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Responsive Feeding Messages and Activities in Care Groups

October 24, 2018

Karen Neiswender Calani, MPH

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Petrona’s Story

Visit to Chio – one of the pilot communities for R&R – I had a chance to visit with a group of leader mothers. About a year after the project ended; 1.5 years ago

Found them still very active, still using the flip chart as one of their main resources,

Petrona shared how she taught all these ideas from R&R for young children, but hadn’t yet practiced it since her children were a little bit older. THEN, she had a little boy and she said she began to follow what she had been teaching others. She proudly told us that her son had never faltered at any of his growth checks, he was healthy and eating well. WE could all see he was a social guy too – climbing all over everyone’s laps, bright eyes, curious, obviously doing well.

After their presentation, I had informal chat with her while I nursed my 1.5 y/o daughter who was with me, and we had “mommy talk” – what’s your child’s favorite food? Etc. Comparing likes and dislikes between our kids (they were pretty similar).

Tell story because:

Empowering nature of CGs – build “mom confidence” in one’s ability to BE Mom.

CG is a great place to compare notes on your kids with other moms – we do this a lot! On developmental stages; dislikes/likes, solving problems (potty training). That also helps build ”mom confidence” – moms having new ideas and moms helping each other.
Honors moms as the ”expert” on their child. They know their baby best. They are the first teacher, influencer, etc.
Place to promote holistic care of our children

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Purpose

Teach recognition of infant behavior and feeding cues to Q’ueqhi’ mothers in rural Guatemala.
Objectives:

Assess the appropriateness of the intervention,
Improve recognition of cues and responsive breastfeeding practices, and
Increase responsive

complementary feeding practices

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Content & Materials Development

Key Educational Messages Development

Developed by CGBI using formative research to help guide content
Evidence-based with stakeholder input
Care Group Module Facilitator’s Guide with 6 Lessons plus Educator Flipchart for each Lesson

Materials Design and Production

Translation to Spanish
Local artist hired for accurate cultural depictions in imagery

After baseline and formative research,

Key Educational Messages Development: Once all data was collected and analyzed, CGBI developed key educational messages, keeping the target group in mind. The educational module created included messages based on Essential Nutrition Actions, as well as content around responsive feeding, cue recognition and response. Initial messages were reviewed and adjustments made as necessary.

Design & Production of Educational Materials: Materials were then sent to translation into Spanish and an artist was hired to produce artwork for the flip charts. Each message was reviewed with the artist to ensure correct depiction, appearances of people in the target group (clothing, community, etc.). Local FH staff provided initial feedback on improvements to the artwork and changes were made accordingly. Once the module was translated, local FHG staff reviewed it for accuracy of messages to the target group (i.e. Correct foods, use of commonly known songs or sayings, etc.).

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Signs/Cues

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Signs/Cues

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CG Activities

Newborn tummy size
Baby sings with me!
Hunger & fullness signs
Affectionate talk
Responsive feeding role play

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Results

Indicator	Baseline	Final
% of mothers of children 0-5 mos. who recognize/know at least 2 common fullness signs in their infants.	48.8%	79.1%
% of mothers of children 0-5 mos. who recognize at least 2 signs of hunger in their infant.	72.1%	76.7%
% of mothers of children 0-5 mos. who recognize/know at least 2 common disengagement behavior signs in their infants.	27.9%	48.8%

Baseline and final evaluations were compared and several changes were observed in key project indicators (see Table 2). Though cue recognition overall did not change much from baseline (27.3% to 30.8%), mothers using two or more responsive breastfeeding or complementary feeding practices increased from baseline (48.8% to 79.1% and 81.0% and 93.0% respectively), indicating that responsive behaviors (i.e., speaking with love to the child, sitting with the child, etc.) may have been better understood or seen as easy to implement by mothers. When cue recognition indicators were examined individually, it was noted that changes in hunger cues were minimal, compared to larger changes in fullness cues (48.8% to 79.1%), engagement cues (67.4% to 76.7%) and disengagement cues (27.9% to 48.8%), possibly because early signs of hunger in infants can be subtle and difficult for a facilitator to demonstrate (see Table 3).

Main result here are the four cues: f/h; d/e. Largest changes in F/D/E. Hunger cues didn’t change all that much, and if we disaggregated signs, would likely find that crying is the most common sign…so the more subtle cues for hunger that babies have are not perceived as frequently. They are also more difficult for a fac. To demonstrate and may have been difficult to teach.

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Results

Indicator	Baseline	Final
% of mothers of children 0-5 mos. who recognize/know at least 2 common engagement signs in their infants.	67.4%	76.7%
% of mothers of children 0-5 months who used at least 2 responsive breastfeeding behaviors, last 24 hours	48.8%	79.1%
% of mothers of children 6-23 months who used at least 2 responsive complementary feeding behaviors, last 24 hours.	81.0%	93.0%

Baseline and final evaluations were compared and several changes were observed in key project indicators (see Table 2). Though cue recognition overall did not change much from baseline (27.3% to 30.8%), mothers using two or more responsive breastfeeding or complementary feeding practices increased from baseline (48.8% to 79.1% and 81.0% and 93.0% respectively), indicating that responsive behaviors (i.e., speaking with love to the child, sitting with the child, etc.) may have been better understood or seen as easy to implement by mothers. When cue recognition indicators were examined individually, it was noted that changes in hunger cues were minimal, compared to larger changes in fullness cues (48.8% to 79.1%), engagement cues (67.4% to 76.7%) and disengagement cues (27.9% to 48.8%), possibly because early signs of hunger in infants can be subtle and difficult for a facilitator to demonstrate (see Table 3).

Main result here are the four cues: f/h; d/e. Largest changes in F/D/E. Hunger cues didn’t change all that much, and if we disaggregated signs, would likely find that crying is the most common sign…so the more subtle cues for hunger that babies have are not perceived as frequently. They are also more difficult for a fac. To demonstrate and may have been difficult to teach.

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Lessons Learned

Teaching cue recognition is possible, but the facilitator must be well trained to recognize and help others identify cues
Providing training and high quality visual materials is key to motivation and confidence building in CGVs

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Lessons Learned

Look for linkages between key

messages and things mothers already do that are

considered responsive feeding behaviors

The inclusion of fathers and grandmothers in sessions can

generate interest of key influencing groups in the topic of resonsive feeding

2) help mothers identify the positive ways in which they are currently providing for their children. This created openness on the part of community members to participate in educational sessions, allowing the facilitator to share the newer messages that had not yet been heard and congratulate mothers on what they already do. Honoring them as the expert, first teacher or influencer of their child.

3) Husbands began encouraging their wives to attend the sessions and, in many cases, attended the sessions in place of or along with their wives in order to learn how to become more involved in the care of their young children. Grandmothers supported the new ideas surrounding responsive complementary feeding and began encouraging mothers to take time to sit with their child as they ate meals and snacks instead of leaving them alone with their food.

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Mataerial Expansion

Reviewed FH CG modules that already existed

Pregnancy / Newborn Care
Exclusive Breastfeeding (under development)
Complementary Feeding (upcoming 2019)

Updated technical information
More Formative Research!
Created new ECD / Nurturing Care messages

Attachment
Normal infant behavior (crying, night waking, etc.)
Early learning messages (i.e. talking to your baby builds her brain)

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Pregnancy / NB Module

Messages about Engagement / Disengagement – built into a lesson on Normal Newborn Behavior

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Exclusive Breastfeeding

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Exclusive Breastfeeding

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Nurturing Care Framework

www.nurturing-care.org

Framework launched in May of this year – 5 components – Good health, adequate nutrition, responsive caregiving, security and safety, opp for early learning.

Main focus: adequate nutrition – FH Guatemala’s project

I don't really see it as "integration" because nutrition is already a component necessary for ECD to occur. I see it as building a more holistic project. FHG focuses more on the nutrition component, but there are elements of the other components (to varying degrees) present in CG material. They are all interrelated and create an environment more conducive to optimal development (thriving). Not siloed.

you could also turn it around a little and say that if you are doing an education project focused on early stimulation/early learning...you should also add components of health, safety, responsive parenting to make it holistic. Not that those are the main focus (education is), but that they are present as they all affect nurturing care and the outcomes we are looking for (optimal child health and wellbeing). We are looking for thriving children, not just children who make it to age 5.

CGs are a good place for this sort of holistic focus because of the potential to empower moms (and dads) to build on what they already know and do. Helps create a nurturing environment for their child that is holistic and not one-dimensional or siloed.

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(Nurturing) Care Groups

Build “Mom Confidence”
Honor Moms as experts, teachers

and influencer of their children

Promote a holistic approach to

caring for our kids.

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Thank You

Resource available on Care Groups Info
Email: kcalani@fh.org