Concepts in Training for Optimal
Infant and Young Child Feeding at
various levels in a community
Sailesh Gupta, Mumbai
Indian Academy of Pediatrics
Concepts in Trainings for IYCF
• Why Train ?
• Who needs to be Trained ?
• Need based levels of Training ?
• Who should Train ?
• The Training Curricula
• How to Evaluate Impact of Training ?
Why Train ?
• Because India’s NMR and IMR are static
Early Initiation of breastfeeding < 30%
Exclusive breastfeeding for 6 mo < 50%
Bottle feeding > 15%
• Therefore –
We need to sensitize and train, at various
levels, in various contexts, and for various
objectives
Barriers to Breastfeeding
• Lack of awareness
• Lack of knowledge of technique
• Lack of will to help a mother
• Socio-cultural factors
• Availability of breastmilk substitutes and bottle
Who needs to be Trained ?
• The Mother – awareness of benefits,
technique of breastfeeding, dealing with early
problems, expression, dealing with ‘inadequate
milk’, HIV +ve, timely complementary feeding
• The family – awareness, support to the mother
in various ways, remove beliefs and practices
that are barriers to breastfeeding, birth spacing
Who needs to be Trained ?
• Community health worker – awareness,
technique (to help the mother), counseling,
remove barriers to breastfeeding, HIV +ve
mother, arrange referral
• Community health provider (doctors in PHC,
district hospital, RMP, General physician) – all of
the above + knowledge of the science of
breastfeeding
Who needs to be Trained ?
• The Specialist (Pediatrician + Neonatologist +
Obstetrician) – awareness, science and technique
of breastfeeding and complementary feeding,
helping mothers through counseling, HIV +ve
mother, protection of breastfeeding through
awareness of IMS Act
• The Paramedical staff – All of the above +
knowledge of ten steps to successful
breastfeeding
Who needs to be Trained ?
• The mother support personnel – awareness,
science and technique of breastfeeding, helping
mothers through counseling and constant predelivery and post-natal support, referral
• The lactation counselor / consultant science and technique of breastfeeding, helping
mothers pre-delivery counseling and post-natal
support, HIV +ve mother, counseling the family
Who needs to be Trained ?
• The Super Trainer – trains counselors and
doctors; needs to update personal knowledge
and skills, needs to document experiences
• The Medical Undergraduate and
Postgraduate – needs to know the complete
works of IYCF
Need based Levels of Training
• The mother and family – sensitization and predelivery counseling sessions; one hour group-counseling
sessions and individual counseling; QnA format,
breastfeeding doll, breast model, pictures, movie
• CHW – 8 hours training; pictures, movie; curriculum –
anatomy and physiology of breastfeeding, early
breastfeeding problems (including breast and nipple
conditions), positioning and latching, expression of
breastmilk, counseling the mother with ‘inadequate milk’,
monitoring growth of baby, HIV +ve mother, need for
referral
Need based Levels of Training
• CHP – Sensitization (2 hours) / 8 – 12 hours
training – same as CHW + protection of
breastfeeding i.e. IMS Act (Govt. doctors)
• The Specialist –
 Unwilling to do the works - Sensitization course (4
– 6 hours; advantages of breastfeeding, technique
of breastfeeding, early problems, HIV +ve mother,
IMS Act)
 Willing to learn lactation management – 2 / 3 day
course (complete curriculum + counseling + role
play + IMS Act)
Need based Levels of Training
• Mother support personnel – take through
all levels of training in a sequential manner
depending on willingness to learn; stress on
helping mothers in all aspects of breastfeeding
and family counseling
• Lactation counselor – highest level of
training + certification + updates
Need based Levels of Training
• The Super Trainer – the highest level of
training + certification + course on ‘how to be a
good trainer’ + updates
Who Should Train ?
• Sensitization for mother and family (Predelivery and post-natal) – Mother support
personnel / obstetric nurse / Specialist (Obs / Ped /
Neo)
• CHW – CHP / Specialist
• CHP – Specialist
• Mother support personnel and paramedics –
Specialist / Trained and experienced Colleagues
Who Should Train ?
• Lactation counselor – International training
Institute – self learning, web learning,
workshops, written exam, practical exam,
certification
• Super trainer – all of the above + course in
being a good trainer + regular refresher courses
+ paper presentation at meetings + writing in
journals etc
Model IYCF Curriculum
• Breastfeeding vs. artificial
feeding
• Counseling for
breastfeeding
• The applied anatomy and
physiology of human
lactation
• Infant feeding and HIV
• The ‘mechanics’ of
breastfeeding
• Breast and nipple
conditions
• Low milk transfer;
Breastmilk in NICU;
Breastmilk expression
• The essence of IMS Act
and Maternity protection.
• Ten steps to successful
breastfeeding
• Complementary feeding
Down scaling and Up scaling
• Model curriculum can be down scaled /up scaled
for various levels of IYCF trainings
• Formats –
 Group lecture / discussion
 Panel discussion (QnA session with experts)
 Lectures and discussion
 Lecturers and discussion + role play + movie
 In-house training + hands-on training in maternity
facility
 Online training, self training, peer learning, onthe-job learning
Designing Curricula / Creating Trainers
• Indian Academy of Pediatrics, Infant and
Young Child feeding Chapter (IYCF training
module of 2008)
+
• Breastfeeding Promotion Network of India
(The ‘3 in 1’ Training Program)
=
• Various levels of Training Curricula + Trainers
Evaluating the Impact of Trainings
• Observing the change in attitudes and
practices
• Pre-test and Post-test
• Examination and Certification
• Change in breastfeeding rates
• Reduction of childhood mortality and
morbidity
Summary
• Training for Optimal IYCF practices essential at
various levels in the community
• Various need-based levels of trainings should
be designed; various formats should be used
• Training organizations should pool their
intellectual resources and manpower, to
increase training capacity and the numbers
trained
Thank You and Kind Regards