

o Abnormal facial features, such as a smooth ridge between the nose and upper lip (this

ridge is called the philtrum)

o Small head size

o Shorter-than-average height

o Low body weight

o Poor coordination
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o Hyperactive behavior

o Difficulty with attention

o Poor memory

o Difficulty in school (especially with math)

o Learning disabilities

o Speech and language delays

o Intellectual disability or low IQ

o Poor reasoning and judgment skills

o Sleep and sucking problems as a baby

o Vision or hearing problems

o Problems with the heart, kidney, or bones

Process the activity by asking the following questions to the participants:

1.What new things have you learned from the session?

2. How will you apply the learnings you gained?

3. Close the session by sharing the key points in the discussion.

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SESSION 4
PHYSICAL ACTIVITY AND EXERCISE FOR PREGNANT
WOMEN

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Understand the importance of physical activity and exercise during pregnancy;

2. Identify exercise recommendations for a pregnant woman;

3. Know different exercises that are safe and beneficial for pregnant women, and

4. Enumerate the warning signs to stop exercise in a pregnant woman.

METHODS:

Group discussion, lecture-discussion, video presentation

MATERIALS:

Laptop, projector, infographic of exercise for pregnant women, exercise video for

pregnant women, object cut-outs

TIME: 2 hours

ACTIVITY 1: Exercise During Pregnancy

Before conducting this session, coordinate with the nurse or midwife on the

health condition of the mothers. Check for vital signs before the conduct of

exercise activity.
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Procedure:

The session will start with the “Me, The Object” game. In this game, the participants will

be asked to rummage through the box of pictures of various activities and select a picture that

they do most of the day. The participants will be asked to explain their choice. To process the

activity, mothers will be asked the following:

1. What is the reason why you engage in exercise/ physical activity?

2. What are the barriers that prevent you from doing daily exercise?

Once the group sharing is done, synthesize the activity by discussing the

importance of exercise during pregnancy.

KEY MESSAGES FOR DISCUSSION

 Physical activity is any bodily movement produced by the contraction of skeletal muscles

in all stages of life, maintains and improves cardiorespiratory fitness, reduces the risk of

obesity and associated comorbidities, and results in greater longevity.

 Exercise is a physical activity consisting of planned, structured, and repetitive bodily

movements which are done to improve one or more components of physical fitness and it

is an essential element of a healthy lifestyle.

 The US Department of Health and Human Services Physical Activity Guidelines for

Americans recommend pregnant women have 150 minutes of moderate-intensity aerobic

activity per week during pregnancy and the postpartum period. Pregnant women who are
 27

obese or have sedentary lifestyles should start with low-intensity, short periods of

exercise and gradually increase the period intensity of exercise as they are able

 Exercise during the period of conception has several benefits such as

a. Improving or maintaining physical fitness

b. Higher incidence of vaginal delivery

c. Lower incidence of Excessive gestational weight gain, Gestational diabetes

mellitus, Preterm birth, Cesarean birth, Lower birth weight

d. Decreased Postpartum Recovery Time

e. Prevents depressive disorders during the postpartum period

f. Less bodily pain, lumbar and sciatic pain, and reduced pain disability

g. Reduced risk of gestational hypertensive disorders, gestational hypertension

 Women with the following conditions or pregnancy complications should not exercise

during pregnancy:

1. Certain types of heart and lung diseases

2. Cerclage

3. Being pregnant with twins or triplets (or more) with risk factors for preterm labor

4. Placenta previa after 26 weeks of pregnancy

5. Preterm labor during pregnancy or ruptured membranes

6. Preeclampsia or pregnancy-induced high blood pressure

7. Severe anemia

 When doing exercise, pregnant women should remain well hydrated and avoid long

periods of lying flat on their backs.

 28

 A pregnant woman should stop exercising if they have any of these warning signs vaginal

bleeding, abdominal pain, regular painful contractions, amniotic fluid leakage, dyspnea

before exertion, dizziness, headache, chest pain, muscle weakness affecting balance, and

calf pain or swelling.

 A pregnant woman who regularly exercises before pregnancy with no complications can

engage in a high-intensity exercise program.

 Adequate caloric intake before exercise or limiting the intensity or duration of the

exercise is important to minimize the risk of hypoglycemia (exercise over 45 minutes).

 Prolonged exercise should be performed in a thermoneutral environment and should

avoid prolonged exposure to heat.

 Exercises that have been extensively studied in pregnancy and found to be safe and

beneficial are walking, stationary cycling, aerobic exercise, dancing, resistance exercises

such as using weights and bands, stretching exercise, hydrotherapy, and water aerobics.

 In the postpartum period, regular aerobic exercise has been shown to improve maternal

cardiovascular fitness without affecting milk production, composition, or infant growth.

Consider feeding the infant or expressing milk before exercising to avoid discomfort and

ensure adequate hydration during physical activity.

To end the discussion, the participants will be encouraged to do a gentle chair

exercise from Gundersen Health System. After the exercise, process the activity by asking the

participants the following

- What happened in the activity? What did you feel?

- What was easy? What was difficult?

- What have you learned from the activity?

 29

SESSION 5
POSTPARTUM SERVICES AND PROPER NUTRITION FOR
LACTATING WOMEN
The period starting right after a child is born and lasting for around six weeks is referred
to as the postpartum period. Since the majority of deaths among women and babies happen
within the first two days following birth, care for the woman and her baby should continue
during this period. A critical window of opportunity for women to get family planning services
is also during the postpartum period.

This session discusses care and proper diet for the postpartum or lactating mother as
well as the importance of child spacing.

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Understand the significance of post-delivery visits;

2.  Determine the risk indicators during postpartum and when to seek medical

attention. 

Determine the range of health services available to new mothers.

4. Recognize the significance of a healthy diet during nursing and the postpartum

period;

5.  Identify the foods to consume during breastfeeding and after giving birth; and

6.  Create menu samples that are suitable for lactating women

1. Understand the importance of follow-up visit after delivery;

2. Identify postpartum danger signs and when to seek care from health workers;

3. Identify the package of health services for a postpartum woman

 30

4. Understand the importance of good nutrition during postpartum and lactation;

5. Determine what foods to eat during postpartum and lactation; and

6. Prepare sample menus appropriate for lactating women.

METHODS:

Group discussion, lecture-discussion, video presentation

MATERIALS:

Laptop, projector,

TIME: 2 hours

ACTIVITY 1: Postpartum Services

Procedure

Group the participants into two. Ask one group to answer the question “What is the

importance of postpartum care? ” and another group to answer “What important health service

should postpartum women receive?  Once the participant has finished writing their responses on

the provided manila paper, ask for a representative from each group to present their responses to

the group. Use the main points listed below to summarize the participant's responses and

continue the conversation.

KEY MESSAGES FOR DISCUSSION

Importance of postpartum care

 After giving birth, the mother needs time to recover from the difficulties

experienced during pregnancy, labor, and delivery. She needs to regain her strength so

she can take better care of herself and her infant.

 31

• The first two days after birth are crucial for both the mother and the baby. Both are at

significant risk of passing dying at this time.

• A postpartum woman needs preventative and promotional care during the first 24 hours to 6

weeks after giving birth since this is when problems like bleeding, hypertension, and

infections are most common. As a result, complications must be recognized and treated

quickly.

• New mothers must get assistance with breastfeeding. This can be done skillfully by family

members who have breastfed their own children, peeeastfeeding counselors in the

community, and skilled health professionals at the health center.

A postpartum woman should:

 Get a postpartum check-up within 24 hours after giving birth; this is typically done at the

medical facility before you are let go. Within three days, a second postpartum visit is

conducted.

 Take a single dosage of Vitamin A (200,000 IU) within six weeks following birth.

 Take iron and folate supplements once per day for up to three months. 

 Take note of the following danger signs and contact local healthcare practitioners

immediately.

- High fever, abdominal pain, paleness, soft uterus, profuse bleeding, foul-

smelling vaginal discharge, convulsions, headache, vomiting, high blood

pressure, and problems with urination.

 Seek counseling and other forms of support for breastfeeding, proper nutrition, diet, and

family planning services

 Observe self-care such as:

 32

- Proper hygiene e.g. sanitary pads every four to six hours, care of breast

- Having plenty of rest to hasten the recovery process

- Having safe sex

After the discussion on postpartum services, the topic of proper nutrition will be

introduced by emphasizing its importance with the use of the Pinggang Pinoy brochure.

 A lactating woman must eat a variety of foods in sufficient amounts including fresh fruits

and vegetables, grains, nuts and beans, milk, eggs, meat, and fish (all well-cooked) to get

the required energy and nutrient during lactation.

- Go (energy-giving foods): Whole grains like brown rice, corn, wheat, bread, pasta,

oatmeal, root crops like camote, gabi, kamoteng-kahoy, and ube

 Carbohydrate-rich foods provide energy to support bodily functions and physical

activity

 These foods are linked to a lower risk of heart disease, diabetes, and other health

problems

- Grow (body-building foods): Fish, shellfish, lean meat, poultry, eggs, and dried beans

or nuts

 These are needed for the building up and repair of the mother and baby’s tissues.

These are also high in iron and calcium.

- Glow (body-regulating foods): Vegetables like malunggay, sitaw, kalabasa,

ampalaya, fruits like banana, mango, papaya, dalanghita

 Fruits and vegetables are packed with vitamins, minerals, and fiber needed for the

regulation of body processes, Green leafy vegetables with high iron and folate

content should be consumed to meet increased requirements.

 33

 Drink lots of fluids including water every day for adequate hydration.

 Avoid tea and coffee during meals since they will hinder the body's ability to absorb iron.

However, the mother may have one to two cups of coffee while breastfeeding. Some

infants are sensitive to caffeine, which makes them agitated or makes it hard for them to

sleep.

 Reduce consumption of sugar-sweetened beverages to reduce the risk of obesity.

 Continue micronutrient supplementation

- 200,000 IU of Vitamin A within six weeks after giving birth

- Daily iron supplementation for 6-12 weeks

- Use iodized salt in meal preparation

 Avoid alcoholic beverages

After the discussion, divide the attendees into four groups and give each group four paper

plates. Use pictures of different foods and ask mothers to fill the plates with a suitable one-

day menu (breakfast, AM snack, lunch, PM snack, and supper) for breastfeeding mothers.

Ask a group representative to present their work. During the presentations, request other

individuals to serve as judges, and if it is possible, provide prizes to the winners. Provide

sample menus that can be used by mothers in preparing their meals. See Annex B for a

sample menu.

Asking the participants, the following questions will help process the activity:

- What new things have you learned from the activity?

- How will you apply the learning you gained?

 34

SESSION 6
CARING FOR NEWBORN: INTRODUCTION TO BREASTFEEDING
AND IMPORTANCE OF GROWTH MONITORING

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Identify the advantages of breastfeeding;

2. Know the correct attachment and different breastfeeding positions;

3. Demonstrate how to position the baby to the breast, and

4. Identify the common breastfeeding problems, its causes, and ways to address

them.

METHODS:

Lecture-discussion, return-demonstration

MATERIALS:

Laptop, projector, manila paper, marking pen

TIME: 2 hours

ACTIVITY 1: Benefits of Breastfeeding

Prepare a manila paper with two columns. Write “Reasons for Breastfeeding” and

“Reasons for Not Breastfeeding” in the first and second columns respectively. Ask the

participants the following questions:

1. Did you breastfeed or have plans of breastfeeding your baby? If yes, why?

2. If not, what are the reasons for not breastfeeding?

Have a short discussion on the advantages and benefits of breastfeeding. Use the key

points for discussion.

 35

KEY MESSAGES FOR DISCUSSION

I. Advantages and Benefits of Breastfeeding

 Exclusively breastfeed the infant up to six months of age.

For babies under 6 months old, a diet consisting only of breast milk is recommended. The

term "exclusive breastfeeding" refers to a baby receiving only breast milk for the first six

months of life. If needed, the baby can take the vitamins and medications that are

recommended by the medical personnel.

 Breastfeed on demand or as often as the baby wants

To be well nourished, the infant must be fed on demand at least eight (8) times over the

course of 24 hours, day and night. A mother should get familiar with how a baby expresses

hunger. The infant may clench his or her fists, cry loudly, or extend their mouth widely

toward the breast. When a baby is hungry, a mother should not wait for the infant to cry

before tending to his or her needs.

• Protein, fat, vitamins A and C, iron, lactose, and other essential elements for

growth and development are all present in breast milk. Additionally, it provides crucial fatty

acids for the growth of the baby's blood vessels, eyes, and brain. Formula milk does not

contain these fatty acids.

 Nutrients are more easily absorbed from breast milk than from formula milk.

 Breast milk provides all the liquid an infant need even in a hot, dry climate.

 Breast milk offers defense from illness. The infant has a lower risk of contracting

illnesses including ear infections, meningitis, pneumonia, and diarrhea. Later in life, it

helps in the prevention of non-communicable illnesses.

 Breastfeeding is practical and affordable. The infant has easy access to breast milk.
 36

 Breastfeeding has advantages for both the mother and the child. In addition to

reducing bleeding and preventing anemia, it aids in the return of the uterus to its pre-

pregnancy size. Additionally, it lowers the mother's later-life chance of developing

breast and ovarian cancer.

 Breastfeeding fosters the growth of a mother's and her child's love bond. The baby

can now stare directly into the mother's eyes. Breastfeeding mothers develop their

ability to pay attention to their babies and recognize when they are hungry or in

discomfort. Even a very young newborn can learn to communicate thanks to this.

 Babies who are nursed have access to food in times of need.

II. The Risks of Not Breastfeeding

• The infant will not have the preventive components and nutrients that come only from

breast milk, increasing the risk of sickness and impeding growth and development.

• The use of breast milk substitutes is dangerous because Enterobacter sakazakii and

Salmonella enterica, which have been linked to child deaths and serious sickness,

contaminated infant formula during manufacturing.

• The water used to mix or wash baby formula may be contaminated.

• To enhance the volume or quantity given to newborns, families may dilute the formula.

• Buying baby formula implies less food for other family members and extra costs for the

household.

ACTIVITY 2: Proper Attachment to the Breast and Breastfeeding Positions

Show Figure 6.1 and 6.2 compares the attachment of two babies to the breast. Ask the

participants to identify the differences in the way the baby is attached.

 37

Figure 6.1 Comparison of good and poor attachment to the breast (outside

appearance)

Figure 6.2 Comparison of good and

poor attachment to the breast (inside appearance)

KEY MESSAGES FOR DISCUSSION

 A baby has good attachment when all the milk tubules underneath the areola are inside

the baby’s mouth as seen in Figure 6.2.1. This ensures that the baby gets all the milk from

the mother. On the other hand, poor attachment as seen in Figure 6.2.2 blocks the flow of

milk as the baby’s lips are pressing the nipple.

 Four points to check if the baby’s attachment is correct.

o The baby’s mouth is wide open.

o The baby’s chin touches the breast.

o The baby’s lower lip turned outward.

o More areola is seen above than below the breast.

 If a baby is well attached to the breast, the baby has effective suckling. The signs are:

o The baby takes slow deep suckles, sometimes pausing.

o The mother may be able to see or hear the baby swallowing after one or two

suckles.

o Suckling is comfortable and pain-free for the mother.

o The baby releases the breast and looks contented and relaxed after feeding.
 38

o The breast is softer after the feed.

Show the pictures of different breastfeeding positions and demonstrate each position

using a doll. For every demonstration, highlight key messages.

Figure 6.3. Breastfeeding Positions

For good breastfeeding, both the mother and the infant should be in a calm and

comfortable position. During nursing, a woman needs support for her back, feet, and breasts.

 Types of breastfeeding positions:

 39

o Cradle position- The baby’s lower arm is tucked around the mother’s side and is

not between the baby’s chest and the mother. The baby’s head should be not too

far into the crook of the mother’s arm and the head should not be pulled to one

side to avoid difficulty for the baby to stay attached.

o Side lying position- The baby’s nose is on a level between the mother’s nipple

and the baby does not need to bend his neck to reach the breast. This position

helps the mother to rest and is suitable for mothers after cesarean section.

o Underarm position- This position is useful to help drain all areas of the breast and

gives the mother a good view of the attachment. This position is preferred

especially when feeding twins. In this position, the baby should not be bending

his neck or forcing his chin down to the chest.

o Cross-arm position- The mother has good control of the baby’s head and body in

this position and is useful when learning to breastfeed, or when feeding a small or

ill baby. The baby’s head should not be held too tightly to allow movement.

 Guidelines when breastfeeding in a sitting position:

o A mother should relax and have her feet up.

o To raise the infant level with the breast, use a cushion, pillow, or towel that has been

wrapped up.

 Guidelines when breastfeeding in a lying position:

o Place a rolled cushion between the mother's legs and beneath her head.

o Mother should have her back supported (lie next to a wall or with the assistance of her

husband)

ACTIVITY 3: Expressing Breast Milk and Cup Feeding

 40

Open the activity with a video on how to express breast milk. Highlight that expressing

breast milk is useful when:

o The mother goes out or goes out to work.

o A mother’s breasts feel uncomfortably full or engorged.

o A mother is sick.

o The baby is ill.

o The baby cannot suckle enough or cannot breastfeed effectively.

KEY MESSAGES FOR DISCUSSION

 Expressed breast milk can be stored in a closed/ covered container

- For about eight hours at room temperature.

- For about 24-48 hours in an ice box

- For 3-5 days inside the refrigerator, and

- For 3-6 months in a freezer

 Steps in expressing breast milk

1. Wash your hands well.

2. Hold the container close to your breast while sitting or standing in a comfortable

posture.

3. Place the thumb and the pointing finger, above and below the areola respectively. The

letter "C" should be formed by the placement of the fingers.

4. To the inside of the chest wall, press. To prevent clogging the milk ducts, don't apply

too much pressure. The ducts in a lactating breast can occasionally be felt. They resemble

peanuts or pods. A woman can push on her children if she can feel them.
 41

5. Before moving on to the opposite side, express one breast for at least 35 minutes until

the flow diminishes. During the expression phase, any hand may be utilized for either

breast.

 Points to remember during breast milk expression:

o The act of expressing milk should not hurt. If it hurts, the method is incorrect. No milk

may appear at first, but after pressing a few times, milk may start to drip out. If the

oxytocin reflex is engaged, it pours in streams.

o Refrain from rubbing your fingers along the skin. The skin should move in rolling

motions.

o Refrain from pressing the nipple directly. The milk cannot be expressed by pulling or

pressing on the nipple. It is similar to a newborn sucking just on its breast.

o It takes 20 to 30 minutes to express breast milk properly, especially in the first few days

when there may be limited milk production. A mother should strive to express milk for a

longer amount of time during this time.

 The ideal way to give the infant the expressed breast milk is through cup feeding. It is

used to prevent "nipple confusion" or interference with the infant's regular nursing and

latch-on practices.

 The advantages of cup feeding

o Cups are easy to clean with soap and water if boiling feeding equipment is not

possible.

o Cups are less likely to be carried around for a long time compared to bottles,

reducing the chances for bacteria to breed on them.

o Cup feeding is associated with less risk of diarrhea, ear infections, and tooth decay.
 42

o The use of a cup does not interfere with the baby’s suckling at the breast.

o The use of a cup enables a baby to control his own intake.

A video presentation on how the cup-feeding method is done will be shown to the

participants. This is to provide information to the participants on how the cup-feeding process is

being done. The participants will also be provided with a guide on what to do if breastfeeding

problems are encountered. See Annex D for the list of common breastfeeding problems and ways

to manage them.
 43

SESSION 7
INTRODUCTION OF COMPLEMENTARY FEEDING WITH RETURN
COOKING DEMONSTRATION

The infancy stage is from birth until less than 12 months old, a period characterized by a

growth and development spurt. Infants and young children are susceptible to malnutrition and

infectious illnesses which can be effectively treated or avoided. The infant's immune system is

still developing, thus exposure to common childhood illnesses like polio, measles, TB, and

others may cause physical impairments and even death. This module contains learnings on

preparing complementary feeding as well as other nutritional interventions and services.

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Discuss the significance of complementary feeding and its characteristics;

2. Learn how to enrich complementary food; and

3. Demonstrate the proper way to make complementary foods suitable to

the baby's age.

METHODS:

Lecture-discussion, return cooking demonstration

MATERIALS:

Laptop, projector, manila paper, marking pen, feeding recommendation charts,

Cooking utensils (spoons, forks, glass, pots, basting spoon, turner, stove, carajay,

bowls), food items (banana, papaya, carrot, squash, mungbean, dilis, fish,

eggplant) and cleaning utensils

 44

TIME: 2- 2 1/2 hours

ACTIVITY 1: Complementary Feeding and its Importance

Introduce the session with a discussion on complementary feeding.

KEY MESSAGES FOR DISCUSSION

 Complementary feeding involves giving them foods in semi-solid or solid form, as well

as various liquids in addition to breastmilk beginning in the sixth month of a baby's life,

complementary.

 After six months of age, the baby's nutritional requirements cannot be satisfied by

breastmilk alone. Without supplementary food to supplement breast milk, kids are more

likely to lose weight and have their growth slow down at this crucial time. Children

require more food as they become older, both in terms of quantity and variety.

 Breastfeeding continues to be beneficial for children older than six months. Breast milk

meets 50% of a child's nutritional requirements from 6 to 12 months of age and continues

to meet 1/3 of a child's requirements from 12 to 2 years of age.   

 Breastfeeding continues to protect the child from several diseases. Therefore, a mother

should keep breastfeeding her infant whenever they want it.

 Complementary feeding has four (4) characteristics: timely, adequate, properly fed,

and safe.

 Timely

- Provision of foods in addition to breast milk should start 6 months onwards. This

period is when the need for energy and nutrients exceeds what can be provided

through exclusive and frequent breastfeeding.

 45

- Adding food too soon may

o Take the place of breast milk

o Result in a low nutrient-diet

o Increase the risk of illness due to less protective factors

o Increase the risk of having diarrhea as food prepared may not be as clean

compared to breastmilk

o Cause difficulty in digestion of foods

o Cause wheezing and allergic conditions

o Increase mother’s risk of getting pregnant again

Adequate

- To meet the nutritional demands of the developing infant while maintaining

breastfeeding, complementary foods should be given in the right amount,

frequency, and consistency.

Properly-fed

- Complementary foods are provided in response to a child's hunger cues. The

frequency of meals and the feeding methods are appropriate for the child's

age.

Safe

- Foods must be prepared and given safely. Measures are taken to reduce

contamination The danger of contamination is reduced with the use of

 46

precautions. Foods are prepared and fed to the child with clean hands, clean

utensils, and with no bottles or teats.

Infants should be given food items from four (4) or more of the seven (7)

food groups daily as per the recommendation of the World Health Organization.

Remember to start breastfeeding first before giving complementary foods.

Adapted from the Philippines Infant and Young Child Feeding Counseling Cards.

1. Staple/ starchy foods - The body, especially the brain, which relies heavily on glucose for its
functions, needs the energy that grains and other starchy foods supply. Examples of
staple/starchy foods include rice, corn, potatoes, sweet potatoes, cassava, and other root crops.
 47

2. Protein-rich foods. Animal sources are essential for a child's body's growth and development.

Foods high in protein are also excellent sources of iron, which is necessary for anemia

prevention as well as brain growth and development.

3. Eggs. These foods are rich sources of protein. The egg yolk provides a natural supply of

fat, other vitamins, and minerals including zinc, choline, folate, and B vitamins, which are

crucial for the brain development of growing children.

4. Legumes and nuts. These are plant-based sources of protein for growth and development.

Examples are patani, mani, sitaw

5. Vitamin A-rich vegetables and fruits. These are sources of vitamins and minerals important

in a child’s metabolism. Yellow and orange fruits and green leafy vegetables are rich in

Vitamin A and C. Examples are papaya, orange, carrot, squash, malunggay and saluyot.

6. Other vegetables and fruits are important sources of vitamins and minerals. Examples of

these are banana, avocado, tomatoes, eggplant

ACTIVITY 2: Feeding Recommendations According to Age

Distribute recommendation charts to the participants and give five minutes to read it.

 Age Texture Frequency Amount at Each Meal

6 -8 Start with thick 2-3 meals per day, plus Start with 2-3 tablespoonfuls
months porridge, well- frequent breastfeeds per feed, increasing gradually
mashed foods Depending on the child’s to ½ of a 250 ml cup
appetite, 1-2 snacks may
be offered
9-11 Finely chopped or 3-4 meals per day plus ½ of 250 ml bowl
months mashed foods and frequent breastfeeds
 48

foods that baby can Depending on the child’s

pick up appetite, 1-2 snacks may
be offered
12-24 Family foods 3-4 meals per day plus 3/4 to full of 250 ml cup/ bowl
months chopped or mashed if frequent breastfeeds
necessary Depending on the child’s
appetite, 1-2 snacks may
be offered
Note: If baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra meals per
day.
Adapted from WHO (20150. Complementary feeding.

After all the participants have reviewed the feeding recommendation chart, conduct a

drill to test their understanding of the topic. The table below may be used as a guide for a sample

drill.

Age of Child Frequency Amount at Each Meal

6 months 2-3 meals (may offer 1-2 snacks) 2-3 tablespoons

22 months 3-4 meals (may offer 1-2 snacks) ¾ to 1 cup

8 months 2-3 meals (may offer 1-2 snacks) Up to ½ cup

12 months 3-4 meals (may offer 1-2 snacks) ¾ to 1 cup

15 months 3-4 meals (may offer 1-2 snacks) ¾ to 1 cup

9 months 3-4 meals (may offer 1-2 snacks) ¾ cup

13 months 3-4 meals (may offer 1-2 snacks) ¾ to 1 cup

11 months 3-4 meals (may offer 1-2 snacks) ½ cup

21 months 3-4 meals (may offer 1-2 snacks) ¾ to 1 cup

4 months A trick question! Only breastfeeding

ACTIVITY 2: Preparing Complementary Foods

 49

Start the cooking demonstration by presenting the picture of an 8-month-old boy showing

the capacity of his stomach to help mothers visualize the capacity of their child.

Adapted from Idol ko si Nanay Learning Sessions

Explain the importance of proper hygiene and handwashing before food preparation to
prevent illnesses, particularly diarrhea. The following are practices to ensure the safe handling of
complementary foods.
 Wash the hands with soap before food preparation and serving.
 Use clean cups and bowls when feeding the children.
 Use clean utensils to prepare and serve food.
 Serve foods immediately after preparation or store them safely for later use.

Continue with the return cooking demonstration. Describe the mechanics of the activity.
Make three groups out of the participants. Each group should prepare complementary food for a
child who is six months old, ten months old, and fourteen months old. Tell the participants to
recall what was discussed on the recommendation chart. Distribute the food items to the group.
Below are the recipes to be distributed to each group. After preparation, each group will be asked
to prepare the cooked food. An invited guest will choose the group who prepared the best
complementary foods per each age group.
 50

Para sa mga Batang Edad 6-9 Buwan:

MALAPOT NA LUGAW

Makagagawa ng
6 nahain
Tagal ng Paghahanda
5 minuto
Tagal ng Pagluluto
30 minuto

Sangkap:
Gamit na kailangan
Panukat na tasa at kutsara, maliit na kaldero, sandok

Paraan ng pagluluto

 Sa isang kaldero, dahan-dahang hugasan ang bigas upang

maiwasan ang pagkawala ng sustansya.

 Dagdagan ng tubig at takpan ang kaldero. Sa simula ng pagluluto, siguraduhing malakas ang
apoy upang mapakuluan ang bigas at tubig sa loob ng 5 minuto.

 Haluin. Ipagpatuloy ang paluluto hanggang 10 minuto o kung ang bigas ay maluto ngunit
may tubig pa. Panatilihing may takip ngunit huwag ilapat ng husto o kaya’y lagyan ng
kaunting puwang upang maiwasan ang pag-awas ng niluluto.

 Ipagpatuloy ang pagluluto habang patuloy ang paghahalo hanggang ito ay lumapot, sa loob
ng 10 minuto.

Para sa mga Batang Edad 10-12 Buwan:

NILAGANG GULAY NA MAY ISDA

Makagagawa ng 6 na hain

Sukat ng isanghain ½ tasa, 1 tasa ng kanin

Tagal ng paghahanda: 15 minuto

Tagal ng pagluluto 20 minuto

 51

Sangkap:

3 tasa Tubig
2 piraso, katamtamang laki Gabi, hiniwa pahaba
1 tasa Sitaw, hiniwa 1 ½ pulgada ang haba
1 piraso, katamtamang laki Kamatis, hiniwa sa apat
1 tasa Kalabasa, maliit na kwadradong hati
2 piraso, katamtamang laki Talong, hinati sa dalawa at hiniwa sa tatlo
1 tasa Alugbati, dahon
¼ tasa Panlutong mantika
1 piraso, katamtamang laki Isda (tilapia), hiniwa sa tatlong piraso
2 kutsarita Asin iodized salt

Gamit:
Panukat na tasa at kutsara, kutsilyo, sangkalan, kaldero, katamtamang laki ng kawali, sandok

Paraan ng Pagluluto:
 Iprito ang isda hanggang mag golden brown at isantabi.
 Magpakulo ng tatlong tasa ng tubig sa kaldero. Ilagay ang gabi, sitaw at kamatis.
 Pakuluan na 5 minuto.
Ilagay ang kalabasa at talong. Lutuin ng 5 minuto.
Ilagay ang dahoon ng alugbati at pritong isda. Timplahan ng asin, lutuin pa ng 3 minuto. Ihain.

Para sa Edad 12-24 Buwan

GINATAANG MUNGO NA MAY DILIS AT MALUNGGAY

Makagagawa ng
5 nahain
Sukat ng isanghain
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½ tasa, 1 tasa ng kanin

Tagal ng paghahanda
10 minuto
Tagal ng pagluluto
30 minuto
Gamit:
Panukat na tasa at kustara, Kutsilyo, Sangkalan, Kaldero, katamtamang laki, Kawali, Sandok

Sangkap:

2 tasa Monggo, ibinabad magdamag

2 tasa Tubig
1/3 tasa Kakang gata
½ tasa Pinatuyong dilis (ginayat)
1 tasa Malunggay, hiniwa
2 kutsarita Mantika
3 piraso Bawang, hiniwa
1 piraso, maliit Sibuyas, hiniwa
½ kutsarita Asin, iodized

Gamit:
Panukat na tasa at kutsara, kutsilyo, sangkalan, kaldero, katamtamang laki ng kawali, sandok

Paraan ng Pagluluto:
 Tanggalin ang tubig na pinagbabaran ng monggo. Isantabi.
 Sa isang kaldero, ilaga and monggo sa dalawang tasa ng tubig sa loob ng isang minute
hanggang lumambot ang monggo.
 Dagdagan ng kakang gata at ng pangalawang gata. Pakuluan sa loob ng 10 minuto. Haluin
paminsan-minsan.
 Idagdag and ginayat na dilis at hiniwang dahoon ng malunggay. Pakuluan ng tatlong
minute. Haluin paminsan-minsan. Habang naghihintay, maglagay ng mantika sa kawali.
Igisa muna ang sibuyas saka bawang. Igisa sa loob ng 1 minuto o hanggang maging brown
ang bawang. Isantabi.
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 Idagdag ang malunggay at lutuin pa sa loob ng 3 minuto. Ilagay ang ginisang sibuyas at
bawang at lagyan ng asin. Pakuluan pa ng 1 minuto. Ihain.

SESSION 8
PSYCHOSOCIAL STIMULATION

Playing is important to young children ’s learning and development. Playtime gives a

chance for a child to connect with parents or caregivers and other children creating closer

emotional bonding and social interaction.

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Identify the significance of giving the child care and psychosocial stimulation;

2. Determine the psychological stimulation and care that a child needs appropriate

to his stage of development;

3. Recognize the significance of age- and developmentally-appropriate, secure

toys for a young child's growth and development, and

4. Describe the qualities of safe and acceptable toys for babies and young children.

METHODS:

Group discussion, lecture-discussion, and exercise demonstration

MATERIALS:

Laptop, projector, manila paper, marking pen

TIME: 2 hours

ACTIVITY 1: Appropriate Psychosocial Care and Toys for the Child

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Procedure

Ask each group of participants to write down the qualities of a good toy on a piece of

manila paper. Show them samples of toys to aid in their discernment, then let them determine if

the toys are suitable, safe, and nice. Introduce the topic using the presentation on psychosocial

stimulation.

KEY MESSAGES FOR DISCUSSION

 Early childhood stimulation includes the stimulation of the senses (seeing, hearing, and

touch) as well as the emotional stimulation that results from a warm mother-child or

caregiver-child relationship.

 This bond, which develops from the time of birth, offers warmth and affection in addition

to sensitivity and response to the child's needs. It creates an atmosphere that is conducive

to learning and the development of the child's physical, cognitive, emotional, social, and

other critical life skills.

 Interactions including play and communication between the mother or caregiver and the

child offer possibilities for psychosocial stimulation. Feeding, getting dressed, and other

everyday chores may all be opportunities for play and interaction. Children can think, test

ideas, and solve issues while playing.

 Being attentive to infants, playing with them, and observing how they react to the

attention will also help mothers and other caregivers feel more engaged and self-assured

in their job as a parent.

 Examples of play and communication activities

- Playing a peek-a-boo helps a mother and child pay close attention to each other.
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- During breastfeeding, a mother can encourage her baby to learn by looking at

him/her movements and sounds with gentle touches and talking up to him/her.

- A mother/ caregiver plays with a child on how to stack bowls of different sizes,

and stimulates several child skills like motor, cognitive, communication and

emotional.

 Play changes as the child grows. The stages of play should progress as the child grows

older. The following could also be used in observing signs of psychosocial development.

- Newborns and infants- relatively still and engaged in random movements

- 0-2 years old play alone and may not notice and not interact with other children;

they are able to explore freely, master new motor or cognitive skills, and prepare

themselves to play with others

- 2 to 2 ½ years old watch and observe other children playing around him/ her but

do not join; as they watch, they learn about the rules of play

- 2 ½ to 3 years old play with each other but are not really interacting together; at

this stage, they may be learning skills to engage together

- 3 to 4 years old develop friendship and prefer playing with some children

- 4 years and older shows cooperation and take turns in playing

 The toys that are given to kids encourage play and serve as a stimulant for their brain

development.

 Safe and appropriate native toys support a child's psychological and psychomotor growth.

Pick toys that help the child grow and exercise their motor, cognitive, social, and self-

awareness abilities.
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 Toys may be dangerous and cause accidents if they are used improperly or are

inappropriate for a child's age.

 The World Health Organization advises that children aged 2 to 4 should spend no more

than one hour a day on screens, and infants under the age of two should not use them at

all.

 The are several reasons why too much screen time is not good for young children. These

reasons include

- Infants and toddlers learn most from human interaction.

- Screen affects attention spans. For children to be successful, they need to learn

how to concentrate and focus. That ability starts to develop during their earliest

years when their brains are more sensitive to the environments around them. For a

brain to develop and grow, it needs essential stimuli from the outside world. More

importantly, they need time to process those stimuli.

- Screens curtail the ability to control impulses. Young children need their dose of

boredom. It teaches them how to cope with frustration and control their impulses.

If young children are constantly being stimulated by screens, they forget how to

rely on themselves or others for entertainment. This leads to frustration and

hinders imagination and motivation. 

- Screens reduce empathy. Research has shown that screen time inhibits young

children’s ability to read faces and learn social skills, two key factors needed to

develop empathy. Face-to-face interactions are the only way young children learn

to understand non-verbal cues and interpret them. 

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- Prolonged screen use in childhood has been linked to negative developmental

health outcomes including obesity, behavior problems, emotion regulation

problems, speech delays, lower executive functioning, impacts sleep duration and

quality, and academic problems.

 Characteristics of a good toy are as follows:

- Safe

 Clean,

 Non-toxic, non-flammable

 Large enough not to be swallowed

 No small parts that can break or chewed off

 No sharp points or cutting edges or splinters

 No dangling strings or connective elastics

 Does not eject or shoot objects that can injure eyes

 Does not make a loud noise that can damage hearing

 Not electrically or battery-operated unless used with supervision of

parents or caregivers

- Educational

- Stimulating

 4 to 6 months: toys they can hold, reach or suck on, shake, make noise

with, look at and listen to. Examples are rattles, teething toys, squeeze toys

 7 to 12 months: toys to drop and take out, build with, use their muscle.

Examples are large balls, large and soft blocks, push and pull toys, soft

toys to crawl over

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 1-year-old: toys to create with, pretend with, build with, and use their

muscles. Examples are stuffed toys, dolls, puppets, board books with

simple illustrations or photos, recording with rhymes and songs, wood

blocks

 2-year-old: toys for solving problems (wood or carton puzzles, objects to

sort by size or color) for pretending and building (transport toys, play

food, dolls with dress-up clothes) for using muscles (balls, hammering

toys), picture books

- Attractive and beautiful in color and form

- Durable

- Affordable

Process the activity by asking the participants the following questions:

1. What did you feel doing the exercise?

2.What did you learn from this activity?

3. What learnings will you apply to your child?

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SESSION 9
CLOSING CEREMONY/ CULMINATING ACTIVITY

This part of the module will celebrate and recognize the “Malnutrisyon ay Iwasan, First

1000 Days ay Tutukan” participants for their completion and active participation during its

implementation. The culminating activity will be medium for the mothers to share their

experiences and the lessons that they learned.

OBJECTIVES:

At the end of the session, the participants will be able to:

1. Discuss how their expectations were met

2. Review the vision they developed on the first day of class;

3. Recall what they learned from the sessions; and

4. Discuss and share the actions that they will do after the sessions.

METHODS:

Group discussion, post-test, recognition rites

MATERIALS:

Laptop, projector, marking pens, paper, post-test questionnaire, evaluation form

TIME: 2 hours

ACTIVITY 1: Post-Test and Review of their Vision Exercise

Before the activity, prepare the following:

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A post-test questionnaire using the pre-test administered at the start of the program, the result of

the pre-test, visioning exercise output, participant evaluation form

Distribute to the participants a blank sheet of paper and pencils or copies of the post-test

questions. Give them 20 minutes to answer the post-test. After all the participants have finished

the test, lead the review and checking of answers. Request the participants to be honest in

checking their papers. The passing score is 8 out of 15.

Ask the participants to pass their checked paper and seek assistance to compare scores

with the pre-test and to record for documentation.

Conduct a group discussion using the drawing from the visioning exercise. Engage all

participants to share their experiences. Use the following questions to aid in the discussion.

b. How do you feel about attending the sessions?

c. What sessions did you enjoy most?

d. What are the new learnings that were most significant to you?

d. What are the lessons you will be using in your daily living?

e. What will you tell your neighbor/ relatives about the sessions?

Ask the participants to accomplish the evaluation form to gather insights on how to

improve succeeding sessions

ACTIVITY 2: Closing Program: Culminating Activity

PROGRAM
I. Invocation
II. National Anthem
III. Welcome Remarks
IV. Message from a Guest
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V. Distribution of Certificate of Attendance

VI. Message from A Mother Participant
VII. Closing Message
VIII. Photo Session
IX. Snacks

Prepare the certificates and tokens. Invite guests and other stakeholders to grace the

event. Prepare the venue, necessary equipment, and snacks. Conduct the closing program.
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ANNEX A. THE PINGGANG PINOY FOR PREGNANT WOMEN FROM DOST-FNRI

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ANNEX B. SAMPLE MENU FOR PREGNANT WOMEN

SAMPLE MENU FOR FIRST TRIMESTER

Breakfast tablespoons
Lunch Clear soup with Veggies
1 piece Paksiw na Isda
1 cup Monggo Guisado with
Malunggay
1 cup Rice
1 piece Banana
Dinner Sinigang Broth
1 slice Breaded Chicken Fillet
1 cup Kalabasa-Sitao Guisado
1 cup Rice
Snacks AM: 1 cup Taho
PM: ½ pc Boiled Camote
1 glass Fruit Juice
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SAMPLE MENU FOR SECOND AND THIRD TRIMESTER

TRIMESTERS tablespoons
Lunch Clam Soup with Green Onion
1 ¼ piece Paksiw na Isda
1 ¼ cup Monggo Guisado with
Malunggay
1 cup Rice
1 piece Banana
Dinner Sinigang Broth
1 1/4 slice Breaded Chicken Fillet
1 1/3 cup Kalabasa-Sitao Guisado
1 cup Rice
Snacks AM: 1 cup Taho
PM: ½ pc Boiled Camote
1 glass Fruit Juice
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ANNEX C. THE DIFFERENT BREASTFEEDING POSITION


ANNEX D. COMMON BREASTFEEDING PROBLEMS
Breastfeeding Characteristics
Problem
Mother’s Perception or One of the most common
Notion of “Not Having reasons why mothers stop
Enough Milk” breastfeeding. Some
situations result in the
misconception that breast
milk is not enough
 The baby crying a lot, and
seeming not to be satisfied
with feeds;
 The baby wanting to feed
very often or for a long
time at each feed;
 The breasts feeling soft;
Not being able to express
her milk.
Nipple fissure/ sore  The most common
nipples cause of sore nipples
and a nipple fissure is
poor attachment to the
breast. 
 If a baby is poorly
attached, he/she pulls
the nipple in and out as
he/she sucks, and rubs
the skin of the breast
against his/her mouth
which result in painful
nipples.
66
Management
Counsel mothers and her support
team and assure them of the
following:
1. Newborns cry for different
reasons (wet diapers,
feeling of too cold or toot,
wanting to be hold, noise
around them)
2. The more frequently the
mother feeds, the more
breastmilk is produced.
3. Feeding times of babies
from one baby to another.
 Check if the baby has good
attachment to breasts. If
not, correct the attachment
of baby.
 Do not wash breasts more
than once a day and do not
use soap or rub the breasts
hard with a towel.
Washing removes natural
oils from the skin and
makes soreness more
likely. Avoid use of
medicated lotions and
ointments because these
can irritate the skin.
 Rub a little expressed
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breast milk over the nipple

and areola with a finger to
promote healing. Have it
air-dried.

Breastfeeding Characteristics Management

Problem
Engorged Breast The breasts become engorged  Let the baby feed as soon
if: as possible after delivery,
making sure that the baby
 There is a delay in is well-positioned at the
starting breastfeeding breast.
after birth.
 Do not 'rest' the breast. It
 There is poor is essential to express milk
attachment to the breast, through hand expression or
so breast milk is not the use of a breast pump if
removed effectively the mother is not able to
breastfeed. If milk is not
 There is infrequent expressed regularly,
removal of milk due to mastitis may develop
not breastfeeding on
demand, or restricted  ·After a feed, put a cold
length of breastfeeding compress on the breasts.
.

Flat or inverted nipples  The nipple is retracted  Use an inverted syringe

or pulled inside the without a needle attached
breast to suck nipples out before
breastfeeding.

 Breastfeed frequently

Mastitis  Mastitis is an infection  Consult a doctor for

of the breast. possible medications.

 Part of the breast is  Breastfeed frequently.

swollen and hard, with This helps the blocked
redness of the area to clear up. Gently
overlying skin. massage the breast while
the baby is suckling.

 Apply a warm compress to

the breast in between
feeds.
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ANNEX E. RETURN COOKING DEMONSTRATION ON COMPLEMENTARY

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