Download revised hearth curriculum

REVISED HEARTH CURRICULUM
1. BALANCED DIETS
Objectives:
1. Define a balanced diet by identifying different food groups
2. Learn the importance of 1. diet variety, 2. feeding frequency (importance of snacks) and 3. food
volumes for children of different ages
3. Learn how to make economical food choices in the market
4. Learn that marissa is a bad food, especially for women and children
Variety
 Children should have a good mixture of foods in their diet
 Why? - food groups (square/bowls) and what each group is good for
 Variety means the child will be interested to eat enough to be healthy and grow well
Frequency and Amount
 What is a meal? (example what we are using in Hearth – affordable and available)
 What is a snack? (example what we are using in Hearth – affordable and available)
 Young children need to eat little and often because they have small stomachs
 Babies less than year should breastfeed before eating and need to eat less often
 As children grow increase the frequency of eating and the amount at each meal
 Young children should eat 5 times a day – 3/4 meals and 1/2 snacks
 What foods are not good value for money? Very sugary foods like sweets. Good alternatives are:
(nutritious snacks) sugar cane, tamia, bread and tahania, bread and honey, zalabia, sweet potato
mashed with milk/oil, bread and milk or fresh fruit juice, groundnuts, dates, mangoes, lentils and
sugar, beans and oil, rice and milk/honey/sugar, boiled wheat with milk/honey/sugar, simsimia)
 Marissa is a bad food for women (especially breastfeeding women, but all women who have to
care for children) and should NEVER be given to children. It is like a poison for a child
Teaching modes and aids:
 Make a food triangle with example foods for 1. growing (proteins = all animal foods MILK is
important for children who are not drinking breastmilk, and lentils, beans and peas), 2. fighting
infection and staying healthy (all fruits and vegetables, although the best are red, orange, yellow
(mango, watermelon, tomato) or dark green leaves (kudra) because these contain lots of vitamin A)
and for 3. energy (for playing, working, learning) (cereals = millet, sorghum, wheat, bread, rice)
 Use the picture of the child to describe how having a small stomach means he must eat often
 Use the picture to show how to make neisha/medida protein rich: add oil AND
daqua/lentils/milk etc
 Discuss Hearth meals and snacks
2. ACTIVE FEEDING
Objectives:
1. Learn what Active Feeding is and why it is good
2. Learn how to make sure the child gets enough food
3. Discuss how to make sure the child eats well if the mother has no time
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Active feeding includes: mother should sit child on lap and feed a young child with her hands or a
spoon; mother should talk to the child and encourage him telling him what the foods are for, playing
games, etc
How to make sure the child gets enough food: younger and older children should have their own
bowls; mother should take time to feed the child (he has a small stomach); if the child won’t eat
mother must encourage/play games/talk/play/take time. Mother must not accept refusal unless she
is sure the child must be full!
Dealing with refusal – offer the child his/her favourite foods, try different tastes, textures, colours,
combinations, make meal times happy, not hurried…
How to make sure the child eats well if the mother has no time: other carers should be given these
same instructions; other carers should be adults or older children that are responsible and love the
child
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Teaching modes and aids:
 Practice during session
 Discussion of poster
3. GOOD CARING
Objectives:
1. Reinforce the importance and reasons for supervision of young children and discuss ways to do this
2. Learn the benefits of playing
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Child should be with mother all the time and breast feed on demand until 2 years old. If he is left
with another carer he might not get enough good food to be able to grow well and stay health. He
also needs breast milk all the time until he is at least 2 years old
If the mother leaves the child, he should be cared for by and adult or older sibling who should
be given clear instructions on hygiene, feeding and caring
Children under 5 must be supervised at all times and taught what is right and wrong
Children need to be played with to make them grow well and be happy
Teaching modes and aids:
 Show the mother a picture of breastfeeding and discuss the importance of breastfeeding until 2
years old
 Group discussion on UNICEF pictures of playing
 Make some small toys for use while the mothers are cooking – use everyday
 Get mothers to teach each other mothers some good games to play with their children /sing songs
 (Use appendix 7 and 8 of management of children with severe malnutrition for guidance on age
appropriate psychosocial stimulation)
4. GOOD HYGIENE: FOOD, PERSONAL AND HOME
Food
Objectives:
1. Define what is food hygiene and why it is important (relate food contamination with diseasediarrhoea)
2. Identify methods of blocking food contamination (from food storage to preparation to cooking
to serving to the next meal)
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Hand washing at critical times: hands should be washed with water and soap before preparing food,
before eating and after the latrine
Raw foods should be washed
Foods should be stored well (airtight containers / away from animals)
Foods and drinking water should be covered from flies
Foods should be kept clean and children supervised to eat (no eating off the floor)
Cooking and eating utensils should be clean and dried on a dish rack
Left over food can be eaten if it has been covered and heated through again until it is very hot
Recap on WHY we must do these things
Personal
Objectives:
1. Define what is personal hygiene and why it is important: identify diseases related to poor
personal hygiene (diarrhoea, skin infection, eye infection) and identify methods of
preventing diseases related to personal hygiene
2. Illustrate how dirty hands are a source of diarrhoea and emphasize importance of hands
washing at critical times
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Hand washing at critical times: hands should be washed with water and soap 1. before preparing
food, 2. before eating and 3. after the latrine
Nails should be trimmed and clean
Bodies and faces should be clean, wash children when they are dirty
Recap on WHY we must do these things
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Home
Objectives:
1. Define what is home hygiene and identify diseases related to poor home hygiene
2. Key needs for good home hygiene: latrine (and proper care and use), rubbish pit, dish rack
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Every house should have access to a latrine, all faeces must go in the latrine, children should be
assisted and taught how to use the latrine, including washing hands with soap and water after use
Animal faeces should be disposed of and the child should not play near them
Use a dish rack for drying cooking utensils
Dispose of rubbish in a pit
Recap on WHY we must do these things
Teaching modes and aids:
 Discuss Oxfam picture handouts
 Discuss UNICEF pictures
 Practice all relevant behaviours during Hearth sessions pointing out when they happen and
discussing them
 Tell older children / show older children how to do these things – hand washing etc
5. GOOD BREASTFEEDING AND WEANING
Objectives:
1. Learn the meaning, importance and benefits of EXCLUSIVE BREASTFEEDING until 6 months of age
2. Discuss good first foods for baby (meals for children 6-8 months old)
3. Discuss how to feed children from 9 months of age until 2 years old
4. Discuss the best time to stop breastfeeding: children need breast milk until they are two years
old
5. Learn how to wean in a way that will mean the child is not in danger
6. Discuss the benefits of breastfeeding even if the mother is pregnant
7. Discuss important foods for a child not drinking breastmilk
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Babies only need breast milk from birth to 6 months of age. They do not need water to drink or
foods to eat. This helps the mother stop from getting pregnant and is best for the child’s health
too (he is less likely to get sick and stop growing well)
At 6 months, baby needs good foods to grow well and stay healthy (what foods? Recap on lesson
one, discuss good meal ideas, e.g. asida/medida/neisha AND groundnut/simsim paste/oil/sugar
/milk/ mashed fruits or vegetables/fruit juice/beans). Before this time is too early and the child is
at risk of getting sick (not being able to digest the food and eating dirty foods). Later than this the
child will not be getting enough goodness from milk alone and might be difficult to feed new foods.
Take time and patience and try different soft foods
From 9 months to 24 months baby needs to start eating more and more and greater variety until he
eats all the family foods
Babies need breast milk until 24 months but they must be weaned slowly. This means the child
needs to be eating more good and different foods and having less breast feeds (stop night feeds
last) slowly slowly (over months) until he is happy eating foods alone – no breast milk. He must
not be sent away to a relative as this will make him unhappy, he will not eat, he will lose weight
and will become sick.
A pregnant woman can breast feed her baby without harm to herself, or her children. Most
children in Mornei become malnourished BECAUSE they are weaned too early. Stopping
breastfeeding early puts the child in danger of sickness from contaminated food and water and
from malnutrition and death. Diarrhoea is caused by dirty foodor water and not breast milk.
The mother must eat well, drink well and both children will grow well and be happy. Breast
milk is a growing food which also helps the child fight infection and have energy to play and
learn. It is 100% clean and safe and an important food for children up to two years old.
A child no longer drinking breast milk NEEDS other growing foods – milk is important in the diet
of a weaned child, but other growing foods are lentils, samak, loubeh, CSB,
Teaching modes and aids:
 Pictures of breastfeeding and weaning – group discussions on what they mean
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6. GOOD HEALTH
Objectives:
1. Discuss importance of keeping children healthy (so they grow well, can play and learn and be
healthy, strong adults)
2. Learn how and why to feed a sick child
3. Remember how to treat diarrhoea
4. Knowing when to go to the clinic
5. Learn the importance of vaccinations
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Sick children need MORE foods and MORE drinks and continued breastfeeding even though they
don’t have an appetite: this is to fight the infection, repair the body and keep growing. Neisha
is good but needs to have added OIL/SUGAR and a growing food, like daqua or milk
A child with diarrhoea and/or fever needs to be taken to the clinic early, and before the Fakhir.
Diarrhoea is 3 or more loose stools in 24 hours. Other danger signs and reasons to go to the clinic
are: convulsions, lots of vomiting, the child is not drinking anything or breast feeding, the child is
sleepy/unconscious. Medicines should be taken as the doctor says and if they do not work you
should go back to the clinic.
Children should have all their vaccinations at the clinic before they are one year old to ensure they
are healthy in later life
NEVER harm a child by cutting them or pulling out their teeth. This has no benefit.
Teaching modes and aids:
 Discuss ORS making picture and how to make at home, discuss vaccination pictures etc
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