1. Family–Led Care Training: Day 1
This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Every Preemie—SCALE and do not necessarily reflect the views of USAID or the United States Government.

2. Why Family-Led Care?
Many preterm/low birth weight or “small” babies need only special attention to thermal care, feeding support, and infection prevention via KMC to survive and thrive.
Family Led Care model is based on the following fact-- a lot of preterm and low birth weight babies can survive and thrive if they are fed and kept warm. Often NO additional care is needed, but without this care, they can get sick or die.

3. Why Family-Led Care?
Facilities often are overcrowded and poorly staffed.
Some staff have not been trained to care for small babies.
Due to lack of training or poor staffing, facility staff may give care of inconsistent quality to small babies.

4. Why Family-Led Care?
Often care for small babies is not documented in case notes or health registries.
Babies in KMC units are sometimes discharged home before adequately gaining weight.
While the Family-Led Care model was developed to address real challenges uncovered in delivering care to PT/LBW babies in a district in Southern Malawi, the model address challenges common to many countries in Africa. Some of the challenges may also be present here in _______<<name of where you are>>___________.

5. Why Family-Led Care?
Families often don’t know how to properly care for small babies and may get discouraged, stop practicing skin-to-skin care or not feed their babies as often as needed.
Family and community members often tell parents, “Your baby is going to die any way. Why are you bothering to care him/her?”
Once small babies go home, many are not brought back to the clinic, health center, or hospital for follow-up assessments and care.
Ask: Are any of the challenges discussed on this and the previous slide also present here <<in location of training>>?

6. Overarching Goal of Family-Led Care
Improved outcomes for:
Preterm, <37 weeks
Low birth weight, <2500 grams
This model was developed to decrease the mortality and morbidity experienced by preterm and low birth weight babies, especially those babies who will survive and thrive with special attention to warmth and frequent feedings of breast milk.

7. Objectives of Family-Led Care
Enhance provider skills to provide quality care to preterm/LBW babies.
Improve monitoring and documentation of newborn care.
Empower families as active participants in the care of their small newborn babies.
Build family confidence to care for preterm/LBW newborn babies both in the healthcare facility and at home.
We began to address the first 2 bullet points by your participation in the Essential Care for Every Baby and Essential Care for Small Babies trainings. These trainings should have strengthened both your knowledge and skills in your ability to care for small newborns. While we will continue to strengthen your knowledge and skills during this training, we now want to focus on your skills for empowering families and building their confidence to care for their small babies in the health care facility and at home. ANY QUESTIONS?

8. Family-Led Care Materials
To empower families:
Family-Led Care Guide
Caring for Small Babies at Home leaflet
Family Monitoring Form
To improve quality of care provided by health care providers:
2 & 3 Hour Feeding Charts
Monitoring Form for KMC Babies (provider)
Follow-Up Care Job Aid
MOH guidelines for KMC including admission and discharge criteria
In order to meet these objectives, special materials are needed. All of these materials were developed to strengthen your abilities as a provider’s to provide quality care to small babies and to help you empower families to provide care to their small baby. ANY QUESTIONS????
We are now going to move onto learning about the Family Led Care Flipbook
STOP SLIDES. NEXT SECTION IS ABOUT FEEDING.

9. The Reality If babies do not get enough breast milk, they:
will not grow
can get sick
can die
We know around the world that too many preterm/low birth weight babies die because they do not get adequate nutrition, and this should not be. We’ll talk now about the methods and frequency with which preterm/low birth weight babies need to be fed in order to both survive and thrive.

10. Feeding Frequency EVERY 2 HOURS: Babies weighing less than 1500 grams
Babies who weigh ≥ 1500 grams, but have problems (don’t tolerate a larger volume, or don’t gain weight)
EVERY 3 HOURS:
Babies weighing ≥ 1500 grams if tolerating well and gaining weight
These are the general rules; we will discuss particulars in detail during rest of today and tomorrow.

11. 60/mls/kg/d
90/mls/kg/d
120/mls/kg/d
150/mls/kg/d
180/mls/kg/d
(volumes in mls)

12. Which Feeding Method? PROGRESSION: TUBE CUP BREAST
< weeks usually need tube feeding
30-32 weeks slowly transition to cup feedings
> 32 weeks slowly transition to suckling directly from breast
We know that the sucking reflex slowly develops from weeks. The transition to totally suckling from breast is a vulnerable time. Many times more than one feeding method is needed. For example, when the baby transitions to cup feeding, s/he may still need some tube feedings to insure adequate weight gain.
Start with 1-2 cup feedings the first day with the remaining feedings by tube and if the baby does well with the cup feedings and continues to gain weight, increase the number of feedings by cup slowly by 1-2 feedings/ day as tolerated. It may be 2-3 days or longer before the baby is ready to advance to additional feedings by cup.
The baby who is tolerating the cup feedings is gaining weight 15 grams/Kg/day.
Is able to finish each cup feeding without difficulty
Awakens before the next feeding ready to feed.
Is giving hunger cues
Alert
Looking around
Licking or smacking lips
Rooting
The baby that is not tolerating cup feeding is becoming tired before finishing the cup feeding, is not gaining sufficient wait, is not waking ready to feed at the next feeding time.
Use the same advancement technique when advancing from cup feeding to breast feeding. Start with 1-2 feedings at the breast each day and increase as tolerated by the baby.

13. Tube Feeding Saves Lives
Cup feeding and breast feeding burn energy, and many small babies do not have energy to spare.
Tube feedings use less energy.
Some babies at later gestational ages may require tube feedings in order to gain weight:
About ½ of 34 week babies require tube feedings.
About ¼ of 35 week babies require tube feedings.

14. Tube Feeding Tube feeding should be used for a baby who:
Cannot feed well by mouth (cannot finish recommended volume in <30 minutes).
Is unable to swallow without choking or turning blue.
Has inadequate intake by breast or cup (<6 wet diapers a day, or unable to take recommended volume).
Cannot take enough breast milk by nipple or cup to grow properly (gain at least 15 gm/kg/day).
These are usually the smallest, youngest, or sickest babes. Even if they are able to take milk from the cup, it tires them out. They use calories/energy for feeding instead of growing. They do not have extra reserves and will not gain enough weight if totally cup fed. Once they begin gaining weight from tube feedings and get a bit older and larger, they can gradually transition to the cup.

15. Cup Feeding Cup feeding should be used for a baby who:
Can take the full desired amount of milk from the cup within 30 minutes.
Is able to swallow without coughing, choking or turning blue while feeding.
Is awake and able to feed every 2-4 hours.
Has inadequate intake when fed at breast (<6 wet diapers a day).
Cannot take enough breast milk by suckling to grow properly (gain at least 15 gm/Kg/day).
Babies who do well with cup feeding are older (less premature) and stronger. They are awake and alert more. They have a coordinated swallow and may even begin to suck. Sometimes they need cup feedings supplemented by tube feedings until they reach a time where they can easily take milk from the cup and gain weight.
Immediately after both tube and cup feedings, you should burp the baby and then give the baby some time at breast. Having the baby lick, touch, or try to suck on the mother’s breasts stimulates milk production and helps the baby learn how to suckle. Be careful not to make the baby over tired.

16. How Do You Know Baby is Getting Fed Enough?
Takes recommended volume (for tube and cup feeding babies)
Wet diapers
Weight gain
The baby should be able to consume the volume recommended on the volume feeding chart at each feeding. IF THEY CANNOT, BABY IS NOT GETTING ENOUGH BREAST MILK.
The baby should have a minimum of 6 wet diapers a day. IF YOU DO NOT SEE THIS, BABY IS NOT GETTING ENOUGH BREAST MILK.
After the initial period of weight loss in the first week or so, you should ALWAYS see weight gain, a minimum of 15 gm/kg/day. IF YOU DO NOT SEE THIS, BABY IS NOT GETTING ENOUGH BREAST MILK

17. Feeding Methods Summary
The baby who cannot cup feed adequately will need tube feeding.
Cup feedings can be combined with either breastfeeding or tube feeding.
Both tube and cup-fed babies need time at their mother’s breast after each feeding to learn to suckle.
Suckling or licking the nipple stimulates milk production.