Maternal & Child Nutrition Counseling (Midwife-led) - Cheat Sheet
Your last-minute revision companion for nutrition supplementation, breastfeeding law, complementary feeding, and growth monitoring — the high-yield midwifery nutrition topics that appear frequently in the PRC MLE.
Maternal Iron–Folic Acid Supplementation in Pregnancy
Formulas
60 mg elemental iron + 400 micrograms (0.4 mg) folic acid, once daily
Meaning
Standard DOH prenatal micronutrient supplement dose per tablet
Watch out
DO NOT confuse 400 micrograms with 400 milligrams — micrograms is the correct unit. Some students write 400 mg by mistake.
When to use
Started at first prenatal visit, continued throughout pregnancy and 3 months postpartum
Common values
Value
60 mg
Symbol
Fe
Quantity
Elemental iron in standard tablet
Value
400 micrograms (0.4 mg)
Symbol
FA
Quantity
Folic acid in standard tablet
Value
12–16 g/dL
Symbol
Hb
Quantity
Normal hemoglobin (non-pregnant woman)
Value
< 11 g/dL
Symbol
Hb
Quantity
Anemia threshold — first/third trimester (pregnant)
Value
27 mg
Symbol
Fe RDA
Quantity
Daily iron need in pregnancy
Value
600 micrograms
Symbol
FA RDA
Quantity
Daily folic acid need in pregnancy
Important facts
- Iron is best absorbed on an empty stomach and with vitamin-C-rich foods (e.g., citrus, tomato); avoid with tea, coffee, or milk.
- Black/dark stools are a normal side effect of iron; counsel the mother NOT to stop taking it.
- Doubling the iron dose to 120 mg daily is used in diagnosed anemia under protocol; refer if Hb < 7 g/dL or signs of severe anemia.
- Folic acid is most protective before conception and in the first trimester; all women of childbearing age should have adequate folate intake.
- Postpartum iron supplementation for 3 months replenishes stores lost during pregnancy and delivery.
Key definitions
Anemia in pregnancy
Example
A Filipino pregnant woman with Hb 10.2 g/dL at 20 weeks is anemic and requires iron supplementation or doubling if already receiving it.
Hemoglobin < 11 g/dL in first and third trimester, < 10.5 g/dL in second trimester; major cause is iron deficiency.
Neural tube defects (NTDs)
Example
A woman planning pregnancy should start folic acid at least 1 month before conception to prevent NTDs.
Birth defects (spina bifida, anencephaly) of brain and spinal cord; prevented by folic acid in first 28 days of pregnancy.
Folic acid teratogenicity vs. Vitamin A teratogenicity
Example
Give a pregnant woman folic acid freely; never give high-dose Vitamin A capsule to a woman of childbearing age unless certain she is not pregnant.
Folic acid is SAFE and beneficial in pregnancy; high-dose Vitamin A is TERATOGENIC and forbidden in pregnancy.
Diagrams to know
- Timeline of folic acid protection: pre-conception → first 28 days → first trimester (high-risk window for NTDs)
- Iron absorption pathway: stomach (acid) → absorption factors (vitamin C, empty stomach) vs. inhibitors (tea, phytates)
Vitamin A — Pregnancy Contraindication & Postpartum Dose
Formulas
High-dose Vitamin A: CONTRAINDICATED in pregnancy
Meaning
High-dose Vitamin A is teratogenic; risk of birth defects if given to pregnant woman
Watch out
Students often forget this is an absolute contraindication. A common MLE trap: 'Should you give Vitamin A to a lactating mother?' The answer is YES if she is in the early postpartum/lactational amenorrhea period (within 4 weeks, not yet menstruating). If she could be pregnant again (past the lactational amenorrhea window or menses have returned), NO.
When to use
Any time you assess whether to give Vitamin A — ALWAYS check pregnancy status first
Postpartum Vitamin A: 200,000 IU, single dose, within first 4 weeks postpartum
Meaning
High-dose Vitamin A given once in the early postpartum period while mother is amenorrheic (breastfeeding, no menses), to build maternal stores and enrich breast milk
Watch out
DO NOT give postpartum Vitamin A if menses have already returned or if there is any possibility of pregnancy. The timing window is the amenorrheic-lactating period.
When to use
At the postpartum visit or early home visit, provided menses have not yet returned and no risk of pregnancy
Common values
Value
200,000 IU
Symbol
Vitamin A
Quantity
Postpartum Vitamin A dose
Value
Within first 4 weeks (amenorrheic-lactating period)
Symbol
Timing
Quantity
Postpartum Vitamin A timing window
Value
Up to 3,000 IU/day
Symbol
Vitamin A RDA
Quantity
Safe Vitamin A in pregnancy (from diet)
Value
10,000 IU/day
Symbol
Risk level
Quantity
Teratogenic Vitamin A threshold
Important facts
- Vitamin A is fat-soluble and accumulates in liver; overdose risk is real with repeated high-dose supplementation.
- Postpartum Vitamin A is given to enrich breast milk — infants below 6 months who are exclusively breastfed obtain Vitamin A from mother's milk if she received the postpartum dose.
- Vitamin A prevents night blindness, xerophthalmia (corneal drying), and reduces infection mortality in children.
- Iodized salt is the primary source of iodine for most Filipinos; counsel use in every home visit.
- The midwife must NEVER assume a woman is not pregnant without confirming; always screen before giving any high-dose supplementation.
Key definitions
Vitamin A teratogenicity
Example
A woman taking a Vitamin A supplement for skin health becomes pregnant; discontinue immediately.
High-dose (>10,000 IU/day) Vitamin A in pregnancy causes cleft palate, heart defects, CNS malformations.
Postpartum Vitamin A supplementation
Example
A mother is given one capsule of 200,000 IU Vitamin A at the day-3 postpartum home visit.
High-dose Vitamin A given once in early postpartum to replenish maternal stores, enhance breast milk retinol, and reduce maternal and infant infection.
Iodized salt (ASIN Law, RA 8172)
Example
Counsel every pregnant woman to use iodized salt in cooking; iodine is essential for fetal brain development.
Salt fortified with iodine to prevent iodine-deficiency disorders and goiter; required in all commercial salt in the Philippines.
Diagrams to know
- Vitamin A safety by pregnancy/lactation status: Is mother pregnant? → NO → Is she breastfeeding and amenorrheic (< 4 weeks postpartum)? → YES → Give Vitamin A. → NO or menses returned → Do NOT give.
- Sources of Vitamin A: preformed (animal: liver, egg, dairy) vs. provitamin A (plant: orange/yellow vegetables, leafy greens)
Infant & Child Vitamin A Supplementation Schedule
Formulas
Age 6–11 months: 100,000 IU (single dose)
Meaning
DOH standard Vitamin A dose for infants in this age group
Watch out
Do NOT give high-dose Vitamin A below 6 months to breastfed infants; they obtain it from breast milk. Giving it early risks overdose.
When to use
First Vitamin A supplementation, given at age 6–11 months or at first opportunity after 6 months
Age 12–59 months (1–5 years): 200,000 IU, every 6 months
Meaning
DOH standard Vitamin A dose for young children, given twice yearly (typically during 'Garantisadong Pambata' rounds)
Watch out
Students sometimes confuse the infant dose (100,000 IU) with the child dose (200,000 IU). Age 6–11 mo = 100,000 IU (once). Age 12–59 mo = 200,000 IU every 6 months.
When to use
Scheduled at 6-month intervals; typically February and August in national campaigns; also at any sick visit
Common values
Value
100,000 IU
Symbol
Infant
Quantity
Vitamin A dose for age 6–11 months
Value
200,000 IU
Symbol
Child
Quantity
Vitamin A dose for age 12–59 months
Value
Every 6 months
Symbol
Frequency
Quantity
Interval between doses in 1–5 year olds
Value
~12% all-cause reduction
Symbol
Public health impact
Quantity
Reduction in child mortality from Vitamin A supplementation
Important facts
- Vitamin A supplementation reduces all-cause child mortality by ~12% and is one of the most cost-effective child health interventions.
- The midwife documents EACH Vitamin A dose given (date, dose, lot number) to avoid over-supplementation and toxicity.
- Vitamin A is given at any sick visit (even if the 6-month round has not been reached), especially in measles, severe pneumonia, or diarrhea.
- High-dose Vitamin A in children with measles improves recovery and reduces complications; it is part of measles case management.
- Non-breastfed infants below 6 months may require Vitamin A supplementation if they are severely malnourished or ill; refer to physician for guidance.
Key definitions
Vitamin A deficiency in children
Example
A 3-year-old child in a remote barangay who has not received Vitamin A for 6 months may present with night blindness or infected eyes.
Causes night blindness, xerophthalmia, increased respiratory/diarrheal infections, and mortality; prevented by supplementation.
Garantisadong Pambata program
Example
The midwife at the BHS prepares a list of all children 12–59 months and ensures they receive 200,000 IU Vitamin A and albendazole 400 mg.
DOH twice-yearly campaign delivering Vitamin A and deworming to all children 1–5 years; critical child-survival program.
Diagrams to know
- Child Vitamin A schedule by age: 0–6 mo (not routine, breastfed) → 6–11 mo (100,000 IU once) → 12–59 mo (200,000 IU every 6 mo until age 5)
- Vitamin A sources and absorption: fat-soluble, requires dietary fat for absorption; animal sources (liver, egg) more bioavailable than plant sources (carrots, sweet potato)
Exclusive Breastfeeding — RA 10028, Milk Code (EO 51), RA 7600
Common values
Value
Within first hour of life
Symbol
EINC / Unang Yakap
Quantity
Initiation of breastfeeding
Value
First 6 months
Symbol
EBF
Quantity
Duration of exclusive breastfeeding
Value
Up to 2 years and beyond
Symbol
WHO/DOH
Quantity
Total breastfeeding duration recommended
Value
8–12 times per 24 hours on demand
Symbol
Frequency
Quantity
Frequency of breastfeeding in newborns
Value
6 or more per day (after day 4)
Symbol
Indicator
Quantity
Wet diapers indicating adequate intake
Value
~98% (with all 3 criteria met)
Symbol
Efficacy
Quantity
LAM contraceptive efficacy
Important facts
- Breastfeeding should initiate within the first HOUR of life (EINC / Unang Yakap principle); this is a midwife priority at delivery.
- Exclusive breastfeeding for 6 months provides optimal nutrition, immune protection (antibodies in colostrum and mature milk), and bonding.
- Continue breastfeeding up to 2 years and beyond (WHO/DOH recommendation); introduce complementary foods from 6 months without stopping breastfeeding.
- Colostrum is NOT to be discarded or given to others; it is the first and most important feeding for the newborn.
- The mother's own nutrition and hydration support lactation — counsel an extra ~500 kcal/day and abundant fluids; even a modestly nourished mother produces adequate milk.
- A flat or falling growth curve in an exclusively breastfed infant suggests poor latch or insufficient milk removal, not true milk insufficiency (rare).
- LAM is only reliable if ALL THREE criteria are met: infant < 6 months, exclusively breastfed (no other food/drink), and menses not yet returned.
Key definitions
Exclusive breastfeeding
Example
A 3-month-old baby is exclusively breastfed; the mother does not give even water, even in hot weather.
Infant receives breast milk only — no water, other milk, formula, juice, or food — for the first 6 months of life.
Colostrum
Example
At delivery, the midwife ensures the infant latches immediately to receive colostrum (Unang Yakap principle).
The first milk produced in the first 2–5 days after delivery; thick, yellowish, rich in antibodies and immune factors; should never be discarded.
Lactational Amenorrhea Method (LAM)
Example
A mother asks about contraception at 2 months postpartum while exclusively breastfeeding and not menstruating; LAM is an option (but counsel on need for back-up method after 6 months or if menses return).
Natural contraceptive effect of breastfeeding; provides ~98% protection only if the mother is < 6 months postpartum, exclusively breastfeeding, and has not yet menstruated.
RA 10028 (Expanded Breastfeeding Promotion Act of 2009)
Example
A mother returns to work at a government office; she is entitled to lactation breaks and a private space to express milk under RA 10028.
Philippine law mandating promotion, protection, and support of breastfeeding; requires lactation stations in workplaces and lactation breaks for nursing mothers.
Milk Code (EO 51)
Example
The midwife at the BHS does not accept or display infant formula samples; she counsels all pregnant women on exclusive breastfeeding and breast milk handling.
Executive Order restricting advertising of breast-milk substitutes, feeding bottles, and teats; forbids health workers from accepting/distributing formula samples.
RA 7600 (Rooming-In and Breastfeeding Act)
Example
In the delivery room, the midwife ensures mother and newborn are kept together immediately after delivery for skin-to-skin contact and first feeding.
Law requiring rooming-in (mother and newborn in same room) to promote early and frequent breastfeeding and bonding.
Diagrams to know
- Breastfeeding benefits timeline: within 1 hour (colostrum, bonding, oxytocin surge for uterine contraction) → first 6 months (exclusive, immune protection) → to 2 years (continued immune & nutritional support)
- LAM contraceptive reliability: Is infant < 6 months? → YES → Exclusively breastfed? → YES → Menses NOT yet returned? → YES → LAM ~98% effective. If any is NO → unreliable, use backup method.
Breastfeeding Positioning, Latch, & Common Problems
Common values
Value
1–2 days
Symbol
Timeline
Quantity
Time to pain resolution with good latch correction
Value
2–3 days
Symbol
Timeline
Quantity
Duration of engorgement (if untreated)
Value
10–20 minutes
Symbol
Duration
Quantity
Baby feeding duration (one breast)
Important facts
- The FOUR keys to good positioning: (1) baby's head and body in a STRAIGHT line, (2) baby held CLOSE to mother, (3) baby's WHOLE body supported, (4) baby FACING the breast, nose to nipple.
- Signs of GOOD latch: mouth WIDE open, LOWER LIP EVERTED (turned outward), CHIN TOUCHING BREAST, more areola visible ABOVE than BELOW.
- Signs of POOR latch: baby's mouth only on nipple, not areola; lips not everted; clicking sounds; pain.
- Breast engorgement: warm compresses BEFORE feeding to encourage letdown; cold compresses AFTER feeding to reduce swelling.
- Expressing a little milk to soften the areola makes latching easier for the baby when the breast is very engorged.
- The mother's own milk on the nipple (hindmilk) is the best treatment for sore nipples; apply after each feed.
- A 'not enough milk' complaint usually reflects poor latch or inadequate feeding frequency, not true insufficiency; assure the mother that supply follows demand.
- Working mothers: RA 10028 mandates lactation breaks and lactation stations, allowing continuation of exclusive breastfeeding by expressing and safe storage of milk.
Key definitions
Good latch (attachment)
Example
A newborn at day 1 with a good latch shows a wide mouth, chin on breast, and slow, deep sucks with audible swallowing.
Infant's mouth covers most of the areola; lower lip everted; chin touching breast; more areola visible above than below mouth.
Effective breastfeeding
Example
A 5-day-old baby at the breast shows 1–2 sucks, pause, swallow pattern and comes off the breast after 15–20 minutes.
Slow, deep sucks with pauses; audible or visible swallowing; infant releases breast when satisfied; mother pain-free.
Sore or cracked nipples
Example
A mother with cracked, bleeding nipples is taught correct positioning; after 1–2 days of good latch, pain subsides.
Almost always caused by poor latch, not insufficient milk; correcting attachment resolves pain in 1–2 days.
Engorgement
Example
A mother's breasts are hard and painful on day 3; frequent feeding and gentle expression of milk softens the areola and reduces pain.
Breast swelling from milk accumulation, typically day 2–4 postpartum; relieved by frequent feeding, expression, and warm compresses.
Diagrams to know
- Good positioning diagram: baby's ear-shoulder-hip in a line; baby's mouth covers areola; chin touching breast; nose close but not pressed into breast.
- Latch assessment checklist: mouth wide open? → areola mostly above the mouth? → chin touching breast? → slow deep sucks? → If YES to all, latch is good.
Complementary Feeding (Starting at 6 Months)
Formulas
Start complementary feeding at 6 COMPLETED MONTHS while breastfeeding continues
Meaning
Not before 6 months, not after 8 months; breast milk continues alongside solid foods
Watch out
Common mistake: Starting complementary feeding too early (3–4 months) or too late (after 8 months). The midwife must teach EXACTLY 6 completed months.
When to use
At the 6-month well-child visit, counsel the mother on introduction of complementary foods
Meal frequency: 2–3 meals/day at age 6–8 months; 3–4 meals/day + 1–2 snacks at age 9–23 months
Meaning
Progressive increase in number of meals as child grows; snacks added from ~12 months
Watch out
Students sometimes forget the snack component for older children (9–23 months). Include 1–2 nutritious snacks, not just 3–4 meals.
When to use
Counsel mothers on age-appropriate feeding frequency and amounts
Common values
Value
6 completed months
Symbol
Age
Quantity
Age to start complementary feeding
Value
2–3 meals per day
Symbol
Frequency
Quantity
Meal frequency at 6–8 months
Value
3–4 meals + 1–2 snacks per day
Symbol
Frequency
Quantity
Meal frequency at 9–23 months
Value
3–5 days
Symbol
Introduction interval
Quantity
Wait time between introducing new foods
Value
~1 teaspoon (5 mL)
Symbol
Amount
Quantity
Fat/oil to add per meal
Value
2 hours
Symbol
Food safety
Quantity
Maximum safe time for prepared food at room temperature
Important facts
- At 6 months, breast milk alone no longer meets energy and micronutrient needs; complementary foods must be added to prevent malnutrition.
- First foods should be soft, mashed, and energy-dense; introduce ONE new food at a time, waiting 3–5 days before adding another.
- Include IRON-RICH foods (animal-source preferred for absorption): egg, chicken, fish, liver, meat; avoid high-fiber cereals alone which inhibit iron absorption.
- Add a LITTLE FAT/OIL (~1 tsp per meal) to increase energy density and enhance absorption of fat-soluble vitamins.
- Include FRUITS and VEGETABLES for vitamins and fiber; variety is important.
- AVOID feeding bottles for complementary foods (aligns with Milk Code); use spoon or cup.
- AVOID sugary drinks (juice, soda), sweetened condensed milk, and tea; these are low-nutrient and displace breast milk.
- Food hygiene is critical to prevent diarrhea: use clean utensils, store food properly, discard leftover food after 2 hours at room temperature.
- By 12 months, the child can progress to family foods (chopped, not whole) while continuing breastfeeding.
- RESPONSIVE FEEDING: Watch the child's cues; do not force feed. A child who loses interest should be allowed to stop.
Key definitions
Complementary feeding
Example
A 6-month-old receives soft mashed rice and vegetables alongside breast milk.
Introduction of foods and drinks other than breast milk, starting at 6 months, while continuing breastfeeding.
Timely, adequate, safe, and properly fed (TASF) principle
Example
Foods are mashed (not whole, choking hazard), prepared fresh daily, kept covered, and the mother watches for the child to accept/refuse.
Framework for appropriate complementary feeding: right time (6 mo), right quantity/nutrients, safe from contamination, responsive to child's hunger/satiety.
Responsive feeding
Example
A 9-month-old loses interest in food and pushes the spoon away; the mother stops feeding rather than forcing more.
Mother and caregiver recognize hunger and satiety cues; feed on demand and allow the child to self-regulate intake; not force-feeding.
Iron-rich complementary foods
Example
A 7-month-old receives mashed liver and egg yolk mixed with rice, 2–3 times per week, to provide absorbable iron.
Animal sources (egg, fish, meat, liver, poultry) and fortified foods; essential to prevent anemia after 6 months when breast milk iron becomes insufficient.
Diagrams to know
- Complementary feeding progression: 6 mo (2–3 meals, soft mashed) → 9 mo (3–4 meals + snack, thicker) → 12 mo (family foods, 3 meals + 1–2 snacks) → 2 years (continue breastfeeding alongside regular family diet)
- Food groups in complementary feeding: grains (rice, oatmeal) + iron-rich (meat, egg, liver) + fruits & vegetables + fat/oil (minimum)
Growth Monitoring & Promotion (GMP) at the BHS
Formulas
MUAC (Mid-Upper Arm Circumference) < 11.5 cm in a child 6–59 months = SEVERE ACUTE MALNUTRITION
Meaning
Indicates severe wasting; child requires referral for therapeutic nutrition
Watch out
Students sometimes use MUAC thresholds for adults (not applicable in children) or confuse the age group. MUAC < 11.5 cm is ONLY for children 6–59 months.
When to use
Rapid screening tool; measure on every child visit; faster and more predictive than weight alone in resource-limited settings
Flat or falling growth curve = EARLY WARNING of faltering
Meaning
A child whose weight is not increasing along the expected percentile (or is crossing downward) has a problem BEFORE the absolute weight becomes very low
Watch out
Common mistake: focusing only on the absolute weight (e.g., '8 kg') instead of watching the TREND. A child at 8 kg who should be at 10 kg (downward trend) is in MORE danger than a child who has always been small but is gaining steadily.
When to use
Every weighing — plot on growth chart and interpret the DIRECTION of the curve, not just the single weight value
Common values
Value
< 11.5 cm
Symbol
MUAC (6–59 mo)
Quantity
MUAC threshold for severe acute malnutrition
Value
6–59 months (6 mo to 5 years)
Symbol
Age group
Quantity
Age range for MUAC screening
Value
< -3 SD
Symbol
WHZ
Quantity
Weight-for-height standard deviation for severe wasting
Value
Monthly (or at every child visit)
Symbol
Frequency
Quantity
GMP frequency at BHS
Important facts
- Growth monitoring is one of the MOST IMPORTANT midwife functions; a flat curve catches malnutrition early, BEFORE the child is severely ill.
- Every weighing is a teaching moment — review feeding, complementary food introduction, breastfeeding status, diarrhea, and hygiene.
- CLASSIFY nutritional status: Normal (weight-for-age, weight-for-height normal); Underweight (low weight-for-age); Stunted (low height-for-age); Wasted (low weight-for-height); Severe wasting (MUAC < 11.5 cm or edema in 6–59 mo).
- MUAC is simple, quick, and age-independent; it predicts mortality risk and does not require knowledge of exact birth date.
- Bilateral pitting edema (particularly of feet/hands) in a malnourished child indicates KWASHIORKOR (protein deficiency) — severe, refer immediately.
- Every child with SAM, severe wasting, or edema should be REFERRED; the midwife does NOT manage intensive nutrition rehabilitation.
- Provide Vitamin A (age 6–11 mo: 100,000 IU; age 12–59 mo: 200,000 IU every 6 mo) and deworming (twice yearly after 12 months) during growth monitoring visits.
- Check immunization status during each GMP visit; immunizations protect against infections that worsen malnutrition.
- Counsel on food fortification (fortified rice, iodized salt, fortified oil) as a low-cost nutrient boost.
Key definitions
Growth Monitoring and Promotion (GMP)
Example
Every month at the BHS, the midwife weighs the 3-month-old, plots the weight on the growth chart, checks the trend, and reviews feeding/complementary food status.
Routine midwife-led activity of weighing and measuring the child, plotting on a growth chart, interpreting the curve, and counseling the mother on feeding.
Growth chart (WHO Child Growth Standards / ECCD card)
Example
A 12-month-old's weight of 8.5 kg plots on the 25th percentile; his previous weight at 9 months was also on the 25th percentile, showing steady growth; no concern.
Standard reference chart showing normal weight/length/height by age; allows visual assessment of a child's trajectory relative to peers.
Undernutrition classification
Example
A 24-month-old weighs 10 kg (low for age — underweight) but is 80 cm (normal for 24 mo); mostly chronic malnutrition with some acute loss.
Acute malnutrition (wasting): current weight too low for length; Chronic malnutrition (stunting): current height too low for age; Global malnutrition: low weight for age.
Severe Acute Malnutrition (SAM)
Example
An 18-month-old has MUAC of 10.5 cm and mild edema of the feet; refer immediately for therapeutic nutrition.
Wasting + edema (bilateral pitting edema of feet/hands, kwashiorkor) OR weight-for-height < -3 SD OR MUAC < 11.5 cm; requires referral.
Faltering growth
Example
A 6-month-old gained steadily until month 5 (25th percentile), then the curve flattened; at month 6 still at same weight; something changed — investigate feeding, illness, diarrhea.
A child's weight gain slows or stops; growth curve becomes flat or falls; indicates inadequate nutrition, illness, or malabsorption.
Diagrams to know
- Growth chart interpretation: Weight plots at 50th percentile → good. Plots at 10th percentile but HORIZONTAL line (flat) → still concerning, investigate. Plots at 50th percentile but line FALLING → RED FLAG, investigate immediately.
- Decision tree for referral: Is MUAC < 11.5 cm? → YES → REFER. Any bilateral edema? → YES → REFER. Weight-for-height < -3 SD? → YES → REFER. Flat/falling curve + poor feeding? → YES → REFER and counsel.
Deworming & Nutrition-Related Programs
Formulas
Albendazole 400 mg, twice yearly, for children 12–59 months; 200 mg for children 12–23 months
Meaning
DOH standard anthelmintic dose for routine deworming in young children
Watch out
Age-specific dosing: 200 mg for 1–2 years, 400 mg for 2–5 years. Do NOT give the same dose to all ages.
When to use
During Vitamin A / 'Garantisadong Pambata' rounds or at any child visit; integrated into GMP visits
Pregnant women: Deworming AFTER the first trimester (usually from 2nd trimester onward)
Meaning
Deworming in pregnancy is safe and reduces maternal anemia and fetal complications; but avoid first trimester
Watch out
NEVER deworm in the first trimester; there is a small teratogenic concern. Second/third trimester is safe.
When to use
At a prenatal visit after week 13–14 of pregnancy
Common values
Value
200 mg
Symbol
Dose
Quantity
Albendazole dose for children 1–2 years
Value
400 mg
Symbol
Dose
Quantity
Albendazole dose for children 2–5 years
Value
Twice yearly (every 6 months)
Symbol
Frequency
Quantity
Deworming frequency
Value
2nd and 3rd trimester (avoid 1st)
Symbol
Safety window
Quantity
Trimester safe for maternal deworming
Important facts
- Intestinal worms compete for nutrients and cause protein loss in stool; deworming is part of NUTRITION care, not just parasite treatment.
- Twice-yearly deworming with albendazole is more effective than once-yearly dosing in high-prevalence areas.
- Deworming is often paired with Vitamin A supplementation to maximize impact; both can be given at the same visit.
- Pregnant women can be safely dewormed in the 2nd and 3rd trimester; it reduces maternal anemia and improves birth weight.
- Food fortification programs (RA 8976) are scalable, low-cost nutrient interventions; counsel families to buy fortified rice, flour, and oil.
- Improve sanitation (toilets, handwashing, clean water) to reduce re-infection with worms; education is as important as deworming.
- The midwife counsels on the IMPORTANCE of deworming and food fortification to caregivers and advocates for coverage in underserved barangays.
Key definitions
Intestinal worm infection (helminthiasis)
Example
A 3-year-old in a rural barangay without a toilet has visible worms in stool and is underweight; deworming and hygiene education are priority.
Parasitic infection (roundworm, hookworm, whipworm) causing malabsorption, anemia, and malnutrition; common in children with poor sanitation.
Food fortification (RA 8976, Food Fortification Law)
Example
Fortified rice provides iron and B vitamins; fortified oil contains Vitamin A; iodized salt contains iodine.
Addition of micronutrients (iron, iodine, B vitamins, Vitamin A) to staple foods (rice, flour, oil, salt) to prevent deficiencies.
Diagrams to know
- Deworming schedule integration: Vitamin A round (February/August) + Albendazole (same visit) + Deworming education (all visits)
Must remember
- IRON–FOLIC ACID PREGNANCY DOSE: 60 mg elemental iron + 400 micrograms folic acid ONCE daily throughout pregnancy and 3 months postpartum. Folic acid prevents neural tube defects — emphasize pre-conception and first trimester intake.
- VITAMIN A — TERATOGENIC IN PREGNANCY: Never give high-dose Vitamin A to a woman who could be pregnant. Postpartum dose is 200,000 IU, single dose, ONLY if the mother is within 4 weeks postpartum, amenorrheic, and breastfeeding (lactational amenorrhea window).
- INFANT VITAMIN A SCHEDULE: 6–11 months = 100,000 IU (once); 12–59 months = 200,000 IU every 6 months. Do NOT give high-dose Vitamin A below 6 months to breastfed infants. Record every dose to prevent overdose/toxicity.
- EXCLUSIVE BREASTFEEDING (RA 10028, EO 51, RA 7600): Initiate within first HOUR of life; breast milk ONLY (no water, formula, food) for first 6 months. Continue to 2 years and beyond with complementary foods from 6 months. Colostrum is NEVER discarded — it is the first essential feeding.
- GOOD LATCH SIGNS (Must memorize all): (1) Mouth WIDE OPEN, (2) More areola ABOVE than BELOW, (3) CHIN TOUCHING breast, (4) LOWER LIP EVERTED, (5) Slow deep sucks with AUDIBLE/VISIBLE SWALLOWING. Poor latch causes sore nipples; correct the attachment, not the pain.
- COMPLEMENTARY FEEDING TIMING & AMOUNTS: Start at 6 COMPLETED MONTHS (not before, not after 8 months) while breastfeeding continues. 2–3 meals (6–8 mo) → 3–4 meals + 1–2 snacks (9–23 mo). Include IRON-RICH foods (egg, meat, liver), fruits, vegetables, and fat. NO feeding bottles; responsive feeding.
- LAM (Lactational Amenorrhea Method) CONTRACEPTION: Only ~98% effective if ALL THREE criteria are met: (1) infant < 6 months, (2) exclusively breastfed, (3) menses NOT yet returned. Counsel backup method after 6 months or if any criterion fails.
- GROWTH MONITORING — INTERPRET THE CURVE: A FLAT or FALLING weight line is the early warning, BEFORE the absolute weight is very low. Plot on chart, assess direction, and refer if flat/falling/MUAC < 11.5 cm or edema. Growth monitoring catches malnutrition early.
- MUAC < 11.5 CM IN CHILDREN 6–59 MONTHS = SEVERE ACUTE MALNUTRITION: Measure at every visit; refer immediately. Also refer if bilateral pitting edema (kwashiorkor) or wasting signs. Deworming (twice yearly, albendazole 200–400 mg by age) and Vitamin A supplementation are part of nutrition care.
- KEY PHILIPPINE LAWS & PROGRAMS: RA 10028 (Breastfeeding Act, lactation rights); EO 51 (Milk Code, ban on formula advertising); RA 7600 (Rooming-In); RA 8172 (ASIN Law, iodized salt); RA 8976 (Food Fortification). The midwife counsels on all and ensures compliance in the BHS/community.
Last minute tips
- VITAMIN A PREGNANCY TRAP: The MLE loves to ask 'Can you give Vitamin A to a pregnant woman?' The answer is NO for high-dose supplementation. But YES for postpartum if she is amenorrheic and breastfeeding. Read the question carefully — is she pregnant NOW, or is she postpartum?
- DOSES BY AGE — WRITE THEM DOWN: Vitamin A 6–11 mo = 100,000; 12–59 mo = 200,000. Iron–folic acid pregnancy = 60 mg + 400 mcg. Albendazole 1–2 yo = 200 mg; 2–5 yo = 400 mg. Examiners often ask for EXACT doses; memorize.
- LAM HAS THREE CONDITIONS — ALL MUST BE MET: The midwife must counsel that LAM works ONLY if baby < 6 months AND exclusively breastfed AND menses not returned. If ANY condition fails, backup contraception is needed. Many students forget the 'all three' requirement.
- EXCLUSIVE BREASTFEEDING = NO WATER, EVEN 'JUST A LITTLE'**: In a hot climate, mothers often feel the baby needs water. Firmly counsel NO water, no supplements, nothing but breast milk for 6 months. This is a high-yield MLE question.
- GROWTH CURVE DIRECTION MATTERS MORE THAN ABSOLUTE WEIGHT**: A child at the 10th percentile who is RISING steadily is doing better than a child at the 50th percentile whose curve is FALLING. The midwife must interpret the trend, not just the number. This concept appears frequently on exams.
Comparison tables
Vitamin A Dosing by Population & Context
| Population Group | Age/Status | Dose | Frequency/Timing | Contraindication/Note | |
|---|---|---|---|---|---|
| Pregnant women | All pregnant women | NOT high-dose | Dietary sources only (max ~3,000 IU/day) | Throughout pregnancy | HIGH-DOSE Vitamin A is teratogenic; absolute contraindication |
| Postpartum women | < 4 weeks postpartum, amenorrheic, breastfeeding | 200,000 IU | Single dose | Within first 4 weeks (lactational amenorrhea period) | Confirm menses have NOT returned; do NOT give if pregnancy possible |
| Breastfed infant (6–11 mo) | 6–11 months old | 100,000 IU | Single dose | First Vitamin A supplementation, at 6–11 months | Do NOT give below 6 months if breastfed; obtain from breast milk |
| Young child (12–59 mo) | 12–59 months (1–5 years) | 200,000 IU | Every 6 months | February and August campaigns (Garantisadong Pambata) | Also give at any sick visit; document each dose |
| Child with measles | Any child with measles | 200,000 IU | Day 1 and Day 2 | During measles illness | Adjunctive therapy; reduces complications and mortality |
| Non-breastfed infant < 6 months | Severely malnourished or ill | Case-by-case | Varies | Refer to physician for guidance | Not routine; physician-dependent |
Iron–Folic Acid in Pregnancy vs. Postpartum
| Parameter | During Pregnancy | Postpartum (3 months) |
|---|---|---|
| Iron dose | 60 mg elemental iron once daily (or 120 mg if anemia diagnosed) | 60 mg once daily (or as prescribed; same as pregnancy to replenish stores) |
| Folic acid dose | 400 micrograms (0.4 mg) once daily | Often continues 400 mcg (as part of the supplement) |
| Timing | Start at first prenatal visit | Continue 3 months after delivery |
| Goal | Prevent anemia, support fetal development, prepare for delivery blood loss | Replenish maternal iron stores lost at delivery; support breastfeeding |
| Absorption hint | Empty stomach, with Vitamin C food, away from tea/coffee/milk | Same absorption principles |
Exclusive Breastfeeding vs. Complementary Feeding
| Factor | Exclusive Breastfeeding (0–6 mo) | Complementary Feeding (6+ mo) + Continued Breastfeeding |
|---|---|---|
| Allowed feeds/foods | Breast milk ONLY — no water, formula, juice, food, or other drinks | Breast milk + soft, mashed, iron-rich foods; add gradually |
| Feeding method | Breastfeeding on demand, 8–12 times per 24 hours | Spoon (NO feeding bottle); responsive feeding; 2–4 meals + snacks by age |
| Frequency | On demand, 8–12 times per 24 hours | 2–3 meals (6–8 mo) → 3–4 meals + snacks (9–23 mo) |
| Indicator of adequacy | 6+ wet diapers per day, weight gain on chart, contentment | Steady growth curve, frequency of feeding, child's interest in food |
| Breastfeeding continues? | Yes, exclusively until 6 months | Yes, alongside foods; continues to 2 years and beyond |
| When to start | Within first hour of delivery (colostrum) | At 6 COMPLETED months |
Good Latch vs. Poor Latch Signs
| Feature | Good Latch ✓ | Poor Latch ✗ |
|---|---|---|
| Mouth coverage | Mouth covers MOST of areola (not just nipple) | Mouth only on nipple; little or no areola in mouth |
| Areola visible | More areola ABOVE mouth than BELOW | More areola BELOW mouth, or symmetric |
| Chin position | Chin TOUCHING breast | Chin does not touch breast |
| Lower lip | EVERTED (turned outward) | Tucked inward |
| Mouth shape | WIDE open | Narrow or pursed |
| Sucking pattern | Slow, DEEP sucks with pauses and AUDIBLE/VISIBLE SWALLOWING | Rapid, shallow, or clicking sounds (no swallow) |
| Pain | No pain or mild initial discomfort only | Sore, cracked, or bleeding nipples |
Breastfeeding Problems & Quick Midwife Solutions
| Problem | Likely Cause | Midwife Intervention |
|---|---|---|
| Sore/cracked nipples | Poor attachment/latch (90% of cases) | 1. Correct latch immediately; 2. Keep nipples dry; 3. Apply hindmilk to nipple; 4. Pain usually resolves in 1–2 days with good latch |
| Engorgement | Milk accumulation, usually day 2–4 postpartum | 1. Frequent feeding (8–12 times/day); 2. Warm compresses before feeding; 3. Cold compresses after; 4. Gentle expression to soften areola |
| 'Not enough milk' | Usually poor attachment or infrequent feeding; true insufficiency is RARE | 1. Reassure mother; 2. Check latch; 3. Increase feeding frequency and duration (both breasts); 4. Ensure baby is finishing hindmilk; 5. Refer if poor weight gain continues |
| Low weight gain in baby | Poor feeding technique, insufficient breast milk removal, or illness | 1. Plot growth curve — flat/falling? 2. Assess latch and feeding; 3. Observe 1 full feeding; 4. Investigate other causes (illness, diarrhea); 5. Refer if severe |
| Working mother | Need to continue exclusive breastfeeding while employed | 1. Teach expression and safe storage (cool place, use within 4 hours at room temp); 2. Inform of RA 10028 lactation rights; 3. Maintain demand (feed at home, express at work) to sustain supply |
Growth Monitoring Classification by Age
| Age Group | Meal Frequency | Food Consistency | Key Foods to Include | Vitamin A + Deworming |
|---|---|---|---|---|
| 6–8 months | 2–3 meals per day | Soft, mashed, pureed | Iron-rich (egg, meat, liver); fruits/vegetables; added fat; fortified cereal | None routine (continue breastfeeding-derived Vitamin A); no deworming |
| 9–11 months | 3–4 meals per day | Mashed, chopped | Same + increase animal-source foods; softer family foods | None routine; no deworming |
| 12–23 months | 3 meals + 1–2 snacks per day | Family foods, chopped fine | All food groups; encourage self-feeding; variety | 200,000 IU Vitamin A every 6 months; Deworming 200 mg albendazole twice yearly |
| 24–59 months | 3 meals + 1–2 snacks per day | Regular family foods | All food groups; include legumes, nuts, fortified grains | 200,000 IU Vitamin A every 6 months; Deworming 400 mg albendazole twice yearly |
Diagrams
Maternal & Child Nutrition Counseling — Complete Topic Map
Mind map showing the complete hierarchy of maternal and child nutrition counseling topics, from micronutrient supplementation through growth monitoring and program integration.
Vitamin A Supplementation Decision Tree — Who Gets What
Decision tree guiding the midwife on whether to give high-dose Vitamin A based on pregnancy/postpartum status, age, and timing. Emphasizes pregnancy contraindication and postpartum lactational window.
Breastfeeding Problem Solving — Diagnosis & Midwife Action
Flowchart for rapid problem-solving when mothers report breastfeeding issues. Guides the midwife to distinguish between latch problems (most common), engorgement, true insufficiency, and working mother support.
Growth Monitoring Referral Decision — When to Refer
Referral decision tree for growth monitoring. Emphasizes the importance of curve direction (flat/falling) over absolute weight, MUAC cutoff for severe acute malnutrition, and signs of kwashiorkor requiring referral.
Nutrition Timeline — Key Milestones from Conception to Age 2+
Timeline showing key nutrition milestones and interventions from pre-conception through age 5+, including supplementation schedules, breastfeeding duration, complementary feeding introduction, and deworming/Vitamin A rounds.