Chapter 12.3 Nutrition counselling

For HIV counselling, see Section 8.3.3.

Identifying feeding problems

First, identify any feeding problems that have not been fully resolved. Ask the following questions:

  • Do you breastfeed your child?

How many times during the day?
Do you also breastfeed during the night?

  • Does the child take any other food or fluids?

What food or fluids?
How many times a day?
What do you use to feed the child?
How large are the servings?
Does the child receive his or her own serving?
Who feeds the child and how?

Compare the child’s actual feeding with the recommended guidelines for feeding a child of that age (see section 10.1.2). Identify any differences, and list these as feeding problems.

In addition, consider:

  • Difficulty in breastfeeding
  • Lack of active feeding
  • Not feeding well during the illness

Advise the mother how to overcome the problems and how to feed the child.

Refer to local feeding recommendations for children of different ages. These recommendations should include details of locally appropriate energy-rich and nutrient-rich complementary foods.

Even when specific feeding problems are not found, praise the mother for what she does well. Give her advice that promotes:

  • breastfeeding
  • improved complementary feeding practices with locally available energy and nutrient rich foods
  • giving nutritious snacks to children aged ≥ 2 years.

Examples of nutritionally adequate diets (see Chart 15, in the WHO manual Management of the child with a serious infection or severe malnutrition could be printed on the reverse of a locally adapted mother’s card.