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Integrated Management of Newborn and Childhood Illness Module: 14. Counselling Mothers

Study Session 14  Counselling Mothers

Introduction

Good communication skills are important in order to carry out your work as a Health Extension Practitioner in a professional and effective way. Establishing a good relationship with mothers is particularly important; good communication helps to reassure the mother that her child will receive the best possible care.

A young infant or child who is treated at the health post often needs to have continuing treatment at home. The success of home treatment depends on how well you communicate and counsel the child’s mother so she understands the importance of the treatment and how to provide it for her child.

In the previous study sessions you have learned how to assess, classify and treat the sick child. In this study session you will learn how to communicate effectively with mothers about the care of their children and how to teach them to provide treatment and care at home.

Learning Outcomes for Study Session 14

When you have studied this session, you should be able to:

14.1  Define and use correctly all of the key words printed in bold. (SAQ 14.1)

14.2  Use good communication skills while counselling a mother. (SAQs 14.1 and SAQ 14.2)

14.3  Teach the mother to give oral drugs at home. (SAQs 14.1, 14.2 and 14.3)

14.4  Teach the mother to treat local infections at home. (SAQs 14.1 and 14.3)

14.5  Advise a mother to increase food and fluid during her child’s illness. (SAQ 14.3)

14.6  Counsel a mother about when to return for a follow-up visit. (SAQs 14.1 and 14.3)

14.1  Using good communication skills

An important aspect of good communication skills, which should begin on the mother’s first visit to the health post, is to counsel, that is to teach or advise, a mother about how to care and treat her child at home. Part of the discussion will include asking questions, listening to the mother’s answers, praising and/or giving relevant advice, helping to solve problems, and checking her understanding.

This study session will help you to understand how to communicate effectively with mothers. We set out the steps below that you should follow.

  • Ask and listen to find out what the child’s problems are and what the mother is already doing for the child
  • Praise the mother for what she has done well
  • Advise her how to care for her child at home
  • Check the mother’s understanding, for example about home treatment.

Ask and listen

Listen carefully to find out what the child’s problems are and what the mother is already doing for her child. Then you will know what she is doing well, and what practices need to be changed.

Praise

It is likely that the mother is doing something helpful for the child, for example, breastfeeding. Praise the mother for something helpful she has done. Be sure that the praise is genuine, and only praise actions that are indeed helpful to the child.

Advise

A health worker talking to a mother whose child is sitting on her lap.

Limit your advice to what is relevant to the mother at this time. Use language that the mother will understand. If possible, use pictures (mother cards or similar) or real objects to explain. For example, show amounts of fluid in a cup or container.

Advise against any harmful practices that the mother may have used. When correcting a harmful practice, be clear, but also be careful not to make the mother feel guilty or incompetent. Explain why the practice is harmful.

Some advice is simple. For example, you may only need to tell the mother to return with the child for a follow-up visit in two days. Other advice requires that you teach the mother how to do a task. Teaching how to do a task requires several steps.

14.1.1  Teaching the mother how to treat a child

Think about how you learned to write, cook or do any other task that involved special skills. You were probably first given instructions. Then you may have watched someone else to do the task. Finally you tried doing it yourself.

When you teach a mother how to treat a child, use three basic teaching steps:

  1. Give information. Explain to the mother how to do the task.

    Example:  explain to the mother how to prepare oral rehydration solution (ORS)

  2. Show an example. Show the mother how to do the task.

    Example:  show the mother how to use a packet of ORS and to mix the right amount of water with ORS

  3. Let her practise. Ask the mother to do the task while you watch her.

    Example:  Observe the mother while she mixes the ORS solution

Letting a mother practise is the most important part of teaching her a task. If a mother does a task while you observe, you will know what she understands and what is difficult for her. You can then help her do it better. The mother is more likely to remember something that she has practised than something that she has heard. Box 14.1 summarises the main points you need to remember when teaching mothers new skills.

Box 14.1  Important points in advising/teaching mothers

When advising or teaching a mother about new skills you should:

  • Use words that she understands
  • Use teaching aids that are familiar to her, such as common containers for mixing ORS solution
  • Give feedback when she practises. Praise what was done well and make corrections if necessary
  • Allow more practice, if needed
  • Encourage the mother to ask questions and answer all her questions.
  • Why is it important to communicate effectively with mothers?

  • Good communication will help to reassure the mother, and will also help you know that she understands the importance of any home treatment she needs to provide for the child and how to give it.

  • Can you think of examples of good communication skills?

  • You may have thought of several examples, such as being able to ask clear and relevant questions. Other examples would be listening actively to the mother, being able to make points using terms that she understands, praising the mother when she has done something well and encouraging her to ask questions.

14.2  Checking the mother’s understanding

After you teach a mother how to treat her child, ask questions to find out what the mother understands and what, if anything, needs further explanation. Avoid asking leading questions (that is, questions which suggest the right answer) or questions that can be answered with a simple yes or no. Leading questions are a poor type of checking question.

14.2.1  Asking checking questions

Checking questions find out what a mother has learned. A checking question must be phrased so that the mother answers more than ‘yes’ or ‘no’. Good checking questions require that she describes why, how or when she will give a treatment.

Knowing how to ask a good checking question is an important communication skill. Good checking questions begin with question words, such as why, what, how, when, how many, and how much. Poor questions, answered with a ‘yes’ or ‘no’, do not tell you how much a mother knows. Some examples of good and poor checking questions are given in Table 14.1.

Examples of good checking questions are:

  • What foods will you give your child?
  • How often will you give them?

After you ask a question, pause. Give the mother a chance to think and then answer. Do not answer the question for her. Do not quickly ask a different question. Wait for her to answer. Give her encouragement.

Table 14.1  Examples of good and poor (leading) checking questions.
Good checking questionsPoor checking questions

  How will you prepare the ORS solution?

  How often should you breastfeed your child?

  Do you remember how to mix the ORS?

  Should you breastfeed your child?

If you get an unclear response, ask another checking question. Praise the mother for understanding correctly, or clarify your advice as necessary.

If the mother answers incorrectly or says she does not remember, be careful not to make her feel uncomfortable. Give more information, examples or practice to make sure she understands. For example, you could teach her again how to give a treatment, then ask her some more good checking questions to be confident that she understands what to do. Box 14.2 summarises the key points you need to remember when checking whether a mother understands information you’ve given her or how to carry out a particular treatment.

Box 14.2  Important points in checking understanding

When checking the mother’s understanding:

  • Ask questions that require the mother to explain what, how, how much, how many, when, or why. Do not ask questions that can be answered with just a ‘yes’ or ‘no’.
  • Give the mother time to think and then answer.
  • Praise the mother for correct answers.
  • If she needs it, give more information, examples or practice.

Sections 14.3 to 14.5 below describe the application of good communication and counselling skills in different cases or classifications.

14.3  Teach/advise the mother to give oral drugs at home

The oral drugs listed in previous study sessions are given for a range of reasons, administered in different doses (for example according to a child’s age or weight) and on different schedules. However, the way to give each oral drug is similar. This section will give you the basic steps for teaching a mother how to give oral drugs to her child. If a mother learns how to give a drug correctly, then the child will be treated properly. The steps below outline how you can help a mother to treat her child with oral drugs at home.

14.3.1  Determine the appropriate drugs and dosage for the child’s age or weight

Use the Treat the Child chart (from your chart booklet) to determine the appropriate drug and what dosage to give to the child.

14.3.2  Explain the reason for giving the drug to the child

Explain to the mother why you are giving the oral drug to her child, and what problem the drug is treating.

14.3.3  Demonstrate how to measure a dose

Collect a container of the drug and check its expiry date. Do not use expired drugs. Count out the amount needed for the child. Close the container.

If you are giving the mother tablets you should show the mother the amount to give per dose. If needed, show her how to divide a tablet. If a tablet has to be crushed before it is given to a child, add a few drops of clean water and wait a minute or so. The water will soften the tablet and make it easier to crush. It can be crushed between two clean spoons.

If you are giving the mother syrup, you should show the mother how to measure the correct number of millilitres (ml) for one dose at home. Use the bottle cap or a common spoon, such as a spoon used to stir sugar into tea or coffee. Show her how to measure the correct dose with the spoon.

One teaspoon (tsp) equals approximately 5.0 ml (see Table 14.2 below).

Table 14.2  Estimation of syrup dosage by teaspoon.
MILLILITRES (ml)TEASPOONS (tsp)
1.25 ml¼ tsp
2.5 ml½ tsp
5.0 ml1 tsp
7.5 ml1½ tsp
10.0 ml2 tsp
15.0 ml3 tsp

Adjust the above amounts based on the common spoons used in your area.

If you are giving the mother capsules, show the mother the amount to give per dose. If her child needs less than a whole vitamin A capsule (or cannot swallow a whole capsule), show the mother how to open the capsule and squirt part of its liquid into her child’s mouth.

14.3.4  Watch the mother practise measuring a dose herself

Watch the mother as she practises. Tell her what she has done correctly and praise her for this. If she measured the dose incorrectly, show her again how to measure it.

14.3.5  Explain to the mother how to give the drug

Tell the mother how much of the drug she should give her child. This means communicating clearly how many times per day, when and for how many days the drug should be given to her child. You should also explain to the mother that if her child is vomiting, she should give the drug even though the child may vomit it up. Tell her to watch the child for 30 minutes. If the child vomits within the 30 minutes (the tablet or syrup may be seen in the vomit), give another dose. If the child is dehydrated and vomiting, she should wait until the child is rehydrated before giving the dose again.

14.3.6  If more than one drug is prescribed, collect, count and package each drug separately

Explain to the mother that her child is getting more than one drug because more than one illness is being treated. Show the mother the different drugs. Explain how to give each drug and what they are for.

14.3.7  Finishing the course of treatment

You should tell the mother that while the child is getting better, she should continue to treat the child. This is important because the bacteria or the malaria parasite may still be present even though the signs of disease are gone. Therefore all of the drugs in a course of treatment must be finished, even if the child appears better.

14.3.8  Check the mother’s understanding before she leaves the health post

Ask the mother good checking questions before she goes home with her child so that you can be confident she understands how and when to provide the oral drug to her child.

14.4  Teach the mother how to treat local infections at home

This section describes how to teach a child’s mother to treat local infections at home. Local infections include coughs, a sore throat, eye infection, mouth ulcers, ear infection, an umbilicus that is red or draining pus, skin pustules and thrush.

When teaching or advising a mother, you should:

  • Explain what the treatment is and why it should be given
  • Describe the treatment steps listed in the appropriate box on the TREAT charts (see your chart booklet)
  • Watch the mother as she does the first treatment
  • Tell her how often to do the treatment at home
  • If needed for treatment at home, give the mother the tube of tetracycline ointment or a small bottle of gentian violet
  • Check the mother’s understanding about how to treat her child and how often, before she leaves the clinic.

Some treatments for local infections cause discomfort. Children often resist having their eyes, ears or mouth treated. Therefore, it is important that you show the mother how to hold her child still. This will prevent the child from interfering with the treatment.

Positioning a child to apply medication.
Figure 14.1  Positioning a child to apply medication.

The drawing in Figure 14.1 shows a good position for holding a child. Tilt the child’s head back when applying eye ointment or treating mouth ulcers. Tilt the child’s head to the side when wicking/cleaning the ear.

Do not attempt to hold the child still until immediately before treatment.

The following examples cover some of the material you have already read in an earlier section in this Module. However, these examples provide good revision for you and also help you see how to apply your knowledge about effective counselling to practical cases.

14.4.1  Treat eye infection with tetracycline eye ointment

If the child is going to be urgently referred, you should treat the eye infection. Clean the eye gently. Pull down the lower lid. Squirt the first dose of tetracycline eye ointment onto the lower eyelid and then refer him. Don’t try to counsel the mother at this point, because there is not enough time.

If the child is not being referred, then you should teach the mother how to apply the tetracycline eye ointment.

Tell the mother that she should treat both eyes and that she will need to:

  • Wash her hands before and after treating the eyes
  • Clean the child’s eyes immediately before applying the tetracycline eye ointment. Use a clean cloth to wipe each eye
  • Repeat the process (cleaning the eyes and applying ointment) three times per day, in the morning, at mid-day and in the evening.

Then show the mother how to treat the eye. Be sure to wash your hands.

  • Have someone hold the child still
  • Wipe one of the child’s eyes with the cloth
  • Hold down the lower lid of child’s eye. Tell her to be careful that the tube does not touch the eye or lid
  • Squirt the ointment onto the lower lid. Make sure the mother sees where to apply the ointment and the amount she should use (see Figure 14.2).
Actual size of tetracycline ointment to be applied to the child’s eye.
Figure 14.2 Actual size of tetracycline ointment to be applied to the child’s eye. (Source: FMOH IMNCI Training Module)

Ask the mother to practise cleaning and applying the eye ointment in the child’s other eye. Observe and give feedback as she practises. When she is finished, give her the following additional information.

  • Treat both eyes until the redness is gone from the infected eye. The infected eye is improving if there is less pus in the eye or the eyes are not stuck shut in the morning
  • Do not put any other eye ointments, drops or alternative treatments in the child’s eyes. They may be harmful and damage the child’s eyes
  • After two days, if there is still pus in the eye, she should bring the child back to the health post.

Then give the mother the tube of ointment to take home. Give her the same tube you used to treat the child.

Before the mother leaves, ask checking questions to ensure that she understands how to give the treatment to her child at home.

14.4.2  Dry a discharge from the ear by wicking

To teach a mother how to dry the ear by wicking, first tell her it is important to keep an infected ear dry to allow it to heal. Then show her how to wick her child’s ear.

As you wick the child’s ear, tell the mother to:

Using an ear wick to treat an ear infection.
Figure 14.3  (a) Using an ear wick to treat an ear infection. (b) A wick should be made from clean cotton or strong tissue paper. Wick the ear three times daily.
  • Use clean, absorbent cotton cloth (see Figure 14.3) or soft strong tissue paper for making a wick. Explain to her that she must not use a cotton-tipped applicator, a stick or flimsy paper as these will fall apart in the ear
  • Place the wick in the child’s ear until the wick is wet
  • Replace the wet wick with a clean one
  • Repeat these steps until the wick stays dry. Then the ear is dry.

Observe the mother as she practises. Give feedback. When she is finished, give her the following information:

  • Wick the ear three times daily
  • Use this treatment for as many days as it takes until the wick no longer gets wet when put in the ear and no pus drains from the ear
  • Do not place anything (oil, fluid, or other substance) in the ear between wicking treatments. Do not allow the child to go swimming. No water should get in the ear.

Before the mother leaves, ask checking questions to ensure that she knows how to wick the child’s ear at home.

14.4.3  Treat mouth ulcers with gentian violet

Treating mouth ulcers controls infection and helps the child to eat. Teach the mother to treat mouth ulcers with half-strength gentian violet. Gentian violet used in the mouth should be half strength (0.25%), not full strength (0.5%).

You should give the following information to the mother:

  • Her child will start eating normally sooner if she paints the mouth ulcers in her child’s mouth. It is important that the child eats
  • She must clean the child’s mouth. She should wrap a clean soft cloth around her finger, dip it in salt water and wipe the mouth
  • She must use a clean cloth or a cotton-tipped stick to paint gentian violet on the mouth ulcers. The gentian violet will kill thegerms that cause the ulcers. Put a small amount of gentian violet on the cloth or stick. Tell her to ensure that the child does not drink the gentian violet
  • She should treat the mouth ulcers twice a day, in the morning and evening
  • She should come back to the health post after two days for a follow-up visit, but she needs to treat the mouth ulcers for five days.

Wrap a clean cloth around your finger and dip it into salt water. Show the mother how to first wipe the child’s mouth clean and then how to paint with half-strength gentian violet.

Ask the mother to practise. Watch her wipe the child’s mouth clean and paint the rest of the ulcers with gentian violet. Comment on what she does well and give feedback on anything that need to be improved.

Give the mother a bottle of half-strength gentian violet to take home. Tell her to return in two days for a follow-up visit. Also tell her that she should return to the clinic earlier if the mouth ulcers get worse or if the child is not able to drink or eat.

Before the mother leaves, ask checking questions to ensure that she knows how to treat her child’s mouth ulcers at home and when she should return to the clinic.

14.4.4  Treat the young infant for local infections

There are three types of local infections in a young infant that a mother or caregiver can treat at home: red or pus-draining umbilicus, skin pustules, and oral thrush.

Twice each day, the mother should clean the infected area and then apply gentian violet. Teach the mother how to treat the infection and check her understanding. If the mother is going to treat oral thrush, give her a bottle of half-strength (0.25%) gentian violet. If the mother is going to treat skin pustules or umbilical infection, give her a bottle of full-strength (0.5%) gentian violet.

14.4.5  Soothe the throat or relieve coughs with a safe remedy

To soothe the child’s throat or relieve a cough, use a safe remedy. Such remedies can be homemade, for example honey, tea, warm soups, and warm gruel, and are as effective as those bought in a store. When explaining how to give the safe remedy, it is not necessary to watch the mother practise giving the remedy to the child. Exact dosing is not important with this treatment.

If the child is exclusively breastfed, tell the mother that she does not need to give other drinks or remedies. Breastmilk is the best soothing remedy for an exclusively breastfed child.

Harmful remedies may be used in your area. Tell the mother not to use cough syrups. These syrups may sedate the child and interfere with the child’s feeding. They may also interfere with the child’s ability to cough up secretions from the lungs. Medicated nose drops (that is, nose drops that contain anything other than salt) should also not be used; these drops might have similar side effects to cough syrups and are also relatively expensive.

14.4.6  Advise the mother to increase fluid during the child’s illness

A sick child requires extra fluids. Advice about fluids is summarised in Box 14.3 below. Give this advice to every mother who is taking her child home unless she has already received many instructions and may be overwhelmed by more advice, or she has already been taught Plan A (on the Treat the Child chart).

Box 14.3  Advice on providing fluids to a sick child

For any sick child:

  • Advise the mother to increase fluid during the illness. For example, give the child soup, rice water, yoghurt drinks or clean water.
  • Breastfeed more frequently and for longer each feed.

For a child with diarrhoea:

  • Extra fluid can be life saving. Give the child fluid according to Plan A or Plan B on the Treat the Child chart.
  • What are the three basic steps you should take when teaching a mother to care for her child at home?

  • You should recall from the beginning of this study session that the three main steps are: give the mother information, show her an example and then let her practise. As you read, the mother is more likely to understand what to do if she has had a chance to practise first.

  • What are examples of good checking questions?

  • Here are some examples you may have thought of, or you might have come up with some of your own: How often do you breastfeed your child? What do you need to do to treat your child’s eye infection? What will you do if your child has a fever?

    Remember you need to use words such as how, why, what and when so that the mother cannot just answer yes or no to your question.

14.5  Advise the mother when to return to see a health worker

Every mother who is taking her child home needs to be advised when to return to the health worker. She may need to return:

  • for a follow-up visit in a specific number of days (for example, when it is necessary to check the progress of a child on an antibiotic)
  • immediately, if signs appear that suggest the illness is worsening, or
  • for the child’s next immunization (the next well-child visit).

14.5.1  Follow-up visits

In the earlier study sessions in this Module, you learned that certain problems require follow-up visits in a specific number of days. For example, pneumonia, dysentery and acute ear infection require follow-up visits to ensure that an antibiotic is working. Persistent diarrhoea requires follow-up visits to ensure that feeding changes are working. Some other problems, such as fever or pus draining from the eye, require follow-up visits only if the problem persists.

At the end of the sick child visit, you should tell the mother when to return for a follow-up visit. Sometimes a child may need follow-up visits for more than one problem. In such cases, tell the mother the earliest definite time to return. Also explain to her that she may need to come for an earlier follow-up visit if a problem such as fever persists. Table 14.3 below sets out the advice you should give the mother on follow-up visits according to the child’s illness.

Table 14.3  Summary of follow-up times for different problems.
If the child has the following illnessReturn for follow-up in:

∙  Pneumonia

∙  Dysentry

∙  Malaria, if fever persists

∙  Fever, malaria unlikely, if fever persists

∙  Fever, no malaria (no malaria risk), if fever persists

∙  Measles with eye or mouth complications

2 days

∙  Persistent diarrhoea

∙  Acute ear infection

∙  Chronic ear infection

∙  Feeding problem

∙  Any other illness, if not improving

5 days

∙  Uncomplicated severe malnutrition

7 days

∙  Confirmed/confirmed symptomatic HIV infection (first follow-up)

∙  Suspected symptomatic HIV infection (first follow-up)

∙  Possible HIV infection (first follow-up)

∙  Anaemia

14 days

∙  Very low weight for age/moderate acute malnutrition

∙  Suspected symptomatic HIV infection (routine monthly follow-up)

∙  Possible HIV infection (routine monthly follow-up)

30 days

14.5.2  Immediate return visits

There will be situations where the mother should not wait for the prescribed time for follow-up but should return to the health worker immediately. It is extremely important that you stress this to the mother when you advise her about follow-up visits. Table 14.4 sets out when the mother should return to see you or another health worker immediately.

Table 14.4  Summary of when to return immediately to the health post.
Advise the mother to return immediately if the child has any of these signs:

Any sick child

∙  Not able to drink or breastfeed

∙  Becomes sicker

∙  Develops fever

If child has no pneumonia: cough or cold

∙  Fast breathing

∙  Difficult breathing

If child has diarrhoea

∙  Blood in stool

∙  Drinking poorly

In your health post, you may have the mother’s card resource. You can use the Mothers Card when teaching her the signs for when to return immediately. Use local terms that the mother can understand. The Mother’s Card presents the signs in both words and drawings. Be sure to check the mother’s understanding so that you are satisfied that she knows in what circumstances she should return to the health post immediately with her child.

14.5.3  Next ‘well child’ visit

Remind the mother of the next visit her well child needs for immunization, vitamin A and deworming unless the mother already has a lot to remember and will return soon anyway.

Good communication with mothers and caregivers of sick infants and children is important. Not only because you need to be confident that the child will receive the correct treatment when they are at home, but also so that you can reassure the mother, who may be feeling very anxious about her infant or child. Being sensitive to the mother’s concerns, praising her for the things she is doing well and taking time to show her how to treat her child is therefore a key part of your role.

Summary of Study Session 14

In Study Session 14, you have learned that:

  1. It is important to ask the mother about the child’s problems and listen to what she is already doing for the child; this will include praising her for the things that she is doing well and advising her on things she can do to improve the care of her child at home.
  2. There are three basic teaching steps you should take when you are teaching a mother how to care for her child at home. These are: give information, show an example and let her practise. Letting a mother practise is the most important part of teaching a task because the mother is more likely to remember something that she has practised than something that she has heard.
  3. Asking good checking questions (rather than poor, or leading, checking questions) allows you to check that the mother has understood what you have taught her and that she knows when she has to return for a follow-up visit.
  4. Counselling the mother about how to care for local infections at home is very important. Local infections include cough, sore throat, eye infection, mouth ulcers, ear infection, an umbilicus that is red or draining pus, skin pustules and thrush. A sick child requires extra fluids and you should give this advice to every mother who is taking her child home.
  5. It is important that every mother who is taking her child home is advised when to return to the health worker; the three common reasons to return are for a follow-up visit to check on the progress of the child’s recovery from illness, for immediate urgent reasons, and for the well child visit.

Self-Assessment Questions (SAQs) for Study Session 14

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 14.1 (tests Learning Outcomes 14.1, 14.2, 14.3, 14.4 and 14.6)

  • a.What information would you give to a mother whose child has mouth ulcers?
  • b.What could you do to ensure that the mother understands your instructions?
  • c.List some of the good communication skills you would be using when advising the mother.
Answer
  • a.Mouth ulcers often affect children’s ability to eat well. You should tell the mother that the ulcers will begin to improve, and her child will start eating normally, if she paints the ulcers with half-strength gentian violet (this kills the germs causing the ulcers). The mother should do this by first wrapping a clean cloth around her finger, dipping this in salt water and using it to clean the child’s mouth. Next, the mother should paint the mouth ulcers with gentian violet on a cloth or cotton-tipped stick. Tell her she should make sure that the child does not drink any of the gentian violet.

    The mouth ulcers should be treated in this way two times per day, in the morning and evening for five days. However the mother should come back to the health post after two days for a follow -up visit so that you can check progress.

  • b.The way to be sure that the mother has understood your instructions is to ask her open-ended checking questions such as, ‘Tell me what you’re going to do before painting the ulcers with gentian violet?’; ‘How often and for how many days do you need to treat the ulcers with gentian violet?’; ‘Can you show me how you are going to do the treatment?’; and ‘When are you going to return to see me with your child?’
  • c.You might have thought of quite a few good communication skills that you would have used in this case. For example, asking and listening to the mother carefully when she tells you about her child and praising her for what she is already doing well. You would give her advice in clear terms that she can understand, and ask good checking questions to ensure she knows what to do and when.

SAQ 14.2 (tests Learning Outcomes 14.2 and 14.3)

  • a.Why is it important to ask mothers or caregivers good checking questions?
  • b.Suggest three examples of good checking questions.
  • c.Give examples of three poor checking questions, and say why these are not effective ways of ensuring the mother understands what you have explained to her during the visit.
Answer
  • a.Good checking questions are important to ensure the mother or caregiver really understands how she is going to provide the best possible home care and treatment for her child. If you have given the mother instructions such as how to give oral antibiotics or treat an eye infection then you need to know that the mother will be able to carry out these instructions safely and accurately at home. If mothers are feeling anxious they may say they know what to do, without really being sure. By asking good checking questions, you can be more certain that the mother has really understood how to care for her child at home and when, if at all, she needs to return for a follow-up visit.
  • b.These are some examples of good checking questions that we thought of — you will probably have thought of some other examples too:
    • Tell me how you are going to make a wick?
    • How many times are you going to clean your child’s ear?
    • When are you going to come back to the health post for a follow-up visit?
  • c.Poor checking questions are ‘closed’ questions, that is, the mother can answer ‘yes’ or ‘no’ but you cannot be really sure she has understood what you have taught her. For example:
    • Do you know how to make a wick?
    • Are you going to clean your child’s ear three times every day?
    • Do you know when you need to come back for the next follow-up visit?

Read Case Study 14.1 and then answer the questions below.

Case Study 14.1 for SAQ 14.3

Mimi is a six-month-old child who is being treated for dysentery and an acute ear infection. She also has a fever.

SAQ 14.3 (tests Learning Outcomes 14.3, 14.4, 14.5 and 14.6)

  • a.What advice would you give the mother about a follow-up visit?
  • b.What information would you give the mother about treating the child at home, and how would you know if she understands your advice?
  • c.What signs would alert the mother that she needs to bring the child back to the health post immediately?
Answer
  • a.The mother should be told that follow-up visits have to take place after two days and again after five days from the initial visit when Mimi’s illness was classified. This is so that Mimi’s progress can be monitored.
  • b.You would advise the mother to breastfeed Mimi more frequently and allow her to take more time at each feed. The mother should also give Mimi more fluids, according to either Plan A or Plan B (on your ‘Treat the Child’ chart). Show the mother how to wick Mimi’s ear to dry up the discharge and remind her that the next follow-up visit is in two days’ time. You would ask good checking questions to make sure that the mother understands everything you’ve told her during the visit.
  • c.Tell the mother that she should return immediately if Mimi is unable to breastfeed or drink, or is drinking poorly, or if her illness appears to be getting worse. If Mimi develops other symptoms, such as fever or blood in her stool, the mother should also return immediately to the health post.