Midwife Licensure Exam Family Planning & Population Nutrition — Nutrition Across the Lifespan & Maternal-Child ProgramsCheat Sheet

Section Title

IYCF: Infant and Young Child Feeding — The Three Anchors

Important Facts

• Early initiation of breastfeeding: within the **first 1 hour** of life (part of Unang Yakap/EINC).
• Exclusive breastfeeding for **first 6 months**—this is non-negotiable for optimal immune development.
• Continued breastfeeding up to **2 years and beyond**, with safe and adequate complementary feeding at **6 months**.
• Newborn demand-feeding: approximately **8–12 times/day**; signs of adequate intake = **6+ wet diapers/day + weight gain**.
• Complementary foods must be **timely (6 months), adequate (nutrient-dense), safe (hygienic), and properly fed**.
• Introducing solids **before 6 months** risks infection and displaces breastmilk; **after 6 months** risks growth faltering.
• Breastmilk provides ideal nutrition + passive immunity + reduced SIDS + maternal involution aid + birth spacing (lactational amenorrhea).
• Correct positioning and latch prevent engorgement, sore nipples, and poor milk transfer.
• Breastfeeding provides **protection against diarrhea, respiratory infection, otitis media, and allergies**.

Key Definitions

Diagrams To Know

• Timeline: Birth → 1 hour (early initiation) → 6 months (exclusive BF ends) → 24 months+ (continued BF + CF).
• Correct latch diagram: infant's mouth covers entire areola; chin touches breast; no pain for mother.

Section Title

Breastfeeding Laws & Milk Code — RA 10028, RA 7600, EO 51

Important Facts

• **RA 10028** = Expanded Breastfeeding Promotion Act (2009); amended **RA 7600** (Rooming-In & Breastfeeding Act, 1992).
• **Lactation period** under RA 10028: **≥40 minutes per 8-hour working period**, **not less**, and **paid break time**.
• **EO 51 (Milk Code)** does **NOT ban breastmilk substitutes** but **prohibits promotion, free samples, and marketing in health facilities**.
• Nurse role: **enforce rooming-in, support working mothers, protect breastfeeding, never promote/accept formula marketing**.
• Breastfeeding-friendly workplaces = increased maternal compliance, improved infant health outcomes, reduced healthcare costs.
• Formula marketing in health facilities = **illegal under EO 51**; report violations to DOH.
• Lactation stations must be **private, clean, comfortable, with refrigeration** for milk storage and expression.

Key Definitions

Diagrams To Know

• Regulatory hierarchy: RA 7600 (1992) → RA 10028 (2009 amendment) + EO 51 (1986, ongoing enforcement).

Section Title

Garantisadong Pambata (GP) — Biannual Child-Health Package

Important Facts

• **Garantisadong Pambata = biannual** rounds, **typically April and October** (twice per year).
• GP package includes: **vitamin A supplementation, deworming, immunization catch-up, nutrition counseling, growth monitoring, breastfeeding/CF promotion, micronutrient supplementation, health education**.
• Delivered through: **health centers, barangay health stations, schools, and outreach** (community-based).
• Nurse role: **organise rounds, ensure cold-chain/supply readiness, record coverage, educate caregivers, monitor outcomes**.
• Recording feeds into **FHSIS (Family Health and Safety Information System)** and **National Nutrition Council monitoring**.
• Priority targets: **preschool (0–5 years) and school-age children (6–12 years)**; vulnerable groups flagged for follow-up.
• Community-based approach ensures **equity and accessibility**, especially in rural/remote barangays.
• Inter-agency coordination: **BNS (Barangay Nutrition Scholar), BHFS (Barangay Health Facilities), LHU (Local Health Unit), barangay officials**.

Key Definitions

Diagrams To Know

• GP cycle: Plan (Jan–March/Jul–Sept) → Execute (April/October) → Monitor/Record (same month) → Evaluate/Report (by May/Nov).

Common Values

Section Title

Micronutrient Supplementation — Ages & Doses (CRITICAL MEMORIZATION)

Important Facts

• **VITAMIN A** — Prevents xerophthalmia (leading preventable childhood blindness); reduces mortality from measles and diarrhea.
• **Vitamin A, 6–11 months**: **100,000 IU**, one dose (during GP or routine consultation).
• **Vitamin A, 12–59 months (1–5 years)**: **200,000 IU every 6 months** (twice a year via GP rounds).
• **Vitamin A, postpartum women**: **200,000 IU within 4 weeks (1 month) after delivery**, single dose; improves breastmilk vitamin A content.
• **Vitamin A NOT given in pregnancy** (teratogenic—causes birth defects); given **postpartum only**.
• **Vitamin A, therapeutic dosing** (measles, xerophthalmia, SAM): age-appropriate dose on **day 1, day 2, and day 15**.
• **IRON + FOLIC ACID IN PREGNANCY**: **60 mg elemental iron + 400 µg folic acid daily** throughout pregnancy and **up to 3 months postpartum**.
• **Iron, low-birth-weight infants**: supplementation from **2 months of age** (monitor for anemia).
• **Iron, infants 6–11 months** (term, normal BW): supplementation to prevent infant anemia; continue if at risk.
• **Iron, adolescent girls & women of reproductive age**: **weekly iron-folic acid supplementation** (secondary prevention of anemia).
• **ZINC FOR DIARRHEA**: Shortens episodes and reduces recurrence; given **with ORS for 10–14 days**.
• **Zinc, <6 months**: **10 mg/day** for diarrhea.
• **Zinc, ≥6 months**: **20 mg/day** for diarrhea (10–14 days).
• **IODINE**: RA 8172 (ASIN Law) mandates **salt iodization**; prevents goiter, cretinism, cognitive impairment.
• **RA 8976 — Philippine Food Fortification Act**: mandates fortification of rice, wheat flour, cooking oil, refined sugar; voluntary fortification = **Sangkap Pinoy Seal**.

Key Definitions

Diagrams To Know

• Micronutrient supplementation flowchart by age: Birth → 6 months (no supplementation, EBF) → 6–11 months (Vit A 100,000 IU + MNP) → 12–59 months (Vit A 200,000 IU q6mo + deworming) → School age (deworming continuation).

Common Values

Section Title

Growth Monitoring, Malnutrition Classification & Operation Timbang

Important Facts

• **First 1,000 Days** = conception to age 24 months; **critical window** for brain development and prevention of irreversible stunting.
• **Growth monitoring and promotion** uses **weight-for-age, height/length-for-age, weight-for-height/length** plotted on child growth standards.
• **Stunting** = chronic undernutrition; **priority indicator** for First 1,000 Days framework; **irreversible** if not corrected early.
• **Wasting** = acute malnutrition; reversible with prompt intervention; **SAM = severe acute malnutrition** (weight-for-height <70% of standard or MUAC <115 mm).
• **Operation Timbang (OPT Plus)** = annual mass weighing to locate malnourished children in barangay; community-wide, participatory approach.
• CMAM with ready-to-use therapeutic food addresses SAM in outpatient settings, improving access and compliance.
• Malnutrition nursing diagnosis: **Unbalanced Nutrition: Less Than Body Requirements** (NANDA); priority intervention = assess/refer for supplementation.
• Growth faltering in infancy/toddlerhood = alarm sign; investigate breastfeeding adequacy, CF timing/quality, infections, hygiene, caregiver knowledge.

Key Definitions

Diagrams To Know

• Child growth standards reference: WHO growth charts (weight-for-age, height-for-age, weight-for-height); classification thresholds (stunted, wasted, underweight).
• OPT Plus cycle: Prepare → Conduct mass weighing/measuring → Identify malnourished → Refer/monitor → Reassess after 3–6 months.

Section Title

National Food Guides — Pinggang Pinoy & Nutritional Guidelines for Filipinos (NGF)

Important Facts

• **Pinggang Pinoy** = single-meal plate guide; shows **proportions**, not absolute amounts; **age-specific versions** (children, adolescents, adults, older persons, pregnant/lactating).
• **Go (energy-giving)**: rice, bread, cereal = **~1/3 of plate**; provides carbohydrates and energy.
• **Grow (body-building)**: fish, shellfish, poultry, meat, eggs, dried beans, nuts, milk = **smaller portion**; builds/repairs body tissues.
• **Glow (body-regulating)**: vegetables, fruits = **largest portion of plate** (vegetables the biggest, plus fruit); regulates body functions, prevents disease.
• **Accompanying Pinggang Pinoy**: **glass of water** (not sugary drinks) and reminder to **be physically active**.
• **Nutritional Guidelines for Filipinos (NGF)** = **Ten Kumainments**: variety, breastfeeding, vegetables/fruits/fish consumption, limit salty/sweet/fatty, safe food/water, active lifestyle, healthy weight.
• **NGF answers "what and how much overall?"** (dietary principles); **Pinggang Pinoy answers "how much per meal?"** (proportions).
• **RA 8172 — ASIN Law**: mandates **salt iodization** to prevent iodine-deficiency disorders.
• **RA 8976 — Food Fortification Act**: mandates fortification of staples (rice, wheat flour, cooking oil, refined sugar); voluntary fortification = **Sangkap Pinoy Seal**.
• Nurse teaches using both **Pinggang Pinoy (practical plate tool) and NGF (principles)** for patient-centered nutrition counseling.

Key Definitions

Diagrams To Know

• Pinggang Pinoy plate diagram: Divide plate into thirds; ~1/3 Go (top), ~1/4 Grow (side), ~1/2 Glow (side/bottom) + glass of water.
• Ten Kumainments as a list or mnemonic: Variety → Breastfeeding → Vegetables/Fruits → Limited salty/sweet/fatty → Safe food/water → Activity → Healthy weight.

Common Values

Section Title

Nutrition in Pregnancy & Postpartum

Important Facts

• **Pregnancy increased nutritional needs**: energy (~300 kcal/day 2nd/3rd trimester), protein (~70 g/day), iron (~27 mg/day), folate (600 µg/day), calcium (~1000 mg/day), iodine.
• **Iron-folic acid supplementation in pregnancy**: **60 mg elemental iron + 400 µg folic acid daily** throughout pregnancy and **up to 3 months postpartum**.
• **Folate (folic acid)** prevents **neural tube defects** (spina bifida, anencephaly); supplementation ideally **3 months preconception + throughout pregnancy**.
• **Iron supplementation prevents maternal anemia**, low birth weight, preterm delivery, and postpartum hemorrhage.
• **Calcium (1000–1200 mg/day) in pregnancy** reduces preeclampsia/hypertension risk and supports fetal skeletal development.
• **Vitamin A NOT supplemented in pregnancy** (teratogenic); adequate dietary intake from non-fortified sources; supplementation **postpartum only** (200,000 IU within 1 month).
• **Adequate weight gain in pregnancy**: underweight (12–18 kg), normal (11–16 kg), overweight (7–11 kg), obese (≥7 kg); poor weight gain = low birth weight risk.
• **Postpartum vitamin A supplementation** (200,000 IU within 4 weeks) improves breastmilk vitamin A content and supports infant immunity.
• **Lactating women** have increased energy (~500 kcal/day), protein, calcium, iron, and micronutrient needs; nutrition counseling essential.

Key Definitions

Diagrams To Know

• Timeline: Preconception (folic acid counseling) → Pregnancy (iron-folic acid daily, monitor weight gain) → Delivery → Postpartum ≤4 weeks (vitamin A 200,000 IU) → Lactation (sustained supplementation).

Common Values

Section Title

Nutrition in Childhood & Adolescence

Important Facts

• **Complementary feeding at 6 months**: introduce iron-rich foods (fortified cereal, egg yolk, meat, beans) to prevent anemia.
• **CF introduction timing**: too early (before 6 months) = infection risk, breastmilk displacement; too late (after 6 months) = growth faltering.
• **Deworming in childhood**: **preschool (1–5 years) and school-age (6–12 years)** receive deworming during Garantisadong Pambata biannual rounds (April/October).
• **Adolescent iron needs**: **boys 11–18 years = 8 mg/day**, **girls 11–18 years = 15 mg/day** (due to menstruation); **weekly iron-folic acid supplementation** for girls.
• **Adolescence = second growth spurt**: rapid weight/height gain; increased energy (~2000–2600 kcal/day depending on sex/activity), protein, calcium (bone accrual), iron.
• **Calcium in adolescence** (1000–1300 mg/day) crucial for peak bone mass accrual; prevents osteoporosis in adulthood.
• **Eating habits established in adolescence** track into adulthood; nutrition education crucial for prevention of obesity, cardiovascular disease, diabetes.
• **Growth monitoring in school age**: tracks weight and height; compares to standards; flags stunting or overweight for intervention.

Key Definitions

Diagrams To Know

• CF introduction: 6 months (iron-rich softs) → 7–9 months (texture increase, variety) → 10–12 months (minced/shredded) → 12+ months (chopped family foods).
• Micronutrient needs across childhood: Infants (iron-rich CF, Vit A) → Preschool (Vit A q6mo, deworming, MNP) → School-age (deworming biannual, growth monitoring) → Adolescence (iron supplementation for girls, bone health).

Common Values

Section Title

Nutrition in Older Adults

Important Facts

• **Older adult nutritional needs**: **lower energy** (due to reduced activity) but **sustained/higher protein** (sarcopenia prevention), micronutrients.
• **Protein in older adults**: **1.0–1.2 g/kg/day** (higher than younger adults) to maintain muscle mass and function.
• **Risk of undernutrition**: reduced appetite (medications, taste changes, satiety), dental problems, swallowing difficulties, polypharmacy (drug-nutrient interactions), social isolation, limited income.
• **Micronutrient risks**: vitamin B12 deficiency (intrinsic factor loss, pernicious anemia), folate, vitamin D (osteoporosis, falls), iron (anemia, fatigue).
• **Hydration**: older adults have reduced thirst sense; risk of dehydration, constipation, urinary tract infections; encourage **6–8 glasses water/day**.
• **Falls prevention**: adequate vitamin D, calcium, protein, strength training reduce fall/fracture risk.
• **Nutrition screening (MUST)**: assess appetite, intake, weight changes, dental status, medication side effects, functional ability, social support.
• **Pinggang Pinoy for older persons**: adapted portions; emphasize nutrient-density, ease of chewing, safe swallowing, hydration.
• **Nurse role**: assess, counsel on nutrient-dense foods, encourage meals with social support, monitor for malnutrition signs, refer for dysphagia/dental intervention if needed.

Key Definitions

Diagrams To Know

• Older adult nutrition assessment flowchart: Screen (appetite, weight, intake) → Assess (dental, swallowing, medications, social) → Diagnose (undernutrition, risk) → Intervene (counseling, supplementation, referral).

Section Title

Nurse's Role & Community Nutrition Programs

Important Facts

• **Nurse's core nutrition role** (aligned with RA 9173): **assess, counsel, administer/record supplements, monitor growth, enforce laws, educate, coordinate**.
• **Assessment**: nutritional status, breastfeeding technique, complementary feeding practices, malnutrition risks, family food security, hygiene.
• **Counseling**: IYCF anchors, Pinggang Pinoy portions, NGF principles, micronutrient importance, safe food handling; use local languages/food examples.
• **Administration & Recording**: **exact doses of Vit A, iron, zinc, deworming**; **record in FHSIS + facility records** (not recording = not done).
• **Growth Monitoring & Promotion (GMP)**: weigh/measure children, plot on standards, classify (stunted/wasted/underweight), counsel, refer for CMAM if needed.
• **Law Enforcement**: protect rooming-in, support lactating mothers, report breastmilk-substitute marketing violations (EO 51), enforce food safety.
• **Community Coordination**: work with **BNS, BHFS, LHU, barangay nutrition committee, municipal health officer** for program delivery.
• **Guarantisadong Pambata Organization**: plan logistics (supplies, personnel, venue), conduct rounds (April/October), ensure cold-chain, record coverage, evaluate, report.
• **Health Teaching**: bedside/group education using **Pinggang Pinoy, NGF, visual aids**; assess comprehension, provide referrals.
• **Documentation (CRITICAL)**: all nutrition interventions recorded in FHSIS; ensures accountability and population-level monitoring.
• **Referral**: malnourished children → barangay nutrition program/CMAM; dysphagia → health facility; food-insecure families → social services.

Key Definitions

Diagrams To Know

• Nurse's nutrition intervention cycle: Assess → Plan (Vit A/iron/deworming schedule, counseling topics) → Implement (administer, counsel, educate) → Record (FHSIS) → Monitor/Evaluate (growth, coverage, compliance) → Report.

Section Title

Philippine Legal & Policy Framework (RA 9173, RA 10028, EO 51, RA 8172, RA 8976)

Important Facts

• **RA 9173 (Philippine Nursing Act)**: defines nurse scope (includes nutrition assessment, counseling, supplementation administration), accountability, continuing education.
• **RA 10028 (Expanded Breastfeeding Promotion Act 2009)**: amends RA 7600; mandates lactation stations, lactation periods (≥40 min/8 hr, paid), breastfeeding-friendly workplaces.
• **RA 7600 (Rooming-In & Breast-feeding Act 1992)**: mandates rooming-in of mother and newborn in health facilities; norm-setting law.
• **EO 51 (Milk Code 1986)**: National Code of Marketing of Breastmilk Substitutes; **restricts (not bans) formula marketing**; prohibits free samples/promotion in facilities.
• **RA 8172 (ASIN Law)**: mandates **salt iodization** nationwide; prevents iodine-deficiency disorders.
• **RA 8976 (Food Fortification Act)**: mandates staple fortification (rice, wheat flour, cooking oil, sugar); **Sangkap Pinoy Seal** = voluntary fortification compliance.
• **Nurse accountability**: enforce laws (rooming-in, EO 51), counsel based on evidence (IYCF, NGF), administer exact supplement doses, record accurately, report violations.
• **DOH nutrition programs** (aligned with laws): Garantisadong Pambata (GP), growth monitoring, CMAM, health education.
• **Penalties for non-compliance**: formula marketing in facilities = fine/closure (EO 51); salt non-iodization = fine (RA 8172).

Key Definitions

Diagrams To Know

• Philippine nutrition policy timeline: RA 7600 (1992 rooming-in) → EO 51 (1986 milk code, ongoing) → RA 8172 (1991 salt iodization) → RA 8976 (1999 food fortification) → RA 10028 (2009 expanded breastfeeding).

Item

**IYCF Three Anchors**: (1) Early initiation within **1 hour** of life, (2) Exclusive breastfeeding for **6 months**, (3) Continued breastfeeding **up to 2 years and beyond** with timely complementary feeding at **6 months**. This is the foundation of all infant feeding counseling.

Rank

1

Item

**Vitamin A Supplementation Ages & Doses** (EXACT MEMORIZATION): **6–11 months = 100,000 IU** (once); **12–59 months = 200,000 IU q6mo** (biannual GP); **postpartum = 200,000 IU within 1 month**. **NOT in pregnancy** (teratogenic). Wrong dose = patient harm.

Rank

2

Item

**Iron-Folic Acid in Pregnancy**: **60 mg elemental iron + 400 µg folic acid daily** throughout pregnancy **+ 3 months postpartum**. Prevents maternal anemia, neural tube defects, low birth weight. One of the highest-yield facts.

Rank

3

Item

**Garantisadong Pambata (GP) = Biannual Package**: Delivered **twice per year (April & October)** at barangay level; includes **Vit A, deworming, immunization, nutrition counseling, growth monitoring**. Nurse must organize, execute, record, and report coverage to FHSIS.

Rank

4

Item

**RA 10028 vs. RA 7600 vs. EO 51**: (1) **RA 7600** (1992) = rooming-in + breastfeeding norm; (2) **RA 10028** (2009) = amended RA 7600, adds **lactation stations + ≥40 min lactation period/8 hr (paid)**; (3) **EO 51** (1986) = **Milk Code**, restricts (not bans) formula marketing, **prohibits free samples in health facilities**. NLE will test distinctions.

Rank

5

Item

**First 1,000 Days Framework** (Conception → 24 months): Critical window; undernutrition causes **irreversible stunting and cognitive loss**. Stunting = chronic; wasting = acute; underweight = composite. Stunting is the **priority indicator for this period**.

Rank

6

Item

**Colostrum is the Infant's First Immunization**: Rich in secretory **IgA** (mucosal immunity); NEVER discard. First milk in first hours/days. Key teaching point with all mothers.

Rank

7

Item

**Complementary Feeding at 6 Months**: Start with **iron-rich foods** (fortified cereal, egg yolk, meat, beans) to prevent infant anemia as breastmilk iron depletes. Textures progress: soft → minced → chopped. Timely, adequate, safe, properly fed.

Rank

8

Item

**Zinc for Diarrhea Dosing**: **<6 months = 10 mg/day**; **≥6 months = 20 mg/day**, given **with ORS for 10–14 days**. This is testable; wrong dose = error.

Rank

9

Item

**Pinggang Pinoy & Nutritional Guidelines for Filipinos (NGF)**: **Pinggang Pinoy** = single-meal plate guide showing proportions (**Go ~1/3, Grow smaller, Glow largest + water**); **NGF (Ten Kumainments)** = overall dietary principles (variety, breastfeeding, vegetables/fruits/fish, limit salty/sweet/fatty, safe food/water, activity, healthy weight). Use both for patient teaching.

Rank

10

Tip

**Dose Precision is Critical**: Vitamin A and zinc doses are exact and testable; a single incorrect digit can be a wrong answer on NLE. Write them down, memorize them verbatim, and triple-check before administering or answering exam questions. Treat every numerical value as exam-critical.

Tip

**Laws Are Distinct**: Don't confuse RA 7600, RA 10028, and EO 51. RA 7600 = rooming-in (1992); RA 10028 = lactation stations/periods (2009 amendment); EO 51 = Milk Code (1986, regulates marketing). NLE commonly asks which law applies to a scenario—read each option carefully.

Tip

**Garantisadong Pambata Timing**: The **exact months (April & October)** are testable. If an exam question says "May" or "September," that's a red flag—GP is specifically biannual in **April and October**. Also know that GP is **twice per year**, not annually.

Tip

**IYCF Anchors Are Non-Negotiable**: The three anchors (early initiation within 1 hour, exclusive 6 months, continued to 2 years with CF) are evidence-based DOH policy. Questions often test whether a scenario aligns with these anchors. A mother introducing water at 3 months = **not following IYCF**; an infant receiving formula at 2 months = **not exclusive BF**. Spot these in exam scenarios.

Tip

**Growth Monitoring Language**: Know the difference between **stunting (height-for-age, chronic), wasting (weight-for-height, acute), and underweight (weight-for-age, composite)**. Also know **Operation Timbang** = annual mass weighing to identify malnourished preschoolers. NLE may ask "which malnutrition type and how to identify?"—use precise definitions.

Rows

Columns

• Age Group
• Dose
• Frequency
• Timing / Notes

Table Title

Vitamin A Supplementation — Age, Dose, Timing

Rows

Columns

• Type
• Definition
• Indicator
• Timing
• Reversibility

Table Title

Malnutrition Classification — Stunting vs. Wasting vs. Underweight

Rows

Columns

• Aspect
• Exclusive Breastfeeding (0–6 months)
• Complementary Feeding (6–24+ months)

Table Title

IYCF: Exclusive Breastfeeding vs. Complementary Feeding

Rows

Columns

• Population
• Iron Dose
• Folic Acid Dose
• Zinc Dose
• Duration / Timing

Table Title

Supplementation Doses — Iron, Folic Acid, Zinc by Population

Rows

Columns

• Law / Policy
• Year
• Key Mandate
• Nurse Enforcement

Table Title

Breastfeeding Laws & Policies — Summary

Rows

Columns

• Classification
• Function
• Examples
• Proportion (Pinggang Pinoy)

Table Title

Food Classification: Go–Grow–Glow