 Hello everyone. So in this session I will be discussing about learning action protocol. Extremely useful if you're working in the field. You can use it for your babies, you know, you can use data card. It's actually learning action protocol that we have created at IIT Bombay. It will really help you to take action while monitoring the baby. So if your baby is not gaining weight you will know exactly what to do, how to do, you know, what to tell to show, where exactly the problem is and it will give you focused attention on that problem. Okay so let's go ahead and understand what this data card is. This particular learning action protocol is for a boy and we have created this only, you know, starting from, you know, a pre-pregnancy till one year of age. Okay looking at initial data that we would like you to collect is a baby's data, name of the baby. Now if you're working in the private practice and you obviously don't need a lot of this government, you know, related data like who is a district health officer, CHO, but if you're working or you're training healthcare workers in government system, you know, we have created this in Hindi, Marathi, Gujarati so you can work on that also, you know, you can teach them, you know, how to collect this data and learning action protocol. So here initially, you know, name of the baby is important, ID number of the baby, whatever may be the ID number, many, you know, many programs they write ID card, but it's all, it all depends. Date of birth, birth weight, birth weight should be in gram, birth length, which is in centimeter, name of the village. So, you know, name of the town, name of whatever. So if you're working in urban area, you can just write name of the city, then Thaluka district where the child comes from. Anganwadi number if baby belongs to Anganwadi. Name of primary healthcare center, name of a sub center, delivery point at district hospital, rural hospital, sub district hospital, PHC, private home, others. So this all basically wherever baby is delivered. Others if baby is delivered in a private hospital or over here, you know, we have given that option also so you can write down. So you know exactly where that baby is delivered. Okay. Name of the designation of the person available during delivery or doctor at the time of delivery. So you can write down, say if there is a private doctor which is available during the delivery, you can just write down over your name of the doctor so that you know who delivered this baby. And if baby belongs to public health, you can just write down all the line listing members, you know, who would be taking care of the baby. Okay. Mother's data, of course, mother's name, you will also have, you know, a caste, ST, SC, OBC general. Education of the mother is important. Age of the mother is also important. So here we can just write down age of the mother also. Here we have the option age of the mother. Height of the mother is very important because many times what happens that mothers are short, you know, so we want to see whether those baby they do better or not. Education of the mother illiterate primary, secondary, graduate. Last menstrual period and your date of registration. Date of second ANC, date of third ANC, so we have all the ANC listed. You want to just write the date. You also want to write the weight to understand whether there is any good weight can or not in this baby's. Okay. Weight of the mother at the time of delivery. This will tell us how much what is the weight difference between her first registration to the time of delivery. Type of delivery, it could be normal, vacuum, caesarean section, gestational age of the baby in weeks, and is it a full term delivery? Yes or no. Okay. So this is what you want to take for mother's data. Baby's feeding data. So again, we want to have some understanding of at the time of delivery or just before delivering during last trimester, whether mother was taught proper techniques or not. So here we have written down was a mother taught cross graded hold. Of course, it's our favorite. So we put that hold. If there if mother was taught some something else, please go ahead and write down over here, which whole mother was taught, whether mother was taught latching using health spoken to tall during her pregnancy. Yes or no. Okay. Now place where mother was taught cross graded hold and latching, whether mother was taught in hospital, whether it was taught at home, PhD, you can just circle them. Okay. Was breastfeeding breast milk given within one hour of birth or not? Okay. So this is this is crucial because this is a virtual recommendation of giving breast milk within an hour. Okay. Was breast crawl performed at the time of delivery? So this is also another one, which is very important. What's the baby exclusively breastfed in hospital? Yes or no. Again, you know, many mothers, they, you know, they are advised to give formula or top feeds or you know, any other, other prelactal feeds. So you want to just find out whether baby was given any, you know, prelactal feeds was a mother taught manual expression of breast milk yes or not. Okay. This is also very crucial because many times, you know, babies do have some latching problems with mothers know how to express a milk, you know, she can express so that she's not coaxed into getting formulas from outside. Mothers need to know how to express her own milk and not just kind of rely on, you know, top feeds or cows milk. Okay. Now, these are the few visits that we recommend. And these are the visits for under six months baby. Okay. Now first three visits are basically in the hospital itself. So staff nurse was taking care of the baby will have to fill out this data not much data as you can see just few few data point. But after that after day three, your home after day two, your homework that starts. So our home visits are basically three day three day five days seven day 10 day 12 day 14, then basically every weekly, then it becomes more, you know, every six weeks, every six weeks. Okay. And then every one month. Okay. But as you can see in first 14 days, there are intensive visits. And this is because as you know, that latching is difficult. It takes time for mothers to learn it. And it's important that we we work on, you know, that growth monitoring, we want to make sure that babies gaining weight. Okay. Because if babies can gain weight in this first 14 days, they'll be an excellent results. Okay. Now data visit here. So on day zero, it'll be on the birthday. Okay. Staff nurse will write down what is the weight in gram per day of birth? What is the weight weight gain? Obviously, this will be empty weight of the babies at what percentile range? This will also be empty length and centimeter. So you want to write on birth weight and birth length also is baby suffering from any illness if at birth baby had an illness, you can write down yes or no, baby has lost weight or gain weight, obviously this will be on day zero, this will be empty also. Was anything else besides breast milk given? So with any prelactal feeds given or not? So here you can write down yes or no. And where were holds health spoken to trial shown as per protocol? Okay, so here on day zero, we have recommended which will come protocol will come later that you know, they need to see cross-graded home and latching. Okay. Now similarly on day one, day two, similar thing. I have also put it down in the protocol to exactly understand what to do on those first couple of days when the baby is in the hospital. Okay. Then again, you know, as per like all this visits, you know, you will have to fill out this forms. Okay. Now length, length will not be in every visit. In protocol I have mentioned on what days that baby will have length check. Okay. Now data for six to 12 months of age, here again, you know, this is the data collection for six months and about. So this will be a complimentary feeding data. Some of the very important questions that we have asked about food groups about junk food, about powder recipes, you know, how many times the baby's given food consistency, frequency, you know, how much, so all that is over here so that we know how much is the intake. Okay. And here again, first two months we have given visits every two weeks. So six to six months, six and a half months, seven months, seven and a half month. And after that, up to eight months, basically, it's there are visits every two weeks. After eight months, you have visits every one month. Okay. So this, this is very important one, two, three, four, five, six, seven, eight, nine. So in from six to 12 months, there'll be nine visits. And this is important because in India, our, you know, complimentary feeding rate is very, very poor. It's extremely poor. Okay. Only 12% should now getting minimum molecular diet. And that includes your enough frequency and your dietary diversity. Okay. So this, this is important. I'm going to now take you to page two. So this is your breastfeeding assessment chart that I have already shown to you. You know, so you have to hear this is your mother's name, baby's name, date of birth, first assessment, baby's birth weight. So here you will write down day zero, okay, or maybe day one, and then you can write down the date over here, you can write down the day of life over here, and then start examining, you know, breastfeeding, if it's positive, you will be ticking mark, you'll be ticking your mark over here. If it's negative, then you will be ticking mark over here. Okay. So here, for example, mother's preparation, mother knows early hunger cues, mother's feed when the baby cries. So if mother is waiting for baby to cry, that means she doesn't know this point. Okay. So that tick mark will come in front of this negative, you know, unfavorable behavior. Okay. So at the end of it, you'll be basically observing each and every point over here. There's all the points that you need to observe, you know, while you're breastfeeding the baby. And once that that is over, you will know anything which is tick mark on the right side will give you will give you points to discuss. Okay. And the most important part of this breastfeeding assessment form is latching. So if you have a latching issue, you know, this baby's can't go home, because that means the baby's not getting any milk. Okay. And this baby's going home hungry and baby will not put on weight. So this are some of the points that we have created for attachment. Okay. Important counseling points are also important. So you want to ask you questions also leading questions if mother feeds 10 to 12 times to 24 hours, if not, then it that tick mark will come over here so that you know that you have to at the end of the breastfeeding assessment, you have to tick mark on that one. Okay. So that's what this is breastfeeding form is about. Then I'm going to talk about. Okay. So this is your this are your growth charts. I've already explained to you about growth charts in my last week session. And you know, as per protocol, you have to fill out this weight for each chart for each and every visit, every visit any contact point with that baby, you need to fill it out. Okay. You can print out this whole, you know, I'm going to load it up on a website. You can print out it's a PNG form. So you print out all the pages are 10 pages, print out on a three size, because it is meant for a three not a four. And then also do a color coding. No need to laminate. But basically just make sure that the print out the paper quality is good so it doesn't get torn. Okay. So that's what is important. Here is your wait for each chart, zero to three months, four months, five months, six months, and your second week, third week, four week, fifth week. Okay. So this are your wait for each chart. Here again, length for age. Remember that this are weekly visit up to three months of age, then you have four, five, six, the some monthly visit. Okay. Because as I showed you, you know, there are a few visits which are weekly, and even some of them are daily, so it'll be much easier to kind of figure out from weekly charts. Okay. Another one is that was your weight and length. There's a percentile growth chart. But for wait for length, we have created, you know, and yeah, this one is mainly your wait for age six months to two years of age. The one you saw previously was from zero to six months. This are from six months to two years of age, a length for age and wait for age. And you can see that, you know, children, they grow beautifully, you know, six months to one year if they are given proper complementary food as we have advised. At every visit, please reinforce. I'm going to go in detail what to reinforce, what to tell us to show of course, when LAP comes. But you know, here, I'm just kind of reiterate that you have learned already so far. Just use it, you know, use that knowledge, pass it on to the, to the mother and the family. Okay. Lower one is your length for age, again, six months to two years of age. That's what we have. That's your boys chart. You know, now here is your wait for length. Now wait for length is always in Z score. Okay. So this is your Z score mean minus one minus two minus three mean plus one plus two plus three. Okay. So here, you want to plot this, you know, at every visit to see if baby any time falls between minus two to minus two minus three or below minus three because those babies are now getting into acute malnutrition. Okay. So that you want to make sure. And here we have shown just one picture of breastfeeding. So that mothers know how to, you know, what, what is cross little hole. And here, you know, it's, it's beautifully kind of animated, you know, just to show mother how the baby should be held. Okay. During cross little hole. Now this particular chart that we have created, this is again, this particular chart that we have created here, what we have done, we have divided all the tutorials into phase wise manner. So in like phase wise, how you want to give this charts. Okay. So for example, for adolescent girls, pregnant mothers, first trimester, second trimester, what charts that what tutorials that you want to show. And here, you will also have a third trimester mother because you also want to show them, you know, this charts. Okay. Charts and of course, your this all tutorials. So you want to show those tutorials to third trimester mother also. Okay. Here the problem they can possibly face in the meantime in during this time is, you know, they are they are iron deficient, they are B12 deficient, they're folate deficient, you know, they have a lot of this deficiency, you know. So in the view of that, you know, we have basically kind of listed all the tutorials that can be shown to mother and the family so that she can come out of those deficiency. Okay. So here again, all the tutorials that you have seen so far on nutrition, you know, protein folate, calcium, B12, choline, C, iron, magnesium, vitamin D, all that. Okay. Another one which we have is junk food. We have also shown pregnant mothers type one type two nutrient also for adolescent girls and pre pregnant mothers. Okay. And then we have listed all this virgin non-veg recipes of all this, you know, nutrient. Okay. So if mother is vegetarian, show her vegetarian recipes. If she's non-veg, show her both veg and non-veg recipes. Okay. That's important. Again, then we have talked about pre pregnancy nutrition. There's a, as you have seen this pre pregnancy nutrition is really good. I really like that tutorial. And then also essential nutrition action. So essential nutrition action for pregnant mothers and importance of first thousand days. So if you can show this tutorial is during, you know, those crucial years of adolescent who pre pregnancy period and, you know, your pregnancy period, then at least she will know all about all the tutorials. Okay. Now third trimester is your, in third trimester mother will be watching all these tutorials which are given in your, you know, during earlier period. But besides that, I also recommend that this mothers, they watch, you know, not only third trimester mothers, but mothers who have delivered or mothers with babies under 10 days. If you have not seen this mother that any time, this other tutorials that I recommend, importance of breastfeeding, complications of formulas, cross-killed hold and breastfeeding latching, importance of first thousand days. So all this kangaroo mother care, storage of expressed breast milk, you know, how to express breast milk is very important to show her because if she goes to private hospital, believe me, they want to get formulas. Okay. But if she knows already how to express milk, how to give that milk with, you know, that cup, she will, she'll know exactly what to do. You know, she will not listen to doctors and provide all these formulas and cow milk rubbish. Anyway, so here I've also added, you know, some of the tutorials on newborn care, important for her to know before she goes home. I've also shown WHO growth chart. It's important to show her how her baby should grow as per WHO standard because that will really improve her, you know, her understanding of how baby should grow. Okay. Five to six months of age babies, six to seven months of age babies and nine to eleven months of age. So this other this other tutorials to be shown for mothers starting from five months of age. Okay. Because we want to sensitize as mothers on complementary foods. Okay. So again, as per LAP protocol, you can start showing this tutorials. Again, this all on type and type to nutrient, you know, complementary feeding guideline, complementary foods, protein powders, nutritious powders, recipes, veg and non-veg recipes. Okay. And this are a nine concept, core concept of health spoken tutorial. You want to make sure that, you know, every family member, yours or your, you know, your beneficiaries should have understanding of this nine core concept. So if you can understand this nine core concept, this is prepared by Dr. Devaji Patil, a dear friend of mine and the colleague. And, you know, just it has basically it is the crux of our health spoken tutorial. Okay. So this was the, you know, your tutorials that we would like to show to pregnant mothers and lactating mothers. Now here the LAP protocol starts. So let's start with the, you know, first LAP protocol. Now this is basically protocol starting from pregnancy till 14 weeks of age. Okay. Now I would say even adolescent and pre pregnant mother should be included. Okay. And what are the contact points that you can show this tutorial is basically either during home visits or when mothers have meetings, un-an-wadi visits, weekly visit, monthly visit during A and C, village health sanitation or nutrition day monthly visits. They have Pradhan Manthri Surakshet Matriva Abhiyan. Okay. And you can show it at primary health care center once a month, you know, or health health and wellness center, community-based event twice a month. Okay. Adolescent married couples planning, married couple planning pregnancy, first trimester, second trimester and lactating mothers and even third trimester. So you want to show these tutorials to all of them. You know, this all again I've already mentioned what tutorials to be shown. Any of these contact visits, these tutorials can be shown. Third trimester, besides showing this nutrition related tutorials, you want to show cross little hole, you know, and, you know, of course you're latching. You also want to show them sideline hole and football hole because that will really help them to understand. Also, you know, you want to show them why babies don't get a gain weight. Okay. So there are mainly two factors breastfeeding factors and other factors. It could be maternal factor, it could be maternal physical factor, psychological factor, you know, all that. Okay. And then, so these are some of the tutorials that you want to show to third trimester and post delivery mothers. Okay. At the time of delivery, you want to make sure that mothers know about breast crawl and early initiation of breastfeeding and skin-to-skin contact. So there is a seren. It's important to show this couple of tutorials to mothers so that you understand that what will be done during cesarean or after cesarean. Okay. But again, I would recommend if you can show her during third trimester then she's prepared for it. Post-little care ward, so now baby is already delivered. Now baby is going to be in the hospital or PHC or wherever she's delivered for at least two days, first 48 hours. So if you can, basically these are the, you know, things that you want to do, you know, show it to mother. Again, show cross little hole and side line hole, latching tutorials. You also need to guide mother. So support for mothers is very, very important. Okay. There is either IAC cards, so you show those IAC cards also. There are stun pun chart, you know, there are nutrition charts. Not necessarily in first two days, nutrition chart so much. But, you know, specifically your stun pun chart and 45 points that I have already kind of shown. Show and demonstrate hand expression. So, again you want to demonstrate how to hand express breast milk. Okay. And how to feed the baby. Also show her KMC. Check birth weight and length. Check daily weight. Okay. Fill breastfeeding assessment form on day one into a normal delivery. So as I told you that, you know, that initially we had shown this breastfeeding assessment form, you do fill out. Okay. On day zero, you just make her learn. From day one, you start filling out those forms so that you know that where mother is lacking. Okay. And you have, if the baby is born by C-section, then that they will be, you will be doing a breastfeeding assessment form or filling out those breastfeeding assessment form on day three and day five. So those are very, very important. Fill initial learning action protocol form and plot W to growth chart. Okay. If it is a hiatus baby or a low birth weight baby at the time of discharge, please inform concerned person. Okay. Discharge only if latching points are correct. The latching points are in the breastfeeding assessment form. So you want to make sure that before baby goes home that you want to, you know, fill out those forms. Okay. Post little day three to four, 14 weeks. Here now, you know, your results will start, home results will start. So I will talk about that in my next part because it will become too lengthy otherwise. But remember that each child should have a separate learning action protocol. So if it's a boy child, a child will have a boy learning action protocol. If it's a girl child, but each child should carry that protocol or data card in, you know, and that mother should have it. Okay. And every visit will require weighing scale, preferably digital weighing scale or at least a calibrated soldier weighing scale, filling of learning action protocol. I see charts, filling of plotting of growth charts, and health book on tutorials, you'll need them. Okay. Encourage the mother to bring LAP card during every visit at the point of contact. Okay. So this I'm going to end over here and I'll come back with, you know, home visits, what are the protocols to be followed and what is to be done. Okay. Thank you.