 Hello everybody, so this is part two of LAP protocol, learning action protocol. So here now your home visit starts from day three. So whoever decides, so if you want Anganwadi worker to take a visit, you can you know actually administration decides for us, you know they decide who would do home visit for what you know what day. So here in home visit first first visit would be on day three. First thing what you need to do is to check weight and length, okay. Make sure that you check this baby's weight accurately, even the length. You have already seen the tutorial on how to check weight and length. Then you fill out the breastfeeding assessment form, okay. So here you have already gone through that breastfeeding assessment form. You tell mother to breastfeed the baby, okay and you just observe. You observe whether she washed her hand or not, whether she drank milk or water or not, whether she you know removed a lot of clothes from the baby. You just have to observe it. You don't interfere, let her do everything. You just what you need to do is to just tick mark that breastfeeding observation form, okay. Because by end of it you will know exactly what all things that you need to advise. Because if we interfere when she is trying to do something, you know you will miss a lot of point. So just let her do it and you observe it. Some of the points you may have to ask leading questions like are you feeding at night or you can ask given questions like how many times baby feeds at night so then she will be able to answer correctly. Actually, or you can ask how many times baby feed during daytime. How do you know that baby is hungry? So some of the questions you know that you can ask avoid the leading questions, ask questions in which mother can reply in kind of you know long sentences. Another thing what you want to do is so once you fill out the breastfeeding assessment form you will know exactly where the problem is. You definitely want to show those IC material that we have shown, not only sun part but 45 points of cross cradle hole while correctly in breastfeeding position in the latch. You fill LEP card, plot a growth chart also so that growth chart I have shown, you plot it so that you know whether baby has gained enough weight or not. You show cross cradle hole and breastfeeding latching video. Day 5 home visit. So now it's day 5. Day 5 home visit is the same thing. You don't need to check the length so I have written over here so just check weight no length. Here then we have shown home visit first check weight and length, fill breastfeeding assessment form while observing breastfeeding, show cross cradle hole, sorry this is day 3, I'm on day 5. So you have the first check weight, fill breastfeeding assessment form while observing and breastfeeding. You show cross cradle hole and 45 points while correcting breastfeeding position in latch. So pretty much the same thing. Here now what I have done, I have shown that if the baby's weight on day 5 is lower than baby's birth weight only then you need to show cross cradle hole and breastfeeding latching tutorial. But while you're doing a breastfeeding assessment form and if you feel that there are a lot of issues, whether it's still not latching properly or there are a lot of skill issues please go ahead and tell her to watch cross cradle hole and latching videos. Important. Another thing what you can do is you can ask her to subscribe to our tutorial, has spoken to her at IIT Bombay and then she can watch it, subscribe in husband's phone, mother-in-law's phone, subscribe to everybody's phone and you can in fact guide them that do it this way, do it that way. So this is important. Make sure that day by day 5 baby's weight should be higher than the birth weight because if it's not then definitely latching is a big problem. Now day 7 you have a home visit, pretty much the same thing, no need to check length. Fill out the breastfeeding assessment form, you show cross cradle hole and ISC chart, fill LAP card and plot to growth chart also. Now here what I have shown that as per WHO growth chart your baby's boy current weight is 200g less than his birth weight. So normally what happens as per WHO growth chart, baby's weight should be higher, at least gain 200g in first week. If baby's not gaining 200g in first week then she will have a problem. And if the baby's current girls generally gain 100g in first week. So if this is not happening then there is definitely issue with breastfeeding latching and other counselling points. So again you show her those health spoken to toll on cross cradle hole and latching and you also show her poor weight gain due to improper breastfeeding. So there is one to toll that you have seen, what are the reasons that why babies don't gain weight. So it's important that you show that to toll to mother so she understand that where she is going wrong. And I recommend to show this to toll every time that you feel that baby's not gain enough weight show that to toll. Now if baby has gained really good weight by one week of age, boy has gained more than 200g, girls have gained more than 100g then you don't need to worry about it. You just basically follow the same thing and you will see congratulate her, tell her that she has done amazing work. You focus on her nutrition, mother's nutrition. So you show her lactating mother's nutrition recipes, veg and non-veg whatever mother prefers and you can start with that. So that was your day 7 visit. Now it's day 9. So let's see what happens in day 9. So here is your, sorry day 10 visit. So now we have third day visit, not after 2 days. So here you can see in day 10 visit you have first escalation. So in day 10 visit if baby has not gained more than 100g from day 7 that means this baby is critical in terms of breastfeeding. Of course always check weight first, you observe breastfeeding, you know show icy material, correct the breastfeeding positioning and latching. You fill LAP card and plot growth chart. Again if baby has not gained more than 100g from last visit from day 7, you want to definitely send this baby. You want to escalate this matter to your colleague or to your supervisor. So if the weight gain is more than 100g then you don't need to worry about it. You just basically show couple of tutorials, importance of breastfeeding and breastfeeding nutrition, essential nutrition action for children. Follow up as per home-based newborn care. So you follow that baby as per home-based newborn care that would be next visit would be day 14. You can skip that day 12 visit if baby has gained good amount of weight. But if baby has not gained good amount of weight, baby has not gained minimum 100g from day 7, then you want to again do the same thing. And here I have written if the baby weight gain since day 7 is less than 150g on day 12 then you want to activate the third escalation. Here similarly in all the visits I have mentioned how much should be minimum weight gain if it's not there then there is an issue. By day 14 by and large all our babies start gaining 500g in two weeks. Okay so if they are not gaining 500g in two weeks, that means there is an issue with breastfeeding again. Okay so you work on that also then your HPNC visit starts. Any time in any visit if you feel that baby has not gaining minimum 40g a day, I would definitely see that baby in two days again. Okay cut-off should be 30g, if baby is not gaining 30g in one day, single day, upper day then I am worried. Okay try to keep your target higher because if your target is higher you will be able to put in more effort to teach mothers and those babies do wonderful. Okay so again your day 21, day 28, day 42, 6 weeks, 4 weeks, 6 weeks, 10 weeks visit. Okay this are again your 6 week, 10 week and your 14 week visit, your PENTA visit. Okay so if you don't want to do home visit, you can do visit when the baby comes to Angadwadi or wherever she goes for vaccination you know and A&M or Asha if they are present they can fill out you know they can do all this stuff at the time of you know contact point. Okay and then you have your you know 14 weeks are over. So now after 14 weeks we will start with a little bit older babies and here is your your protocol a little bit older babies. Okay so here you know your protocol for 3 and half month to 12 months of baby, 3 and half month, 4 and half month now you can see this visits are all monthly visits right because mothers they already know how to breastfeed. Again at any visit if you feel that baby is not gaining good amount of weight you know and now after 3 months their weight can is about 20 grams per day. Okay so babies not gaining 20 grams per day and that would be a problem. You check weight and length, fill learning action protocol, plot the growth chart. Okay you do essential nutrition action for type 1 and type 2 nutrient. Here again just follow those protocols you know I have written that how much should be the weight can if baby's weight can is less than written over here then what to do I've mentioned this is called learning action protocol. Okay so you're learning you're taking an action and that's what you're you know you're understanding how babies grow. Okay 3 and a half month, 4 and a half month, 5 and a half month complementary feeding phase from 6 months to 12 months of phase. So if the baby is vegetarian you start with protein rich food like beans lentils millet curd paneer of course as you can see over here I've mentioned food which are very high in protein. Okay so you start protein rich food as I mentioned again and again and again babies who are start on non protein rich food we have seen stagnation. Okay so stones start with apple puree don't start with fruit puree or vegetable puree please start with you know protein rich food and if the baby's non-veg then you just go ahead and start with non-veg food. You don't have to wait till one year of age you know start with eggs start with fish puree meat puree chicken puree you know then you can start with dal and millets and you know dahi paneer and those vegetables and fruits. Okay at 6 months of age so now this again protocols for you know your babies. One more thing I wanted to kind of bring your attention to that here starting from 3 and a half months of age we are now sensitizing mothers on nutrition okay so here you will be showing them health spoken to all on essential nutrition action for children and one type one type two nutrient okay but here you want to kind of definitely mention that babies need to start on breast milk after 6 months of age not before 6 months of age okay and at 4 and a half months of age you teach mother how to do how to prepare safely these are tutorials on safe preparation serving storage of the baby food you know personal hygiene so you want to start slowly slowly kind of sensitizing mothers on upcoming complementary feeding phase okay and 5 and a half months we have started with complementary feeding guideline and complementary food. These are only to watch tutorial but again do mention to her that you know she should wait till a baby completes 6 months of age and then start complementary foods okay at 6 months again we have written about what tutorials to be shown check weight and length not to forget fill out your learning action protocol and your growth chart show nutrition IC chart so those nutrition IC charts are important and then your baby's weight is less than 6 and a half kg you observe breastfeeding and correct the latch okay so all that is important at 6 and a half months you do home visits again same thing here I've written how much baby should be eating and what powders that mothers need to make how many powders that she needs to make so all that and I've also written that how much weight can baby should have okay then at 7 month visit again same thing you know I've written baby should can at least 200 grams from 6 month visit if baby's weight is less than 200 gram from 6 months then you see this baby after one week so in complementary feeding stage if baby's not gaining weight you start seeing babies are in a week time don't wait for too long because if you wait for too long and if the stagnation or weight occurs then the height will get affected okay so that is important very elaborate LAP protocol that we have created have put in a lot of effort so do kind of you know take advantage of it you learn a lot really to be frank so here is your protocol on you know starting from 7 and a half months to up to 12 months of age similarly just you can go through it I've written very distinctly how to what to do what you know if baby's not gaining weight what to do whom to send escalation visits are also there okay and you know so at 7 and a half month 8 month there are different tutorials that you need to show during each visit okay because we have to tall as per age of the baby okay you do use those IC material nutrition charts so which I'll be explaining another session and you know here is the chart which we have shown 1 2 3 4 5 6 7 8 you know that's all the food groups okay so when you're talking about nutrition do talk about this food groups also okay so this is your learning action protocol for every visit I hope you use it I'm going to put the link on the website do print out on a 3 chart on a good material do a good print out okay just don't zerox it and you know make a folder you know bind it put a plastic cover in front and back so it will last you for almost a year or two you know just remember that it's its first 1000 days plus your pre pregnancy period and adolescent period so don't forget that phase also you want to bring the smothers in a perfect health before they become pregnant okay so just remember that and thank you so much