 So, this is my last part of the last session, it is basically I will be talking more about the conclusion of this whole maternal infineum child nutrition course, I hope you enjoyed it, it is all this whatever that we have mentioned has come of course from field experiences but we have also conducted research in many areas and it has this is all evidence based but as I mentioned we are still learning and every time that we help mother, every time that we teach her different techniques of breastfeeding or every time we discuss with mothers on complementary foods and we actually try in the field, every child teaches us new things. So, I am sure you know you all would feel the same that you will experience learning you know throughout your life, okay. So, one thing I want to kind of tell you that this as you learn please share your experience with us because this was more of a sharing of course through NPTEL it was more of a one way session except for live Q&A sessions but you know I would like to learn from you all your experiences it would matter a lot to me you know. Now just talking about different phases you know of maternal infant young child nutrition and I want to kind of start with the pre-pregnancy nutrition, adolescent nutrition focus on protein please avoid junk food we are seeing lot of PCODs, PCOS, polycystic ovarian syndrome, polycystic ovarian diseases in children. So, adolescents I am talking about and then they have when they get married they have infertility problems. So, do avoid junk food, do avoid too much of carbohydrate, decrease your carbohydrate intake remarkably increase your protein intake, increase your good fat intake, okay and that would basically help get you into good health, do muscle resistant exercise to tell them to do a lot of play sports to kind of if they have access to sports arena like swimming pools they can do swimming or they can do dancing they can do whatever they want but I prefer that they are very active avoid a lot of screen avoid social media you know also I do recommend holistic health. So, for example, I do recommend that if adolescent can go through meditation courses or some of those you know that would really help them a lot pre-pregnancy similar same thing as I mentioned in adolescent you are preparing your body for conception, okay. So, focus again on your protein, focus on your nutrient which are not easily available like your B12, choline you know those nutrients are really important iron is important in their struggling with iron deficiency anemia. So, do focus on those nutrients, okay. Again keep the carbohydrate content low in the diet, sugar, jaggery absolutely I do not recommend at all. For lactating mothers, pregnant mothers similar things you know as you watch the nutrient count of day to day foods you will definitely now know that what food to recommend to pregnant and lactating mothers also. Lactating mothers you know I mean I get a lot of queries from mothers whether she should have satavari, whether she should have methi seeds or whether she should have moringa leaves, yes of course you can have it but believe me your output will increase when baby gets good milk transfer, okay. So, it is basically demand and supply demand and supply so demand is more means if the more milk is get kind of pulled out from mother's breast by proper latching, proper milk transfer will automatically will increase mother's supply, okay. Thus nature's weight protected baby to make the baby grow, okay. If the milk pulling or the milk transfer is not good, milk is being developed but baby is not being able to latch properly and get that milk out however hard you try with all these galactogogs eventually it will decrease, okay. So, just to make sure that you know focus on the technicality aspect for pregnant mothers I strongly recommend that besides working on nutrition at see around 8 month to 9 months around 8 months for last 2 months of pregnancy I insist that mothers should learn proper breast feeding technique and cross-cruel hold really works so well any hold whatever works for you it is fine but in my program I have seen remarkable results with cross-cruel hold technique, okay. So, please teach mother those counseling points which are important teacher how to look for hind milk how does she know whether it is for milk hind milk you know talk about night time feeding, teach her all this is a content, okay. Because what has happened and this is this has been my experience that all these mothers they come to us I am talking about the educated mothers you know privileged mothers they come from corporate hospital to us after one month of undergoing so much of complication of lactation just because they were not guided properly during pregnancy and when mothers were in the hospital as well as when she went home. So I do recommend that please kind of prepare your client pregnant clients in the last trimester, okay. Teacher about breast crawl, teacher about nipple complication nipple shield complication tell her that she does not need nipple shield so even if somebody offers nipple shield in the hospital she should immediately refuse to say no I do not need it I know how to breast feed I know how to latch the baby, okay. So if she is confident believe me she will have such a beautiful journey as soon as baby comes out, okay. Also teach her how to breast feed the baby if she has Cezarean section, teach her how to manually express because believe me 99% of doctors would say oh you have Cezarean section you know you cannot breast feed the child because milk does not come in and that is absolutely it is a myth, okay. So you teach her how to do breast compress release how to you know if baby has difficulty latching do not rush to start formula do not rush you know teach mothers all these different kind of survival mechanism before she goes into delivery, okay. So teach her how to express, teach her how to store that milk, teach her how to kind of feed the baby with spoon, direct latching when the baby mother is in Cezarean section also while she is you know post Cezarean when she is in the hospital for 4-5 days, teach her how to put the baby kind of you know we have shown that in a tutorial. So prepare her with that prepare her with all this you know these are her tools, okay. When everybody is against breastfeeding in the hospital all these tools that you have taught her will come in the use, okay. So do that and as of course lactating mothers you know more she is prepared during pregnancy better it is do talk about her nutrition she will require good amount of protein and other nutrient-dense food give her energy in the form of good fats again you know do not give too much of carbohydrate especially starch give them good carbohydrates like all the different vegetables you know about the ground grown vegetables you know all that of course absolutely millets are really good you know leafy vegetables extremely good your dals your you know dairy products for lactating mothers you know amazing seeds nuts. So focus on this nutrient-dense food rather than just rotis and rice rotis and laddoos okay after baby is born as I said about the baby now. So again teach mothers or show her some tutorials on how to take care of newborn babies you know like you know a lot of time I see babies are wrapped so many times or babies are not properly especially low birthed babies are not given proper KMC so that is also very important so kind of you know you have all this access to all this health spoken tutorial so do use them in your practice and you know just kind of be very empathetic and think of how if you have gone through all this thing what would have helped you and you know just support this mother as your own sister or as your own you know friend and it will it will go long way it will be easier for you also to manage all this issues it will you won't find any complication if everything goes right you know and that's again it's in your hand how well prepared your client is you know from the time of pregnancy okay and then comes your complementary feeding stage. So what I do recommend is to of course always give information about excuse the breastfeeding till six months of age but I do recommend to sensitize mother I think by the time child is four months old you just sensitize her sensitize her about dietary diversity sensitize her about you know picky eating and all that how to start complementary feeding sensitize her about personal hygiene how to store foods talk about food that she can start with once baby finishes six months you know so you can basically start as you had trained this mother during last trimester about breastfeeding similarly I want you to train this mother's when baby's four months of age you know keeps sensitizing her so as soon as baby is six months old then she will know what to do you know and one more thing I want all the lactation consultant to know it's good to follow up these babies so if you have kind of health this mother with lactation in say first three four days in the in the hospital I want you to follow these babies up at least check the way make sure that whatever advice you are given is it helped or not because I get so many mothers from all over India you know they say that okay I had this lactation consultant in the hospital but then you know I don't like you know I'm not in touch with her so then how will you learn whether whatever advice you gave worked or not so if you really want to learn from the field I would not let that baby go till you see demonstrate 40 to 50 grams of weight gain per day for next two three weeks because that's what WHO recommends 42 or 43 grams weight gain per day for at least up to fifth week right so I would recommend at least kind of monitor those babies and see your advices are working or not because if it's not working that means you want to re-learn or you want to understand where you're going wrong okay again once a child turns six months or complete six months again you'll have to hand hold the mother for probably next couple of months or so okay because she's always skeptical about what food should I start what should I give whether I can give egg or not whether I can give meat or not whether I can do this or not as you guys had question mothers have many many more questions okay so please you know guide them properly sensitize them in between four to six months of age so that the initiation of complementary feeding goes so well that you know you will be so happy and you will actually you know when you use a lot of this app so there is one app that I really like it's called child growth tracker you know on the logo is basically the baby's kind of climbing on the stairs you know or the ladder so so that basically that's child growth tracker and you know you follow those babies and put that baby's growth on those tracker and you will see how babies grow so beautifully and when you start on nutrient dense foods you know like beans or nuts and seeds and eggs and meats you will see children length grow beautifully you know and focus on length after six months okay because you have focused on weight for for six months now comes the length because now if child is not growing in length and if child is growing only on weight that means child is getting lot more energy dense food that means child is not getting enough nutrients most likely it's protein and some of this type of nutrients which I mentioned okay so for after six months of age I generally look at the length aspect and if length is growing well and if child has already had good weight at six months of age in which child do not gain so much of weight you know as recommended by WHO I don't I don't worry too much because if the length is growing that means child is getting enough nutrients yes you may need to increase some calories in the form of good fats so do not give too much of this starch potatoes or rice or you know lot of this fruits to to gain child's weight okay you gain child's height and to get weight going I do recommend to kind of give more amount of you know good fats again in the form of egg or you know your meats or you know your ghee your yogurt with full fat you know so all that will definitely improve the calorie intake okay but you want to have a good calories you don't want to have calories which are anti-calories okay again I'm not going too much into calorie more because you know you can have a good calorie and bad calorie but if you see a child growing very well in height and not so much on weight so then you may need to increase you know your fat intake baby's fat intake okay all right so that comes your complimenting feeding stage one more thing which I've also noticed that many mothers start junk food very early on okay please refrain from exposing children to lot of junk food believe me the habit that you create when children are young that happy habit will go long way long way you know and you want to be the role model you you cannot expect that you eating lot of junk food you eating samosas and jalees and you are telling children that no no you don't eat it's okay if I eat but you cannot eat no that's it doesn't go that way so keep your junk food to just occasion maybe one once a month or so there has to be some special occasion okay and believe me children will do the same so inculcate those good habits inculcate about exercising so if you're exercising children will even young child will look at you you know there and you are me you'll be amazed how such good observation that they have you know so think of that and you know just inculcate all those habits by you being a role model for them okay avoid kind of exposure to screens even for younger children especially because you know they do have a lot of attention deficit when they exposed to kind of digital screen too early on life so in America in fact we are very very strict about you know we have zero tolerance to screen for first couple of years or so okay so that's important and I think I think I have covered pretty much all the topics that I wanted to discuss and I would like to thank a few people first of all I would like to thank NPTEL both Ms Bharti, Ms Bharti Satpal and Ms Bharti Thari and also my TAs Bela and Tasneem you have just been amazing also Tushar who has coordinated my live recording and sessions and his team and full IT Madras team who is coordinating this NEPTEL course and of course all of you for joining this course and you know you know and they might be difference of opinion but we all are still learning and you know I'm open to learn from you guys so if you have any experiences that you may have after taking this course and in the practical life do share it with me and thank you so much and hopefully you know we will have next session or next course in Hindi so if anybody would like to take this course in Hindi you can ask them to join probably in July let me see if I can do it but thank you so much