To Assess and Celebrate
How was the visit? Was it possible to observe and talk about the Indicators of Opportunities and Achievements?
Based on what was seen and felt what else would you like to share?
Do you remember any message, reflection or prayer that celebrates this moment?
The four to five months baby
1- How do the mothers feed their babies in this age?
The mother’s milk continues to be the best and the only necessary food for the baby. In the first exclusive breastfeeding months, it is common the baby be fatter. Close to the four and five months the tendency is for the baby to continue to gain weight, now more slowly. But the gain of health and love that breastfeeding brings continues to increase more each time!
The mother’s milk is so appropriate for the baby that around the fifth month it gets less sweet so that in the sixth month new food can be introduced for the baby's needs.
When the mothers work out of home, they should continue to breastfeed. While the mother is out, the person that takes care of the baby can give the mother’s milk taken from the mother through the milking procedure. When the mother returns home, she can offer the breast to the baby.
Before doing the milking procedure, to keep the quality, some advices are to be followed:
• Wash and dry very well the hands with a clean tissue;
• Select a clean and water boiled container;
• Find a comfortable position to be and, if possible, in a quiet environment.
To take the milk from the breast:
• Make a circular massage with the fingers’ tip on the base of the breast towards the nipple;
• Put the thumb on the breast, above the areola, and the other fingers in the lower part of the breast, making a shell with the hand;
• Make the milking movement, gently squeezing in and out the breast rhythmically;
• Discard the first milk flushes because they bring microbes located in the closer part of the breast’s nipple. These microbes may spoil the milk that is stored but they do not harm the health of the breastfed baby.
When the mother returns home, she should offer the breast to the baby. After that, she can do the milking procedure to be used in the following day. The amount and the appearance of the milk vary from one milking procedure to the other.
• Repeat rhythmically the milking movement, circling the hand around the areola to empty all the milk from the breast.
• Alternate the breasts when the milk diminishes or every five minutes, repeating the massage and the milking procedure till it reaches the expected amount of milk;
• After the milking procedure is done, pass a little milk on the nipples to avoid cracks.
How to store the breast milk:
• Soon after the milking procedure, the breast milk needs to be cooled. The container with the milk should be covered and put in icy water for two minutes. Then the milk should be stored in one of the fridge shelves (never in the fridge door). It shall be consumed within 24 hours;
• When offering the milk to the baby, use first the one milked earlier and after stewing it. This milk should be served to the baby with a spoon or straight from a glass.
When the mother is home, it is necessary that she often offer the breast to the child. Thus she stimulates the production of more milk and extends the breastfeeding period. The use of the milk bottle, instead, encourages the baby to quit breastfeeding.
The person who takes care of the baby needs to serve this milk with a spoon or from a small glass. The baby gets easily used to the nipple from the milk bottle and this makes him/her thereafter refuse breastfeeding.
Leader, you can verify in the growth curve if the baby’s weight is adequate for his/her age. This will indicate if that the baby is receiving enough amount of milk for his/her growth.
When the baby does not gain weight in between months, talk to the mother to know what is happening. Maybe the baby is sucking little, or the mother is tired or she is not eating properly. In case the mother has already gone back to work, talk also to who is taking care of the baby.
When there is not enough milk from the mother, it is rather preferable to introduce baby food as of the fifth month than the milk bottle. Thus, beside breastfeeding, some food can be served with a spoon to the baby avoiding the competition with the nipple of the milk bottle.
How the baby can learn and grow
Does the baby show he/she identifies the people who are always with him/her
The baby begins to realize he/she has a name and shows this when he/she looks at the person who calls him/her. He/she already recognizes better the other family members and enjoys staying with them. The baby smiles, waves the arms around and shakes the body to the people. He/she likes to hold their hands and touch their faces. The intimate contact with the grandparents, uncles and the older siblings also helps the baby’s development.
When put near strange people the baby can become very shy, suspicious and can even cry. This shows that he/she already distinguishes who is not known to him/her or those people that are not always with him/her.
The baby reacts to be separated from the mother, and usually cries when is left alone. The parents and the family members can find ways to do the housekeeping leaving the baby, whenever possible, close to them.
When someone makes noises behind the baby does he/she turn the head searching for the noise?
The parents and the family members can create several opportunities for the baby to hear and identify sounds. And they do so when they pay attention and repeat the sounds the baby does and when they put things with different sounds close to him/her. The baby catches them, plays of shaking them, beats one object against the other and then hears the noise it makes.
The baby has already other ways to communicate. Before, he/she would only make sounds with the throat; now he/she makes sounds with his/her lips. He/she squeaks and says “m, m, mum; “”p, p, pa, pa”. He/she likes repeating and hearing his/her own voice. When the baby acts like that he/she shows that is decided to learn to speak. If the family members repeat the sounds he/she makes, then they are helping the baby to learn to speak.
“What I speak of is what I have seen at my Father's side, and you too put into action the lessons you have learnt from your father.” Joh 8:38
Do the parents encourage the baby to try to catch the things they put close to him/her?
In this age the baby can start to be interested in objects. But, for this to happen, he/she needs help from the people around him/her. It is necessary that they put several objects close to the baby, encouraging him to pay attention to them.
Doing so, the people also help the baby to coordinate his/her movements with his/her senses, such as the sight, hearing and touch. He/she looks at them, puts them in the mouth, bites, licks and shakes them. This makes the baby feel how things feel like: hard, soft, light, heavy, rough and smooth.
When someone puts the baby to sit, with support, can the baby remain in this position?
The baby has to be put in the sitting position, with support, for not falling forwards or sideways. Thus, he/she learns how to sit alone. This new position helps the baby to see and catch more things and get prepared to stand up.
In this age it is necessary to put the baby on the floor, making sure it is clean, so that the child can move more. Thus he/she can learn to turn around and roll to both sides without the danger of falling.
Attention: The baby cannot be left alone in places where he can roll and fall. It is also necessary that dangerous things be not left close to him/her, such as plastic bags, for he/she may choke and get suffocated.
The baby enjoys the bath time even more. He/she likes feeling the warm water on his/her skin, to play beating the feet and the hands in the water and the state of well being that being clean brings.
Each family has a way to take care of their babies, but it is necessary to follow a daily routine with time for bathing, for feeding, for sleeping and also for playing. He/she can become nervous and insecure when there is a lot of change in his/her daily routine.
Before the first teeth appear, the gums become swollen and painful. Therefore, the baby may become irritated and restless. It is good to continue cleaning the baby’s mouth. This cleaning is made with a clean wet tissue, after the baby has been fed, particularly after the night last breastfeeding.
The appearance of the first teeth varies from child to child; there are children who are born with teeth and others who complete one year without teeth. In general the first tooth appears when the child is six months.
If the baby is already receiving baby food it is recommended they are not made with sugar. The baby food should not be blown to get cool or be fed with the same spoon that the adult is using to eat. This can transmit bacteria from the adult’s mouth to the baby’s. When the pacifier falls on the floor, some people usually put it in their mouth and return it to he baby; this can also transmit tooth decay to the baby – besides the fact that the dirty, which was on the pacifier, contaminates the adult.
Check if the Health Unit of your municipality provides dentists for babies. If it does, encourage the parents to take the baby for a consultation.
“The Almighty gave to the men the science so that they could praise Him for His wonders.” Ecc 38,6
In the 4th month the baby receives:
A- The second dose of vaccine against Poliomyelitis (the drop);
B- The second dose of Tetra vaccine, against Diphtheria (Croup), Tetanus, Whooping Cough and other infections caused by Hemofilus (Meningitis and others);
C- The second dose of vaccine against Rotavirus (the drop).
Some vaccines need to be taken more than once for them to have an efficient and lasting effect. Therefore, it is important that the babies take all vaccine doses prescribed. Thus, if they catch any of those diseases against which they are vaccinated, the disease will come much lighter.
In the Vaccination Campaigns, extra doses of vaccines are given. It is important to participate in those campaigns so the diseases are controlled!
Following the Baby’s Growth Curve
The graph with the weight curve assessed per age is in the Health Card. This curve shows us the expected weight for each age of the child. In this graph are written down the child’s weight, the diseases the child has already had, if he/she has been hospitalised and when the child has stopped to be breastfed.
Let us understand the weight/age curve?
The interpretation of curve is the following:
• Obesity: Above line +3 (black line on top of the graph);
• Overweight: Above line +2 (red line on top of the graph);
• Expected weight: Between lines +2 and –2 (grey part of the graph);
• Malnourishment: Below line –2 (lower red line);
• Serious malnourishment: Below line –3 (lower black line);
Let us see an example on how to fill in the weight/age curve?
A) Claire was born on April 2006. In the lower part of the graph, in the first date field, we note down the April month which was the month Claire was born.
B ) We also note down April in number 12, which is the month Claire will complete 1 year old, and we also note down April in number 24 which is the month Claire will complete 2 years old.
C) Her weight when she was born was three kilos (3,000 g). We note down that weight exactly in the line that corresponds to the zero month
D) Claire was only breastfed and when she was one month she was already weighing 4 kilos (4,000 g).
E) Claire continued to be breastfed and weighed every month. In September 2006, Claire weighed six kilos and eight hundred grams (6,800 g).
Claire was increasing in weight as expected, for her weight line is always rising, and this occurs in the same proportion that the green curve, between lines +2 and –2.
Itálico - texto biblico
“And as the child grew to maturity, he was filled with wisdom; and God's favor was with him” Luk 2:40
The graph should be shown and explained to the parents or to who takes care of the baby, for them to see the weight change.
When a child has the weight lower than line –2 (red line), he/she is malnourished. When from one month to the other, the child does not gain weight or loses weight; this is an alert sign. In these situations, it is necessary to verify what is happening with the child. Maybe the child is being less fed, maybe the child is sick or receiving little attention and caress.
In the home visit it is necessary to clarify the subject to the parents. Together you can find out what has to be done to help the child to develop better.
In the leader’s Notebook:<
>In question 7, note down the child’s weight.
This weighing has to be done on the Life Celebration Day.
In case the child has not participated in the Life Celebration Day in
that month, the weight taken at the Health Unit can be noted down there;
In question 8, note down [Y] (yes) if the child increased the weight compared to the
previous month. If the child had not been weighed the previous month, put a [?] (question mark);
In question 9, note down [Y] (yes) when a child’s weight in that month is lower than line –2.
A child below line –2 is malnourished even if he/she has gained weight in the previous month;
In question 10, note down [Y] (yes) when the child’s weight that month is above line 2;
A child above line 2 is overweighed even if he/she has lost weight in the previous month;
The Life Celebration Day is another important activity that you, leader, performs at the Chld’s Pastoral.
On this day, that takes place once a month, the children are weighed, the families gather to celebrate the children's good health condition and to help each other when they are facing difficulties.
The chosen place for this celebration should be close to where the families live. It is recommended that the groups are not very big so that the families can feel warmly welcomed, feel comfortable and have the opportunity to speak and the children have space to play.
The Life Celebration day is a living faith witness. It shows through solidarity and participation of a community in the search of their citizenship rights. That is why this is a day blessed by God.
Leader, why weighing children in the community?
When you weigh a child that is below the expected weight and talk to the family, the parents may think that the child is malnourished because they do not know how to take care of him/her. However, we know that the families want the best for their children. Certainly the families have already done everything they knew and could for the child to grow well.
When the families are gathered to weigh the children and celebrate life, they can notice that some difficulties are common and can be shared with the others. The parents of malnourished, obese, sick children or of those who are not growing well will realize that they are not alone and that together they may find ways to face such difficulties.
Thus, it is important to encourage the families to participate in the Life Celebration day.
The Life Celebration day needs to be planned with a lot of love. It is advisable to count on the help of other leaders, of people from the families such as the mothers, the fathers and the grandparents from the community, so that together they can organize this day and can prepare:
• A warm welcome to the children and their families;
• A joyful spiritual moment that pleases the children;
• A delicious snack enriched with regional food;
• A place with toys and games for the children.
Apart from that, the family members can help to take off the children’s clothes, talking to them about how important it is to be weighed and can also put the children in the scale.
Thus, you and the other leaders can devote yourselves to the preparation of the scale, to the weighing of the children and also to taking note in the leader’s Notebook and in the Health Card graph.
When there is someone to entertain the children, the leaders can talk better to the parents.
Talk to the parents about the weight result is as important as taking the weight. What is the purpose of knowing that there are malnourished children if the community does not get together to search for solutions?
In the talk with the families, it is better not to cite, for example, the name of the malnourished or obese children, but try to find out the causes and what can be done to solve the problem.
After the activities of the Life Celebration day end, it is important to gather the leaders to evaluate the result of that activity, observing if something lacked, what went all right and what can be improved on the next weighing day.
Besides the Life Celebration day, it is necessary to find other occasions to talk to the parents. In these talks, the parents can exchange information about health, education and other situations that affect the families’ life in the community.
They can see that some of their problems can affect everybody and that they can be solved if taken to the local authorities. For example: the lack of day care centres, basic sanitation and health services.
When the families get together to talk, everybody has more condition to discuss the problems, find out solutions, verify what are the people’s duties and plan actions to be taken in order to ensure the children and the families’ rights. Informed and organized families know what their duties are and have more pressure power to claim for their rights!
“These remained faithful to the teaching of the apostles, to the brotherhood, to the breaking of bread and to the prayers” Act 2: 42
In these visits it is important to:
Talk about breastfeeding/feeding;
Talk about the baby’s growth in this age;
Answer the questions in the Leader’s Notebook.
Suggestion for the task of this qualification stage:
Visit the babies that you follow and check how their growth is in the weight curve.
Invite the babies’ families to take part of the Life Celebration Day.