Handbook For ASHA On Home Based Care For Young Child-English
Handbook For ASHA On Home Based Care For Young Child-English
Handbook For ASHA On Home Based Care For Young Child-English
The Handbook for ASHAs on Home Based Care for Young Child covers topics related to Nutrition,
Health, Early Childhood Development and Water Sanitation and Hygiene (WASH). The sections
on Nutrition, Health and WASH formed a part of previous training of ASHAs. Thus, training in this
handbook will serve as refresher for these topics, will build on existing knowledge of ASHAs and help
her develop new skills related to Early Childhood Development.
As part of Home Based Newborn Care, ASHAs are already undertaking six or seven home visits on
3rd, 7th, 14th, 21st, 28th, and 42nd days of birth for the newborn (for home deliveries, an extra visit
on day of birth). This handbook will support ASHAs in undertaking activities for the additional visits
for the child during the 3rd, 6th, 9th, 12th and 15th months of age to provide the Home Based Care
for the Young Child.
The handbook is intended as a reading material for the ASHA and is therefore to be given to each
ASHA during the training. The content of this handbook will be covered in five days training.
ACKNOWLEDGEMENTS
The Handbook for ASHA on Home Based Care for Young Child has been developed by the National
Health Systems Resource Centre (NHSRC) and Child Health Division of Ministry of Health and Family
Welfare in technical consultation with experts from JHPIEGO-NIPI and UNICEF. The sections of the
handbook also incorporate content from the resource material of the Home Based New Born Care
+ (NIPI), Integrated Management of Newborn and Childhood Illnesses (IMNCI), Intensified Diarrhoea
Control Fortnight, Anemia Mukt Bharat, Mother’s Absolute Affection (MAA) Programme, revised
Maternal and Child Protection (MCP) Card and material related to growth monitoring developed by
Ministry of Women and Child Development and National Institute of Public Cooperation and Child
Development (NIPCCD).
LIST OF ABBREVIATIONS
SECTION 1
Introduction and Rationale of Home Based Care for Young Child Programme 1
SECTION 2
Roles and Responsibilities of the ASHA in Home Based Care for Young Child 9
SECTION 3
Planning for Home Visits 15
SECTION 4
Nutrition 23
4.1 Exclusive Breastfeeding 25
4.2 Complementary Feeding 28
4.3 Iron and Folic Acid Supplementation36
SECTION 5
Health 41
5.1 Family Planning 43
5.2 Full Immunization for Children 45
5.3 Growth Monitoring 48
5.4 Management of Sick Child During Home Visits 51
SECTION 6
Early Childhood Development 61
SECTION 7
Water, Sanitation and Hygiene 69
ANNEXURES 77
1
SECTION 1
Introduction and Rationale of
Home Based Care for Young Child
Programme
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 3
1.1 BACKGROUND
The implementation of the National Health Mission (NHM), has
helped India in reducing maternal and child deaths, and greatly
improved access of women and children to health care services.
In your own communities, you would have seen an increase
in children getting immunized, in pregnant women getting
antenatal care, in using health care facilities for deliveries, in the
use of family planning by couples, and generally making more
use of health care facilities. A large part of this success can be
attributed to your work as an ASHA. However, many healthcare challenges persist, and they need our
attention.
One example of this continuing challenge is malnutrition among young children. You know from your
training that child malnutrition is an important cause of deaths in under-five children. Children who
are undernourished have increased risk to infections, frequent episodes of illness and take longer
to recover. Malnutrition also affects their physical growth and mental development. There are many
programmes to address this problem, but the burden of malnutrition in children continues to remain
high in our country.
It is observed that-
• About half of the children under 6 months of age are exclusively breastfed.
• About 4 children out of 10 children under 3 years are breastfed within one hour of birth.
• 1 child out of 10 breastfeeding children aged 6-23 months receive an adequate diet (adequate
diet means-feeding several times a day as per the age recommendation and giving a diverse
variety of foods to meet the requirement for optimal growth and development).
• More than half the children between 6-59 months of age are anaemic (haemoglobin level less
than 11.0g/dl).
Underweight Children
About 4 children out of 10 children under five
years of age are underweight (have low weight
for their age).
Wasted Children
About 2 children out of 10 children under
five years of age are wasted (have low
weight for their length/height).
Stunted Children
About 4 children out of 10 children under five
years of age are stunted (have low height for
their age).
Early childhood is the most rapid period of development in human life and ensuring care of the
mother and the child from the point of conception to the first few years of life lays the basis for
healthy mental, emotional and physical growth of children.
A healthy childhood is not achieved by providing adequate nutrition and health care alone. Children
need an environment with parents/caregivers giving them love, affection and appreciation. It is
important for parents/caregivers to spend time playing and communicating with children for social,
mental and emotional development, which ultimately leads to healthy and happy children, leading to
a productive society. Such development helps the child to improve learning capacity, perform better
in school and form strong social bonds.
It has also been observed that around 3 months of age and beyond, problems such as discontinuation
of breastfeeding, delay in initiation or incomplete complementary feeding beyond six months,
poor care seeking for sickness, etc. arise. In addition, poor hygiene and sanitation and poor child
rearing practices in the home during this period may also lead to sub-optimal physical growth and
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 5
development of the child. Through structured home visits, these issues can be identified early and
appropriate actions can be taken, thus reducing the adverse impact of these factors.
To provide support for nutrition and early childhood development, the Home Based Care for Young
Child (HBYC) has been launched as part of the National Health Mission and POSHAN Abhiyaan of the
Ministry of Women and Child Development.
addition to the 6/7 visits for HBNC. You will visit SECOND 6th
the child on completion of 3 months, 6 months, 9 VISIT month
Home visits will allow you to identify problems early and support families in taking the appropriate
action, whether through improved home care practices or through visiting health facilities. The
additional home visits will increase contacts with the child and parents/caregivers during the first
fifteen months of life, providing opportunities for the following:
• Promote exclusive breastfeeding for the first 6 months of life.
• Emphasize timely, adequate and appropriate complementary
feeding for children on completion of six months and beyond.
• Build the capacity of mothers/caregivers through counselling
and support to identify and manage problems related to
nutrition and health in their child.
6 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
• Allow for early identification of delay in growth and development of children by using the
MCP card.
• Enable prevention and management of common childhood illnesses.
• Ensure prompt referral of sick children to health facilities for management of complications.
• Follow-up for compliance to medication and care of sick children discharged from health facilities.
The HBYC programme will target all children (girls and boys) between 3 months up to 15 months
of age. However, you have to give special attention to the healthcare and follow-up needs of low
birth weight children, sick children, malnourished children and children discharged from SNCU/
NBSU and NRC.
Using past training experience, ensure that girl children receive equal care and attention as given
to boys. Therefore, counselling of parents/caregivers during home visits to avoid discrimination on
account of gender should be given due priority.
Under HBYC, you will continue to work as a team with AWW and ANM/MPW to undertake the wider
range of actions to improve the nutritional status, growth and early childhood development of young
children. Details of roles and responsibilities are provided in the next section.
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 7
Figure 1: Existing contacts with children and families by ASHA and proposed additional visits
under HBYC
Before HBYC
There are no Home visits by ASHA for the child after 42nd day*
After HBYC
SECTION 2
Roles and Responsibilities of the
ASHA in Home Based Care
for Young Child
10 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 11
HBYC does not mean that the focus on the newborn is reduced. The 6/7 visits you make as part
of HBNC will continue, and you will undertake the following activities, which you have already
been undertaking. You will also continue to fill the HBNC form (Mother-Newborn Home
Visit Card) as you have been trained to do. Just to recapitulate, few of the activities under HBNC are
listed below:
1. Counsel mothers and families on key messages on newborn care such as infant
and young child feeding, assessment of malnutrition, keeping the newborn
warm, promotion of hand- washing, etc.
2. Provide skin, cord and eye care of the child.
3. Assess if the child is high risk, pre-term or low birth weight, and take action
accordingly.
4. Support the mother in sustaining breast feeding through teaching the mother
proper positioning and attachment, diagnosing and counselling in case there are problems
with breastfeeding.
5. Teach the mother to express breastmilk and feed baby using cup and spoon in
case of pre-mature newborn in order to sustain breastfeeding.
6. Advocate the family regarding the need for the mother to get
adequate rest and nutrition which helps the mother in recovering
from child-birth and in breastfeeding.
7. Monitor newborn’s weight and temperature.
8. Look for any signs of sickness and arrange for prompt referral to appropriate
facility in case you find danger signs in newborn.
9. Discourage unhealthy practices such as early bathing, bottle feeding, etc.
State
logo
2.1.2 The activities for HBYC are based on the revised Mother and Child Protection
(MCP) card. The MCP card forms the basis for you to plan interventions, both MOTHER AND CHILD
PROTECTION CARD
(MCP CARD)
for yourself and as support to AWW/ANM (MPW). The MCP card will work as a
reference material to help you complete all the activities. In the training, you will
be taught how to use the revised MCP card and undertake age-appropriate actions
as listed in the card (Refer page-8 in the MCP card). The ASHA Facilitator (AF) and
ANM/MPW will provide support and supervise you in effectively carrying out the
activities under HBYC.
Keep this card safe and carry along with you
during every visit to Village Health Sanitation
and Nutrition Day, Anganwadi Centre, Health
Centre and Hospital
2018 Version
1
12 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
Table 1: Key tasks at various ages of the child that will be performed by ASHA and AWW
Home Visits ASHA AWW*
At 3rd • Support exclusive breastfeeding • Weigh infants monthly
Month • Ensure recording/plotting of growth • Record weight of the child and plotting
chart- weight-for-age and weight- on growth chart (weight-for-age)
for- length/height by AWW; identify
• Record length/height of the child and
growth faltering
plotting on growth chart (weight-for-
• Check immunization status length/height)
• Counsel for the following- • Identify underweight and wasting
a. Exclusive breast feeding (birth to 6 in children and take appropriate
months) action
b. Hand- washing practices
• Counsel regarding growth monitoring
c. Family planning
d. Parenting-ensuring appropriate • Counsel mothers for exclusive breast
play and communication feeding from birth to 6 months of age
In addition to the tasks described in Table-1, you will also be trained on the components of HBYC
namely Nutrition, Health including family planning for the couple, Early Childhood Development and
activities related to Water, Sanitation and Hygiene (WASH).
early CHILDHOOD
NUTRITION HEALTH WASH
DEVELOPMENT
SECTION 3
Planning for Home Visits
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 17
1. ASHA diary/register- To help you list all young children between 3 months-15
months of age in your area. Among these, you will require to prepare an updated
list of children who have registered in Anganwadi Centre (AWC) and are due for
immunization.
2. HBYC card- HBYC card will be used to record details of activities undertaken
by you for receiving incentives for five additional home visits for each young
child (Annexure-1). The HBYC card will be provided to you by your state for
recording details of activities for each child. You will tick mark (√) and write yes/no (as specified)
against the activities conducted in two forms- HBYC card and in the MCP card (page-8) of the mother/
caregiver. HBYC card will be the basis for your payment. The MCP card will be retained by the mother/
caregiver.
3. Job-Aid- Job-Aid will be provided to you to conduct the home visits more effectively. This will help
you in recalling the key messages to be given to the mother/caregiver during each HBYC visit.
4. MCP card- You will be provided a copy of new MCP card during your training and you will be
required to use the MCP card as a reference material during your HBYC visits.
6. ASHA Kit- You will continue to use (medicines and HBNC kit) that
has been earlier provided to you for HBNC.
given for teaching the mother/caregivers to conduct age-specific milestone assessments for the
child. These items will be locally available in your area (e.g. handbell, torch, red plastic bangle, plastic
mirror, etc.) and can be collected while planning your HBYC visits to demonstrate use of these items
to the mother/caregivers. Some of these items may also be easily available from the nearest AWC.
Remember- It is not necessary that each ASHA will have exactly 1000
population under her. There is a variation in the population covered
under ASHA across the states.
*You will fill the HBYC card (given as Annexure-1) after completion of specified activities listed for 3 months, 6 months, 9
months, 12 months and 15 months visits and get them validated by your supervisor- ASHA Facilitator or the ANM/MPW. Your
supervisor will verify the activities completed for enabling you to earn Rs 50 incentive/visit (Rs. 250/- for five additional home
visits). Finally, the HBYC card will be submitted to your supervisor on completion of activities for each child. A counter foil of
HBYC card (given in Annexure-1) will be retained by you as reference copy.
In addition, as mentioned earlier in this section, you will also tick mark (√) and write yes/no
(as specified) against the activities conducted for each child in the MCP card of the mother/caregiver.
You may provide your signature and write the date of completion of home visit for the particular
month in the MCP card. This MCP card will be returned to the mother/caregiver.
• Families living in distant hamlets/tolas, whose houses lie between villages on hilltops or in
the fields, or in areas which are cut off during the rainy season.
• Families living in slum/slum like locations, homeless people
living on roadsides, under bridges, flyovers, along railway tracks,
in night shelters, homeless recovery shelters, beggars’ home,
leprosy homes, etc.
• Families with differently abled children, unaccompanied
children, elderly people or families where there is no adult
support. Families having members living with HIV and AIDS,
Tuberculosis, Leprosy, etc.
• Migrant families, either those who migrate into the village
community, or those who stay outside the village for livelihood
such as to urban areas- cities, towns, etc. and return periodically.
• Families engaged in unorganised/informal work and hazardous
occupation- construction, brick and lime kiln workers, head
loaders, sex workers, ragpickers, street children, etc.
• Families of those who work as daily wage labourers or are
seasonal workers, who have no employment and are destitute.
• Displaced populations usually in the case of any sudden impact
disaster, such as an earthquake or a flood-like situation, threat or
conflict, etc.
In addition to these social categories, two classes of children are particularly vulnerable.
1. Girl children- Across the country, we note that boys are given preference
over girls whether in feeding or health care-seeking for any illness. Girl
children are therefore particularly vulnerable and you must ensure that
your visits to homes with girl children also highlights the importance of
equal non-discriminatory behaviour in addition to other support that you
provide.
As the ASHA and a member of the community you know the families who fall in the category of being
vulnerable and marginalised. Your prime focus should be on children belonging to such families who
are the most vulnerable and likely to be unreached.
1. Mapping
You have already mapped children under five years of age within your
population. Ensure that a list of all those families which fall in the categories
of being vulnerable and marginalised (as discussed above) having
children from 3 months to 15 months of age is prepared and updated on a
routine basis.
2. Prioritizing
Under HBYC, you are required to make quarterly home visits to all children between 3 months to 15
months of age. However, due to specific constraints, children belonging to vulnerable and marginalised
households may get missed. You need to make extra efforts to ensure
that children from such families are not missed. Once you have mapped
all children eligible for HBYC in your population, you will particularly
focus on vulnerable and marginalised-families having girl child, where
children have not registered at the Anganwadi centre, families that do
not visit the Village Health Nutrition Day (VHND)/Urban Health
Nutrition Day (UHND) sessions, where a previous child death has
occurred, where children are malnourished, where children have not
been identified or admitted for nutritional rehabilitation due to lack of
prompt access to healthcare services, children discharged from SNCU
or NRC, families where children fall ill frequently or live in unhygienic
conditions, etc.
3. Communicating
You should inform the families about why these services are needed, where they are available, and what
their health entitlements are. The job-aid and MCP card which will be used as reference material can
help ensure that you do not miss any important message for the child during the scheduled home-visits.
4. Understanding
Often people have a reason or a problem for why they are not able to use health services. Do not
assume that their attitudes are bad. You may have to explore options for changing the way existing
services are being provided. You will have to discuss these concerns with your supervisors and bring
to their notice. For instance, in some cases, the ANM/MPW will need to make a home visit to provide
immunization to the child, or the Anganwadi worker will have to deliver the Take Home Ration (THR)
to the household for the child or to record weight and length/height of the child to monitor growth.
You may have to accompany these mothers/ caregivers during VHND/UHND sessions or healthcare
facilities if required, etc.
22 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
5. Counselling
6. Persisting
7. Coordinating
It is quite likely that there still remain families, who despite your persistent efforts will not
access services. You can ask members of the Village Health Sanitation and Nutrition Committee
(VHSNC), Mahila Arogya Samiti (MAS), Self- Help Group (SHG) or request your ASHA Facilitator
or the ANM/MPW, who may be in a position to influence these families, to accompany you on a
home visit.
8. Mobilizing
Getting people together gives people the confidence to change. Organization provides strength.
Building solidarity creates confidence. Leadership provides inspiration and optimism to break out
of age-old inertia. So, organize community meetings, join together to sing songs, take out a rally, and
celebrate survival. Mobilization is the most important tool of all.
23
SECTION 4
Nutrition
4.1 Exclusive Breastfeeding
4.2 Complementary Feeding
4.3 Iron and Folic Acid Supplementation
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 25
This section will further reinforce some of these important concepts to counsel families (mothers and
caregivers) during your HBYC visits.
• Listen but be careful not to sound critical. Try not to repeat questions. Some mothers/caregivers
tell you these things spontaneously. Others will give you information when you empathize and
show that you understand how they feel. Some mothers/caregivers take longer.
• Encourage the mother/caregivers to contact you, or the AWW or the ANM/MPW of their area in
case of problems related to breastfeeding.
You should reinforce the following key messages to promote breastfeeding amongst the mother/
caregivers:
26 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
• Mother should breastfeed as often as the child wants in day and night.
Frequent feeding helps mothers to produce more breastmilk.
• Breast feeding mother should eat extra and drink plenty of fluids to provide
adequate milk for the child during this time.
• Mother should pay attention to/observe early signs of hunger in the child like
restlessness, opening mouth and turning head from side to side, putting tongue
in and out and sucking on fingers or fists. Crying is a late sign of hunger. Mother
should smile, talk and look into child’s eyes while breastfeeding, encouraging
the child to communicate (but not rock the child while breastfeeding).
Counsel and reassure the mother in busting the myth that she does not have
enough milk for the growing child. Almost all mothers produce enough
breast milk for one or even two children up to 6 months of age. Usually, even
when a mother thinks that she does not have enough breast milk, her child
is in fact getting all that she/he needs. Build her confidence and support her
to breastfeed by increasing the number of times she feeds the child. She
should also be advised to take adequate rest.
Support the mother in recovering
from childbirth and advocate to the family members the
importance of adequate rest and nutrition for the mother.
Also, encourage the family to support the mother by sharing
her workload so that she can successfully breastfeed her
child.
Mothers also resume work during this time. You can counsel
them to feed the child before going and after coming back.
Also suggest these mothers to express milk for the day which
can be given to the child by other caregivers.
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 27
Remember
• To counsel that all children- both girls and boys from birth
to 6 months need to be breastfed on demand, both day and
night-at least 8 to 12 times in 24 hours.
• To use your skills learnt during your training in ASHA
Module-6 and 7, to correct the position for breastfeeding,
address common breastfeeding problems and common
reasons for decreased/stopping breastfeeding, teaching
expressing milk by hand and feeding the expressed milk.
• To reassure the family members and seek their support for
the mother in providing additional care to low birth weight
baby.
• To advise mother regarding storage of Expressed Breast Milk
(EBM):
¾¾ Can be kept in a covered container at room temperature for up to 6 hours.
¾¾ Milk not fed to the infant within 6 hours of expressing should be discarded.
¾¾ Can be stored in the main compartment of a regular refrigerator (2°C to 8°C) for 24 hours.
During your home visits, ensure that the mother continues to breastfeed exclusively for 6 months.
1. Timely
Introduced at completion of six months when requirement for energy and nutrients exceeds that
provided by breastmilk alone.
2. Adequate
3. Properly Fed
Active feeding method to encourage the child to eat more without forced
feeding. Children have small stomach therefore should be fed more
frequently. Feed children from a separate cup/katori/plate at recommended
frequency (Table 3).
4. Safe
Disadvantages of adding foods too soon i.e. Disadvantages of adding foods too late
before completion of 6 months of age i.e. later than completion of
6 months of age
• Decrease the intake or output of breast milk • Growth and development slows down or stops-
resulting in a low nutrient diet physical and brain growth faltering*
• Increase risk of illness especially diarrhoea • Risk of deficiencies and infectious diseases
*Growth faltering means the child does not grow in an age appropriate manner in terms of weight and length/height.
30 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
¾¾ Is the child breast fed at night? If yes, how many times is the child fed at night.
¾¾ Does the child receive separate serving from the family members?
¾¾ If yes, how?
The mother’s/caregiver’s answers to these questions will give you an idea whether the child is
receiving adequate amount of nutrition from breastfeeding and complementary feeding. You should
counsel for continuation of breastfeeding during the home visits, support them in maintaining age-
appropriate feeding pattern by counselling on what should be avoided and teach right quantities for
complementary feeds. It is also important to inform them about feeding during illness and recovery
phase and regarding specific nutritional needs of malnourished children.
• Introduce only one food at a time, variety can be increased by adding new foods one by one.
• Show interest, smile or play games to encourage children to eat enough food.
• Continue complementary feeding during illness and increase the amount during the recovery
period.
• Feed the child in a separate
cup/katori/plate as it will help Breastfeed
4 to 6 times/day
mother/caregivers to understand 3
the quantity of food eaten by the Don’t Dilute
2 4
Add Fats
unnecessarily
child. ‘Not Daal water
and Oils
but Daal’ Seven
• If the child dislikes a particular Messages for Yellow, Red and
Greens-More
The quantity mentioned may be difficult for a family to measure correctly. The size of cup/katori,
serving spoon/karchi, teaspoon and tablespoon can vary in size and shape. Thus, it is important to
explain the mother and caregiver about the quantity by showing common household utensils that
are used in the family for serving food.
With the child’s bowl, it can be easy to demonstrate how much is 1/2 (half), 3/4th, and a full cup/
katori as shown in the figure given below.
At 6 months - On completion of 6
months, start feeding 2-3 tablespoons
at each meal of soft, well-mashed
foods, 2-3 times each day.
For 2 years and older children, give a variety of family foods to the child, at least 1 full cup/katori
(250ml) at each meal, 3-4 meals each day with 1-2 nutritious snacks between meals.
messages related to early and exclusive breastfeeding and age- appropriate complementary feeding,
respectively can be explained to the mother/caregiver. During each home visit from 3 months up to
15 months, you will:
• Encourage the mother/caregiver to exclusively breastfeed the child from birth to 6 months and
provide complementary feeding on completion of 6 months of age, to girl and boy children alike.
• Ensure support from family members- First 3
Visit
husband, mother and father in-law, etc. Month
Fourth 12
• Refer mothers with problems in breastfeeding Visit
Month
As an ASHA, you can mobilise support from VHSNC/MAS, VHNDs/UHNDs, self-help group meetings,
mother’s group meetings, support groups, etc. for promotion and counselling activities related to
breastfeeding and complementary feeding. These groups can also help you in overcoming the harmful
traditional practices and beliefs related to young child feeding and nutrition prevalent amongst mothers-
in- law, fathers- in-law, husband and other family members.
On completion of 6 months of age, counsel mother/caregiver to ensure that all children are being
given healthy food in adequate amount through responsive feeding and continued frequent on
demand breastfeeding for at least 2 years.
36 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
To overcome this problem, government has launched Anemia Mukt Bharat campaign recently to
promote Iron and Folic Acid (IFA) supplementation for prevention of anaemia in all children 6-59
months of age. The dose and regime of IFA supplementation and deworming under the programme
is explained in this chapter.
Table 5: Dose and regime for Iron Folic Acid supplementation for prevention of anaemia*
Age group Dose and regime
Children 6-59 Biweekly, 1 ml Iron and Folic Acid syrup
months of age* Each ml of Iron and Folic Acid syrup containing 20 mg elemental
Iron + 100 mcg of Folic Acid
Bottle (50ml) to have an ‘auto-dispenser’ and information leaflet
as per Ministry of Health and Family Welfare guidelines in the
mono-carton IFA SUPPLEMENT
Source: Operational Guidelines for Programme Managers. Anemia Mukt Bharat-Intensified National Iron Plus Initiative
(I-NIPI), Ministry of Health and Family Welfare, Government of India, 2018.
*IFA syrup should not be given in children suffering from acute illness (fever, diarrhoea, pneumonia, etc.). Mother/caregiver
should be advised to continue subsequent doses of IFA supplementation as soon as the child recovers from these illnesses. It is
also not to be provided in children suffering from thalassemia major and in those with history of repeated blood transfusion.
The IFA supplementation in severely acute malnourished (SAM) children, should be continued as per management protocol for
SAM management provided by NRC or Primary Health Centre (PHC/UPHC) Medical Officer.
4.3.3 Deworming
Children and adolescents: To address the problem of transmission of worms
from soil, the government has been implementing the National Deworming Day
programme. The programme undertakes biannual mass deworming (albendazole
tablet) campaign for children and adolescents in the age groups between 1 and 19 ALBENDAZOLE
• You will be provided 50 ml IFA syrup bottle (with auto-dispenser) from PHC/Sub-centre; 2
bottles/ child/year (in first year of child, one 50 ml bottle will be required). You will write the
date of giving the IFA syrup bottle to the mother/caregiver in the compliance card as given on
page 27 in the MCP card.
• The IFA syrup bottles have an auto-dispenser so that only 1 ml of syrup will be dispensed at a
time (having the required dosage for children).
• You can provide the 50 ml IFA syrup bottle (with auto-dispenser) to mothers/caregivers during
home visits or utilize the platform of VHND/UHND or other dedicated rounds such as Vitamin A
round, etc.
• Albendazole tablets will be provided to children for biannual deworming, with dose as given
in the table above (once in 6 months) during the National Deworming Day (10th February and
10th August every year). Under this strategy, under-five children, out-of school children and
adolescents are provided deworming tablet at Anganwadi centres by AWWs, whereas school-
going children and adolescents are provided the deworming treatment through school platform.
The date of administration of albendazole to the child will be entered by ANM/MPW as given on
Page 27 in the MCP card.
Fortified Foods
FORTIFIED
FOODS
Food fortification refers to the addition of micronutrients (vitamins and minerals required in
small amounts for development) in a food so as to improve the nutritional quality of food at very
reasonable cost and to provide public health benefit with minimal risk to health. Fortified food
is a food which has undergone the process of fortification as per regulations. The Government of
India has mandated the use of fortified salt, wheat flour and oil in foods served under Integrated
Child Development Services (ICDS) and Mid-day Meal (MDM) schemes
to address micronutrient deficiencies. In addition, all health facility-
based programmes where food is being provided are mandated to
provide fortified wheat, rice (with iron, folic acid and vitamin B12), and
double fortified salt (with iodine and iron), and oil (with vitamin A and
D) as per standards for fortification of staple foods (salt, wheat, rice,
milk and oil) prescribed and notified by the Food Safety and Standards
Authority of India (FSSAI, 2016).
• Demonstrate to the mothers/caregivers to provide IFA syrup through the auto- dispenser bottle.
Follow these steps for giving IFA syrup:
a. Child must be held in the mother’s/caregiver’s lap.
y s
the entire dose. bo
ta and
Wan ID BODYD?
O L I N
e. Explain the mother/caregiver that child should S RT M
SMA
be administered IFA syrup only on fixed days
on a biweekly basis (preferably Wednesday and
Saturday).
IRON RICH FOODS
EAT
f. IFA should be given at least one hour after VITAMIN C
ALBENDAZOLE
RICH
g. Mark a tick (√) in the compliance card as given on page 27 in the MCP card after giving the dose FREE
¾¾ Importance of providing the IFA supplementation and biannual deworming in children; its
positive impact on physical and mental development of the child e.g. improvement in well-
being, attentiveness in studies and intelligence, etc.
¾¾ Minor side effects associated with IFA administration such as black discolouration of stools.
¾¾ Preservation of IFA bottle – in a cool and dark place, away from reach of children, keeping the
lid of the bottle tightly closed each time after administration, etc.
¾¾ Immediately contacting the ANM/MPW in case of any problem after consumption of iron folic
acid syrup by the child.
¾¾ Informing them to contact either you or the ANM/MPW for a new IFA syrup bottle if the bottle
finishes.
Provide mother/caregiver with the IFA syrup bottle and during your home visits ensure
children receive biweekly IFA supplementation. Mobilise the families having children aged
12-59 months of age for biannual deworming with albendazole tablets.
41
SECTION 5
Health
5.1 Family Planning
5.2 Full Immunization for Children
5.3 Growth Monitoring
5.4 Management of Sick Child During Home Visits
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 43
Under HBNC visits, you have been maintaining and updating the list of eligible couples, lactating
mothers, children below 5 years of age in your community in the health register, counselling the
mother after delivery regarding the need of contraceptive services, reinforcing the concept of
healthy timing and spacing of births, enabling them to make an informed choice, and ensuring
access to contraceptive services.
Remember
Of all the contraceptive methods available, COCs (Mala- N) should not be taken by women
who are breastfeeding till six months after delivery as it affects the quantity and quality of
breastmilk. Centchroman pills (Chhaya) and POPs can be started anytime after delivery once
woman is comfortable. Injectable MPA (Antara Programme) can be taken by women after 6
weeks of delivery and IUCD can be inserted immediately or within 48 hours of vaginal delivery
(and immediately after Caesarean section). Thereafter, IUCD can be inserted beyond 6 weeks of
delivery. IUCD can also be inserted within 12 days of completion of abortion. All other spacing
contraceptives can be started immediately or within 7 days of completion of abortion.
3. Emergency Contraceptive Pill (Ezy pill)- This is not a regular method of contraception. It must
be consumed within 72 hours (the earlier, the better) in cases of unplanned/ unprotected/ forced
intercourse or accidental breaking/ slipping of the condom.
You are being incentivized for ensuring spacing of 3 years after the birth of 1st child and in case
the couple opts for permanent limiting method after 2 children. Additionally, you are incentivized
for counselling and escorting the client for Postpartum IUCD (PPIUCD)/Post Abortion IUCD
(PAIUCD) insertion.
5.1.2 During your home visits, you will counsel the couples on family
planning
• Explain the risk of unprotected sex and high chances of conceiving. Mention that return of
fertility is uncertain and women can conceive even before their menses/periods return.
• Counsel couples to maintain spacing of 3 years between two children for the health of both
mother and child.
• Counsel the couple on available basket of contraceptive choices under the National Family
Planning Program for spacing and limiting births.
• Counsel couples for adoption of appropriate family planning methods in post-partum/ post
abortion period.
• Deliver contraceptives like Nirodh (condoms), Mala-N, Chhaya and Ezy pills at the doorstep of
beneficiaries.
• Inform the couples about availability of all contraceptives services free of cost in the public health
facilities.
• Escort the woman to health facility if she chooses to adopt PPIUCD/PAIUCD services or
sterilization services.
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Additional Home Visits to Address the Young Child 45
• Inform the couple to contact you or other healthcare providers to seek information
regarding available methods and help them choose a method that is most suitable to them.
During your home visits, counsel the couple on the importance of family planning and maintaining
healthy timing and spacing of birth, also inform them regarding the availability of wide range of
contraceptive methods and help them make suitable choices of these methods.
5.2.1 National Immunization Schedule VACCINATION NAME BIRTH 1 1/2 2 1/2 3 1/2 9 1 1/2
months months months months years
BCG
prevents tuberculosis
Page 36 of the MCP card provides detail of National Hepatitis B
Immunization Schedule for children at birth to 9 months prevents liver disease
OPV
of age and page 37 of the MCP card provides details for prevents polio
IPV
children from 16-24 months to 16 years of age. prevents polio
Penta
prevents whooping
ANM/MPW will fill the details- date of vaccination and cough, diptheria,
tetanus, Hep B and
also write the next vaccination date in the MCP card and Hib infections
PCV
will return the card to the mother. You may refer to the prevents pneumonia
MCP card, page 36 to check the immunization status of Rota
prevents diarrhoea
the child during the household visits from 3rd month to MR
prevents measles,
15 months of age and use the Immunization Essentials rubella
as given on page number 38, to understand the updated Japanese
encephalitis
immunization schedule of vaccination from birth to 11/2 prevents brain fever
DPT
years of age. prevents whooping
cough, diptheria and
tetanus
5.2.2 Possible reasons for low
immunization coverage
To address the gaps in improving population coverage it is important to understand the possible
reasons for low immunization coverage. From your experience you will know that some of these
possible reasons are-
• Lack of awareness of benefits of routine immunization- Families/caregivers are unaware
regarding the benefits of Routine Immunization (RI).
• Failure to organize immunization camps- At planned outreach site (anganwadi centre during
monthly VHND/UHND), Sub-centre (SC) or Primary Health Centre (PHC)/Urban Primary Health
Centre (UPHC) sites due to shortage of frontline staff.
46 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
• Lack of information- The healthcare providers have not informed the families/caregivers about
what vaccines are due, when they are due and why they are needed.
• Drop-outs- Children who receive one or more vaccination, but do not return for subsequent
doses. Often families migrate for livelihood and children belonging to these families miss out on
vaccination.
• Unreached population- There are usually the vulnerable or marginalised populations (the
categories belonging to such families has been taught in social vulnerability section) who do not
know about immunization or face socio-economic barriers to utilize health services.
• Geographic barrier- People living too far away from a health centre or outreach site are unable
to travel long distances and face challenges in completing a full immunization schedule for
children.
• Resistant population- Families do not believe in immunization services, even though a health
centre is within reach, as there is fear of side effects, etc.
• Missed opportunities- Seen in case of children who visit the health centre for some other reason
but are not screened for immunization by health workers.
• Cultural or religious reasons- There is refusal of vaccination due to myths, rumors and
misconceptions prevalent in few sections of the society.
• Gender barrier- Sometimes women are not allowed to attend sessions by their family members.
Also, if it is a girl child, family members may not give importance to her vaccination.
• Financial barrier- Sometimes families do not attend immunization sessions because of wage
loss, etc.
• Fear of Adverse Effects Following Immunization (AEFI)- Fear of AEFI is also a major cause of
refusal of vaccines.
• Pay special attention to include children from families who are vulnerable or marginalised, sick,
LBW and malnourished infants. Joint visits may be undertaken with ASHA Facilitators and ANMs/
MPW to mobilize these children for immunization.
• Ensure effective mobilization of children for immunization
sessions during VHND/UHND session or at the health
facilities. This can be achieved by-
¾¾ Escorting the mother/caregiver and child to the session/
health centre for immunization, if required. This may
be required for families living in remote areas or those
having sick children, malnourished children, girl child,
etc.
¾¾ VHSNC/MAS members playing an important role to motivate resistant families for immunization.
Initiate community level action to enable positioning of ANM/MPW and AWW in sub-centres/
AWCs in hamlets or urban slums/basti which do have these frontline functionaries.
A Routine Immunization Counterfoil, as given on Page 39 and 40 in the MCP card, enlists the date of
vaccination from birth to 16 years of age, which is to be kept with the ANM/MPW to maintain the
child’s record.
During each visit, check the immunization status of the child in the MCP card to ensure that child
is up to date as per the immunization schedule.
48 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
These changes are useful in giving advice to the mother about the growing pattern of the child. This
process is called ‘GROWTH MONITORING’. You are already familiar with growth monitoring from
your training in ASHA Module 7.
Weight (kg)
Weight (kg)
yr.
Birth
Age (completed weeks, months and years) Age (completed weeks, months and years)
ensure equal care for the girl child Have your child weighed at the AWC every month
32 32
32 32
3
30 30
30 3 30
28 28
28 2 28
2
26 26
Weight (kg)
-2
(kg)
-2
32
Weight (kg)
18 18
18 18 -3
16 16
16 16
14 14
14 14
12 12
12 12
10 10
10 10
8 8
The AWW uses the growth chart for monitoring growth for every child, separately available for girls
and boys. Every child in the village, should be weighed and her/his weight be plotted on the growth
chart according to the age of the child. In addition, the length/height of the child will also be recorded
in the growth chart given for weight-for-length/height. The AWW will be responsible for recording
weight and length/height of the child during VHNDs/UHNDs, or the ANM/MPW can also record the
weight and length/height of the child in the SC or during outreach sessions.
As part of your HBYC visits, you need to ensure that the weight and length/height of the child is
recorded by the AWW and details are made available to the mother/caregiver by the AWW either
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 49
in MCP card or other mechanism as specified by your district or State. If the weight and/or length/
height of the child is not recorded, you will mobilise and accompany the mother/caregiver to the
nearest Anganwadi Centre (AWC) or SC for recording the weight and length/height of the child for
ensuring growth monitoring.
By joining the weight dots on the growth chart, the curve (called growth curve) on the growth chart
can be understood. The direction of the growth curve indicates the progress of the child and is
helpful in providing appropriate counselling and initiating necessary actions such as referral etc. for
malnourished children.
Praise, and assess feeding to Review feeding, praise what she is doing Follow- up after 5 days to
reinforce the good practices of well and identify feeding problems, if ensure compliance.
the mother/caregiver. any and give appropriate feeding advice
for bringing about change. Check for any
episode of illness. Take corrective action.
Follow-up for compliance.
You have already learnt in ASHA Module- 7, on how to check for nutritional oedema of both feet. To check for oedema (swelling
due to fluid retention), grasp the foot so that it rests in your hand with your thumb on top of the foot. Press your thumb gently
for a few seconds on the upper surface of each foot. The child has oedema if a pit (dent) remains in the foot when you lift your
thumb. This is one of the ways to detect children with severe malnutrition in the community. Such children will require prompt
hospitalisation in a centre which manages such children. This is often the District Hospital.
50 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
• Discuss the trend of growth of the child with the mother/caregiver during each of the
home visits by looking at the MCP card or as communicated by the AWW. Provide
counselling depending on the direction of the growth curve in the MCP card or as specified by
the AWW.
• Prioritise and list children who are underweight, wasted, low birth weight, not gained weight for
2 months, are not growing well or who are “at risk” of undernutrition due to frequent illnesses
like fever, diarrhoea and acute respiratory infection; children with inadequate or insufficient
dietary intake, mother with illness or those living in unhygienic conditions, etc., should also be
weighed frequently for taking corrective and timely action.
• Ensure early registration of all children soon after birth to 15 months of age at the nearest AWC
to avail the child care services like supplementary nutritional support, growth monitoring and
promotion, immunization, early child care, health check-up, referral services, etc.
• Ensure that children from 6 months of age to 15 months are provided Take Home Ration (THR)
at the AWC.
• Counsel the mother/caregiver regarding promotion of exclusive breastfeeding for the first six
months of a child’s life, age-appropriate complementary feeding practices for all children aged
6–24 months, importance of hand-washing, using clean drinking water and its storage, safe
sanitation and hygiene practices, age-specific immunization, appropriate play and communication
with the child, etc. for proper growth and development.
• Pay extra attention to malnourished children, sick children, low birth weight children, etc. and
refer to the health facility for further management in case of growth faltering. Follow-up with
mother/caregiver to ensure adherence to treatment plan suggested by health facilities for these
children.
• Use platforms like VHSNC/MAS, VHND/UHND, camps, mother support groups, self-help
groups, community meetings, etc. to disseminate the importance of growth monitoring
and finding suitable measures for rehabilitation and management of the malnourished
children.
• Explore the option of using untied funds of VHSNC/MAS to meet the special care needs of
malnourished children if required.
During each visit, ensure that weight and length/height of the child is recorded by the AWW and
details are made available for understanding the growth pattern of each child.
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You along with the ANM/MPW at community level will work together to protect, prevent and treat
children below 15 months of age from common childhood illnesses discussed in this section.
2. Refer urgently to the nearest health facility if the fever has been
present every day for more than seven days or if there are any general
danger signs or stiffness of neck.
¾¾ Offerthe child extra to drink (home fluids)- rice-pulse based drink, vegetable soup, green
coconut water, milk, lemon drink, plain clean water, yoghurt drink, etc. (if child is above
6 months of age).
Pneumonia, one of the most common ARI in children, is caused by certain germs, such as bacteria
or viruses and affects the lungs. It can spread in a number of ways. The viruses and bacteria that are
commonly found in a child’s nose or throat, can infect the lungs if they are inhaled. They may also
spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through
blood, especially during and shortly after birth.
The MCP card, on page 9 provides details of identification of pneumonia and breath counts to identify
pneumonia. Counsel mother/caregiver on identification of pneumonia using the MCP card during
your home visits.
It can be identified by breath counts. Coughing Fast breathing Chest indrawing Fever
Count the breaths in one minute to gets worse
assess difficulty in breathing based
on what you have learnt in earlier trainings.
If the child’s age is The child has fast breathing if you count
Less than 2 months 60 breaths per minute or more
2 months to 12 months/1 year 50 breaths per minute or more
12 months/1 year to 5 years 40 breaths per minute or more
Note: The child who is exactly 12 months old (1 year) has fast breathing if you count 40 breaths per minute or more.
54 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
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Classify and provide appropriate management of ARI as follows if you come across a child suffering
from ARI during your home visit.
Watch for the following signs and return quickly if they occur:
• Child becomes sicker
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 55
• Fast breathing
• Difficult breathing
• Develops a fever Keep children covered Do not keep new born Use LPG gas stove
in warm woollen without clothes for cooking to avoid
clothes during winters smoke in the house
The MCP card, on page 9 provides details of and do not let them
walk barefoot
prevention of pneumonia. Counsel mother/
caregiver on prevention of pneumonia using the
MCP card during your home visits.
4. Assess for the classification of dehydration and administer appropriate treatment as per the
table below.
The MCP card, on page 9 provides details on prevention and treatment of diarrhoea. Counsel
mother/caregiver on prevention and treatment of diarrhoea using the MCP card during your
home visits.
Table 10– Classification for appropriate management for different types of dehydration in children
Refer Annexure-2 for age-specific dose of Paracetamol, Cotrimoxazole and Antimalarials for children.
2. Pour all the ORS powder from a packet into a clean container.
3. Measure one litre of clean drinking water and pour it into the container in
which you poured ORS. (If you have ORS packets for 1/2 liter of water then
take 1/2 liter water.)
4. Stir until all the powder in the container has been mixed with water and
none remain at the bottom of the container.
Ta
5. Taste ORS solution before giving it to the child. It should taste like tears - ste
ORS
neither too sweet nor to salty. If it tastes too sweet or too salty then throw
away the solution and prepare ORS solution again.
6. Any ORS solution which is left over after 24 hours should be thrown away.
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 57
Remember
• Ask the mother/caregiver to give one teaspoon of the solution to
the child. This should be repeated every 1-2 minutes (an older child
who can drink it in sips should be given one sip every 1-2 minutes).
• In case of a diarrhoeal or vomit episode during ORS administration,
the child and mother/caregiver and the area should be thoroughly
cleaned.
• After washing hands again with soap and water, the mother/
ORS
caregiver should administer ORS more slowly than before. Breastfed
babies should be continued to be given breast milk in between ORS.
58 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
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5.4.7 Initiate and Suggest Plan A to mothers and care givers: If the
child has diarrhoea but no dehydration
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Additional Home Visits to Address the Young Child 59
One zinc tablet in the blister pack contains 20 mg of zinc (zinc tablets will be provided to the ASHAs).
1. If zinc is to be administered to children 2 – 6 months age
a. Half- tablet (i.e. 10 mg). is to be given. Discard the remaining half tablet.
c.
Request the mother to express milk from her
breast into the spoon and then add ½ tablet.
2. If Zinc is to be administered to children 6 months to 5
years age, the dose is full tablet (20 mg).
c. Shake the spoon slowly till the tablet dissolves completely. Do not use fingertip or any
material to dissolve the tablet.
d. Tell the mother/caregiver to hold the child comfortably and ask her to feed the solution to
the child.
e. If there is any powder remaining in the spoon, let the child lick or add little more breast
milk or water to dissolve it and then ask the mother/caregiver to give it again.
3. Counsel the mother/caregiver to administer zinc once a day for a total of 14 days to children of
all ages (2 months - 5 years of age).
61
SECTION 6
Early Childhood
Development
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Additional Home Visits to Address the Young Child 63
Some children show an interest or skills in an activity earlier than others or later than others.
Some children develop very early, such as learning how to walk or talk much earlier than other
children of the same age.
• Low weight babies, malnourished children, sick children,
children discharged from SNCU/NBSU/NRC etc. need extra
stimulation with play and communication activities, to grow
and develop well. Families of such children should be constantly
encouraged and motivated to play and communicate with their
children.
• If the child seems ‘slow’ or ‘unable to respond’, families must
be encouraged to provide extra care-play and communicate
with the child through touch and movement.
The MCP card (page 12-25) provides details of milestones of children from 2-3 months of age up to
3 years of age, which is divided in three sections. These are what most babies do, parenting tips for
children and “warning” signs.
You will undertake the following activities during the household visits to support the early
childhood development-
a. Help the mother/caregivers understand what most babies do at a specific age-This is
done by using the MCP card section on ‘What most babies do’ (page 12-21), to track progress on
development milestones of the child. There are certain milestones that have been given for 2-3
months to 15-18 months of age children.
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Additional Home Visits to Address the Young Child 65
b. Teach the mothers/caregivers to undertake milestone assessment- You will need to teach
mothers and caregivers the right method to observe and elicit information for various milestones
at a particular age. This is explained in detail in the Learning Tool for
Milestone Assessment (LTMA) that is included as Annexure-4 in the
handbook. You will use this tool to teach the mother and caregivers to
conduct an assessment for the milestones achieved by the child at a
particular age. The tool provides details of normal milestones/ expected
activities that are undertaken by the child at a particular age, what are
the ways to observe these milestones and warning signs that require
referral. You will need to teach the mother/caregiver, age-specific
milestone assessments prior to your scheduled HBYC visit for the
particular age group. For example- To assess the milestone assessment
by mother/caregiver at 3 months, you will have to teach them the
assessment during your 42nd day of HBNC visit or any other in-between contact with the family.
Likewise, for assessment at 6 months, you will need to inform mother/caregiver about milestone
assessment for this age-group during your 3rd month household visit. Such a pattern will be
required for subsequent age groups till 15 months of age of the child.
c. Demonstrate the use of local toys/items to elicit information on
milestones-The LTMA mentions using a set of commonly available
items for teaching the mothers/caregivers conduct age-specific
milestone assessment for the child. These items are easily available,
locally in your village/slum area and can be collected while planning
your HBYC visits to demonstrate use of these items to the mothers and
caregivers. The items required for ECD screening is given in Annexure-3.
d. Inform mothers/caregivers to record observations in the MCP Card- Once the mothers/
caregivers have learnt to conduct the age specific milestone assessment for their child, you
will inform them to record their observations for each activity in the child’s MCP card on the
first day that their child performs these activities. For the child who is able to perform the
age specific activity, the parents/caregivers will need to a provide a tick mark (√) against the
specific activity in the MCP card. For any activity that the child is unable to perform the parents/
caregivers will leave the box blank ( ) in the MCP card for the activity concerned. You will
explain the mothers/caregivers that they should not worry or panic even if the child is unable
to perform some of these activities at the specific age mentioned in the MCP card because each
child is unique and not all children develop at the same rate. Timings of development milestone
could vary from child to child. Some children show an interest or skills in an activity earlier
than others or later than others. Some children develop very early, such as learning how to
walk or talk much earlier than other children of the same age. Thus, at any circumstance a
mother/caregiver is not expected to a put a cross mark ( X ) in the blank box ( ) provided in
the MCP card against these activities.
Do not forget to inform the mother/caregiver that the MCP card will serve as a photo-album for
their child. They should preserve it because it is the health record for the child and she/he will
find it interesting and will be happy to see her/his developmental journey later in life.
66 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
¾¾ If the parents/caregivers do not play with the child, discuss ways to help child see, hear,
feel and move, appropriate for child’s age and ask caregiver to do play or communication
activity, appropriate for age. Encourage the family
members to use non-sharp household objects that
are clean and safe for the child for playing, if the
household does not have toys for the child to play.
¾¾ If the parent/caregiver does not talk to child or
talks harshly to child and child is less than 6 months,
ask caregiver to look into child’s eye and talk to the
child. For older children, give caregiver and child an
activity to do together. Help caregiver understand
what child is doing and thinking and see if child responds and smiles. Help the caregiver in
understanding that talking before the child talks prepares the child for talking, as children
copy speech and actions of others around them.
¾¾ If the parent/caregiver tries to force smile or is not responsive to child, ask caregiver
make gestures and cooing sounds; copy child’s sounds and gestures and see child’s responses.
Inform them about ways to make the child smile- e.g. make a funny face, gently rub the child’s
tummy, clap their hands, play games with the child, etc.
¾¾ If the parent/caregiver shows anger at the child, help caregiver distract child from unwanted
actions by giving alternative toy or activity.
¾¾ If the parent/caregiver is not able to comfort child and child does not look at the caregiver
for comfort, help caregiver look into child’s eye and gently talk to child and hold child.
¾¾ If the parent/caregiver says the child is slow to learn, encourage more activity with the
child, check hearing and seeing. Refer child with difficulties to the nearest health centre.
Children learn by playing, trying things out and by observing and copying the actions what
others do.
¾¾ Keep the child in clean surroundings by placing the child on a clean mat or clean carpet (dari)
or clean cloth while playing.
¾¾ Keep dangerous substances like medicines, poisons, insecticides, bleach, acids and liquid fertilizers
and fuels (kerosene) out of children’s reach. Store carefully in clearly marked containers.
¾¾ Keep children away from fires, cooking stoves, hot liquids and foods, and exposed electric
wires to prevent burn injury.
68 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
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¾¾ Never leave young children alone in or near water as they can drown in a very small amount of
water, even in a tub/bucket.
¾¾ Do not let young children play on or near the road; always have someone older supervise them.
¾¾ Secure stairs, roofs and windows using barriers in order to protect children from falling.
¾¾ Keep sharp and thin objects like knives, scissors, needles, etc. out of reach of children.
¾¾ Keep small objects, such as coins, nuts and buttons, etc. out of reach as young children like to
put them in their mouth. This can lead to choking.
You will teach the mother/caregiver to undertake milestone assessment, check for
developmental delays and provide appropriate counselling on parenting the child as provided
in the MCP card during each home visit.
69
SECTION 7
Water, Sanitation and Hygiene
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Additional Home Visits to Address the Young Child 71
To accelerate the efforts to achieve universal sanitation coverage and to put focus on sanitation, the
Government of India launched the Swachh Bharat Mission (SBM) on 2nd October, 2014.
You must make sure your hands are washed properly with soap before touching the child. Proper
hand-washing means washing your hands for at least 30 seconds with soap and water to remove
germs and dirt from the hands.
You have been taught the steps of hand-washing in ASHA Module-6. The steps involved in hand-
washing are given in the figure below.
72 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
Remove rings, bangles, wrist watch or any other Scrub your palms of both hands from the front and Scrub your knuckles of
ornament or bands from both hands. back and clean the area between your fingers. both hands.
Roll the sleeves of garment up to elbow level. Wet
hands and forearm up to elbow with clean water.
Apply soap properly on wet hands and forearm up
to elbow to create good lather (foam).
Scrub your thumb of Scrub your nails of Scrub both the wrists, Wash your hands and forearms thoroughly
both hands. both hands by rubbing by moving down slowly with clean water.
against your palms. scrubbing both the Air-dry with hands up, elbows facing the
forearms. ground.
Do not use towel or any cloth to dry the hands
and not touch the ground or dirty objects after
washing hands.
You must practice the steps of hand-washing during each visit. Also, ensure that families are
counselled on hand- washing and hand-washing is practised by them to prevent the spread
of illness within the household.
77
ANNEXURES
78 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
Sub-Centre PHC/UPHC
Home Based Care for Young Child visits after 6 weeks (To be filled by the ASHA during home visits,
verified by ASHA Facilitator or ANM/MPW after completion of each scheduled home visits-3 months,
6 months, 9 months, 12 months and 15 months and submitted to ASHA Facilitator or ANM/MPW after
completion of each visit).
Sub-Centre PHC/UPHC
(DD/MM/YYYY)
80 HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child
1. Dosage of Paracetamol for High Fever (38.5 degree Celsius or above/101.3 degree
Fahrenheit or above)
a. Paracetamol Tablet
¾¾ 1 tablet = 500 mg
Paracetamol
Age and weight of the child Dose of Tablet Frequency
2 months up to 3 years (4 - 14 kg) ¼ tablet (One-fourth) Maximum 4 times a day
Source: ASHA Module 7-Skills that Save Lives, Ministry of Health and Family Welfare.
b. Paracetamol Syrup
� 5ml (1 tsp) syrup=125 mg/5ml (Each 1ml contains 25mg of paracetamol)
Source: ASHA Module 7-Skills that Save Lives, Ministry of Health and Family Welfare.
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
Additional Home Visits to Address the Young Child 81
3.2 Vivax malaria: If blood smear positive for Plasmodium vivax (P.v), give Chloroquine for 3
days and Primaquine for 14 days.
Chloroquine for P. vivax:
25 mg/kg body weight divided over 3 days i.e. 10mg/kg body weight on day 1, 10 mg/kg body weight
on day 2 and 5 mg/kg body weight on day 3;
Primaquine: 0.25 mg/kg body weight daily for 14 days.
Source- Operational Manual for Malaria Elimination in India. Directorate of National Vector- Borne Disease Control Programme,
Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, 2016.
Source- Operational Manual for Malaria Elimination in India. Directorate of National Vector- Borne Disease Control Programme,
Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, 2016.
months which
is persistent or
no eye contact.
9. Toy car or any colorful toy Look for toys that have been
and cloth Or Red Ball with hidden in front of them by 7-9
a plastic katori or plastic months.
bowl
Does not search for half hidden
toys that the child sees you hide
by 12 months.
10. Pull toy Does not walk steadily while
pulling an object by 24 months.
12. Pictorial Book with only The child will be able to identify
single photo on each page and name common objects in
the picture book. This test
should be performed by 18
months of age.
Age Normal milestone/ How to Elicit and Observe these milestones Warning Signs Requiring Referral
Expected activities
By 2-3 • Make eye contact Th ese three tests can be done sequentially: in a quiet By the age of 3 months, if the child is
Months and calm room after feeding the child. observed with:
(a) The mother is asked to lean over the child’s face close a. Not making an eye contact with the
to a distance of 10 -12 inches and to look into the eyes of mother during breast feeding or
the child . He/she will spontaneously make an eye talking
contact with the mother. Does the child make eye
contact? (Focus their eyes on the eyes of a care giver)
• Develop social smile b) After establishing the eye contact the mother at the
child and the child will spontaneously smile back at her
as response to her smile. The duration of this
interaction increases with age. Does the child give a
social smile? (Reciprocal, responds to mother expression
or smile i.e. smile back at you) b. No social smile
• Begin to recognize the c) By this age, the child also starts identifying the
mother’s face. mother’s face and shows more interest towards the
mother compared to others. Does the child respond to
mother’s face by looking directly at her face? c. The child is cranky most of the time
Record the responses in the MCP card. and may be difficult to
console when starts crying
even for a mother
d. Persistent squinting
after 2 months
• Raise head when on The child should be fed at least half an hour before and The child cannot lift head at all and
tummy at times should remain awake. Put the child lying on stomach on unable to clear his or her nose due to
the bed and observe whether the child lift his/her head very low tone
at least 2 -3 inches from the surface for a brief period . By
the age the child will be able to raise the head more and
for a longer period.
Record the response in the MCP card..
Additional Home Visits to Address the Young Child
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
89
90
Age Normal milestone/ Expected How to Elicit and Observe these milestones Warning Signs Requiring Referral
By 2-3 • Move both arms & both legs, Place the child on the bed or observe on mother’s lap. The child a. The child does not move arms and legs at all.
when excited. should be awake and fed. The child should be minimally dressed [in
Months b. The child only moves arm and leg of the same side
diaper (chaddi) and a vest]. The ambient room temperature should and do not move the arm and leg of the other side
of the body as vigorously as the other side.
be comfortable in comparison to outside temperature.
c.
The child will kick vigorously both legs alternately horizontally and
• Keep hands open and relaxed. While throwing his or her legs and arms, his or her shoulders and
trunk will remain stable in midline.
Additional Home Visits to Address the Young Child
she may voluntarily close and open his or her hands while playing
d.
• The child respond to voice or Put the child lying on his/her back. The room should be quiet and a. The child does not react at all.
startles with loud sounds or
becomes alert to new sound by
hand
then on the other beyond the child’s visual range.
The child may react in any of the following ways:
a) Frown
b) Stops moving for a while
c) Wide opening of eyeballs b. The child turns his/her head persistently on
one side and not on the other.
d) Turns eyes towards the source of sound
e) Turns head towards the source of sound
Age Normal milestone/ Expected How to Elicit and Observe these milestones Warning Signs Requiring Referral
By 4-6 • Keep head steady when held a. The child unable to li his or her head up.
upright and can sit with support
Months
•
sound or towards the known The child should be able to hold his or her head up straight in
colourful objects.
around his or her upper or middle of trunk as the child does not
achieve enough stability of the trunk to support his or her head
upright. The child will turn his or her head and look around towards
b. The child unable to maintain head upright even if
the family members or colourful toys etc.
c.
due to abnormal tone.
d. Sudden dropping of head or sudden back thrust
that topples his or her balance.
•
forearms. Moves arms forward
to reach for an object. Brings
elbows in front of shoulders and shoulders to put weight on it.
turns head to follow an object
Additional Home Visits to Address the Young Child
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
91
92
Age Normal milestone/ Expected How to Elicit and Observe these milestones Warning Signs Requiring Referral
By 4-6 • Keep the child lying on his/her back on the bed. The child should be a. The child is unable to raise his or her shoulders
object. in an alert state. and arms against gravity due to low muscle tone.
Months
b. The child does not regard the toy held above
either due to visual problem or due to lack of
in front of his or her eyes. The child will extend his or her elbow to
reach for the toy. c. The child only reaches with one arm and the
The child laughs aloud as you talk and shake your head. You can also
• Begin to babble “ah, ee, oo” The child should be in an alert state. Observe the child’s natural a. The child does not regard her mother’s face
other than when crying. either due lack of hearing or due to lack of
understanding.
• Like to look at self in a mirror. observe the child’s response as she talks to her or him. The child will
b. The child does not vocalize or there is no body
look at her and will vocalize with sounds like aaaa, eeee, uuuu. There movements due to excitement that mother’s
will be an exchange of smile. More the mother talks to her or him presence bring in the child.
tone of voice more the child reacts by vocalizing
with higher pitch and increase in body and limb movements.
By 7-9 • a.
Months
• a. The child keeps his or her hand all the me fisted
whole hand. or a small toy within the reach of the child. The child will pick the as a part of generalised sffness.
object by either hand. He or she will keep the block in the palm of b. The hands are loosely open and does not close due
By 7-9 • Turn head to visually follow a. The child does not react at all.
familiar faces or toys. should be absolutely free of any noise. Observaon by the examiner-
Months
• Turn head towards the source Stand behind the child and call the child in a whispering voice. Do it
of sounds.
from both sides. The child will immediately turn his or her head to
locate the source of sound. If he or she lacks head control, her facial
expression will change such as frowning, wide opening of eyeballs,
sudden movement of body and limbs, smile or cry. Repeat three
Additional Home Visits to Address the Young Child
By 7-9 • a.
pa..pa, ma.. ma, ba.. ba..ba, etc
Months
falling.
• Raise arms to be picked up. Let the child play a. Does not stretch hands to be picked up.
the mother the child will generally stretch his/her arms towards the
mother as if he/she wants to be picked up.
By 10-12 • Crawl to get desired toys Asked the mother whether the child bumps against the door ways a. The child does not show any interest and not
without bumping into any or furniture while crawling. crawl towards the object.
Months objects.
b. The child bumps against the objects during
Record the response in the MCP card. crawling.
• Use one or two commonwords The child does not understand simple requests and
in mother tongue. does not respond appropriately to the command.
Additional Home Visits to Address the Young Child
By 15-18 • Stand and take several Keep the child on the ground. The child will be able to stand Cannot stand on his/her own without support.
independent steps. independently and starts walking.
Months
HANDBOOK FOR ASHA ON HOME BASED CARE FOR YOUNG CHILD
By 15-18 • Put pebbles/ small objects in a Make the child sit on the mat. Keep some raisins or small beads Cannot pick the raisins to put into the container
container. in front of the child. The child will be able to pick up a raisin with (cup or katori).
Months
• The mother should show the picture in a picture book with a single
objects and their pictures in a single common object in the picture book by the age
book. of 18 months.
By 18-24 • Walk steadily, even while Does not walk steadily while pulling a toy.
pulling a toy. her how to pull and play with it, the child will be able to walk steadily
Months
without falling down even while pulling the toy.
By 18-24 • Imitate household chores The mother should show the child the common household tasks for The child does not take any interest in the household
acvies even if mother’s encouragement to
Months parcipate in.
• Correctly point out and name Does not point to even a single body part.
one or more body parts in parts with its name. The mother should ask the child to point out
person or in books. Pinky
a body part.
For example:
By 24 • Drink from a cup without Put some water or milk in the cup and give it to the child, the child Cannot eat and drink without help and the food is
spilling. will be able to drink from cup without spilling it outside. spilled over during his/her try.
months-
3 Years
Record the response in the MCP card.
Age Normal milestone/ Expected How to Elicit and Observe these milestones Warning Signs Requiring Referral
By 24 • Climb up and down the stairs. Has trouble climbing up and climbing down stairs.
months- task should be observe at a safe stair having proper railing to avoid Either the child will not be able to climb the stairs or
3 Years any accident and should be performed under the supervision of
the elders. The child will be able to climb the stairs independently
• Name most familiar things a. Not able to name even the single object in the
things such as colours, shapes, animals, birds etc. the mother should book.
shapes, etc.
ask to name the object/colour/shape/animal/bird by showing in the b. Does not communicate meaningfully and
frequently repeats others’ speech.
Cat Dog picture book. The child will be able to name most of the objects
Bird consistently.
c.