• By the end of this unit, participants will be able to:
• Describe physical characteristics of the newborn.
• Describe and demonstrate three comfort techniques.
• Model child care skills that new parents need to know.
• Using a chart, describe to clients which immunizations a baby needs, and at what age; explore parent's concerns regarding immunization safety.
• Describe at least five safety hazards in the home and for each one, ways to "baby proof" a child's environment.
• Describe how a parent can tell if a child is sick.
• Demonstrate how to take a baby's temperature.

8.5 hours

A. Introduction/Parenting
B. Physical Characteristics of the Newborn
C. How To Comfort a Crying Baby
D. Modeling Infant Care Skills
E. Preventing Illnesses
F. Taking Care of a Sick Child
G. Safety
H. Practice Session: Role Plays and Case Studies
I. Summary and Review

• Resource Mothers. (1993). Handbook. Sterling, VA: INMED.
• Infant States and Parents Responses (Handout #1)
• What Your New Baby Will Do (Handout #2)
• Kitchen Hazards (Handout #3)
• Home Safety Tips (Handout #4)
• Suggestions for Safety (Handout #5)
• Infant States (Training Aid #1)
• Calming a Baby (Training Aid #2)
• Case Study: Helping Mother Comfort her Baby (Training Aid #3)
• To Hold or Not to Hold (Training Aid #4)
• Baby Care Needs (Training Aid #5)
• Taking Care of a Baby (Training Aid #6)
• Safety Role Plays (Training Aid #7)
• Case Studies (Training Aid #8)
• Role Play Feedback (Overhead #1)
• Post-Unit Test
• Post-Unit Evaluation
• Baby doll(s), as life-like in size as possible
• Baby bathtub or sink
• Oral and rectal thermometer(s)
• Immunization schedules
• Video Equipment: video camera, tripod, television, VCR.
• Video: "Comforting Your Crying Baby" or other suitable video showing calming techniques. This one is available from: Parent Infant Resource Center, Department of Psychology, Georgia State University, Atlanta, GA 30303-3083, Tel: (404) 651-2928.
• Video: "What Lilly Learned -- Immunizations" Crommie & Crommie, ALTSUL Group Corporation, Evanston, IL 60201.
• Video: "Preventing Childhood Injury" Mead Johnson Nutritional Infant Care Series for New Parents, Bristol Meyers U.S. Pharmaceutical and Nutritional Group, Evansville, IN 47721.
• Easel, newsprint, markers, tape and/or blackboard and chalk
• Colored chalk for "Immunization Hopscotch"

• Make sufficient copies of handouts.
• Read the Resource Mothers Handbook, Chapter 12, "Taking Care of a New Baby," and Chapter 15, "Safety."
• Assign these chapters to participants as background reading.
• Review above videotapes.
• Make transparencies of Training Aids #2 and #5 and, if appropriate, of Handout #3.
• Make a tape of a crying baby (optional) for Section C.
• Find pictures of a healthy newborn and a low birthweight newborn. The March of Dimes is a good source.
• Copy and cut up Training Aids #8 and #9 to give out as role plays.
• Bring a copy of Eisenberg, A., Murkoff, H. & Hathaway, S. (1989). What to Expect in the First Year. N.Y.: Workman Publishing. (or other popular book on child care).
• Make copies of Handout #4, Home Safety Tips, for each trainee. If you plan to make hundreds of copies to use with your clients, the Consumer Products Safety Commission will be printing copies of Home Safety Tips later this year (1993). For more information, call Elaine Tyrell at the Consumer Products Safety Commission, (301) 504-0580. Or, you can obtain the original artwork from the National Healthy Mothers/Healthy Babies Coalition. For more information, call: Tel: (202) 638-5577.
• Another resource for parenting skills development that you may wish to review is: Honig, A. (1982). Playtime Learning Games for Young Children. Syracuse, N.Y.: Syracuse University Press.
• To obtain a copy, write: Syracuse University Press, 1600 Jamesville Road, Syracuse, NY 13210.
• Try out video equipment. Set up camera to videotape role plays.

Although Parenting Support Specialists already have experience taking care of new infants, this unit provides an opportunity to update the information and to practice ways of best transferring accurate information and skills to their clients.

1. Mini-lecture and group discussion. Begin this unit by pointing out that trainees will be working together on ways to transfer information and skills about the care of an infant, and thus help new mothers reduce their anxiety levels and enjoy their new roles as mothers. Let participants know that they have more cumulative experience in taking care of infants than you do, and that this session will really be a review of a variety of materials with which they may be familiar.

However, child care is not a static field. The pediatric community changes the advice they give new mothers as new theories, studies, and test findings warrant. Ideas and practices about the use of pacifiers, spoiling a baby, how infants perceive the world, ways of holding an infant, and even the types and number of immunizations has changed over the past fifteen to twenty years. This Unit will help trainees integrate new knowledge with previous experience.

2. A human infant is completely dependent on his/her caregivers. That's usually the mother, although many fathers also take an active and involved role. Do participants think this last statement is true and, if so, is it good? Why or why not? Before moving to the next topic, mention that when participants make postpartum home visits, they should be alert to the fact that some fathers may also want some skills training (but may feel it's "unmanly" to come out and say so).

3. "Parenting" may not even have been a word when some of the trainees were first parents, but it's come to be associated with all the things to do -- and the skills needed -- to be good parents. Ask participants to think of all the things one must do to take care of (or "parent") an infant. Ask someone to write this list on the board. Overwhelming, isn't it? Babies need so much!

Ask the group to look again at the list they just prepared, and decide if an item meets a physical need or an emotional need -- or can it be both? For example, changing a baby's diaper when she wets meets a physical need to be kept clean and not let her body get sore or chapped. But, over the first months of her life, being changed when she wets or dirties herself will help a baby build a sense of trust as she begins to sense that she can count on someone "being there" for her. Thus the act of changing an infant regularly and not letting her stay uncomfortable and wet can meet an emotional need as well.

Is it fair to say that all babies need TLC (tender, loving care) and that anything a parent does to meet her baby's physical needs, provided she does it in a caring fashion, will show the infant that she is loved, and will thus also meet her emotional needs? Discuss.

4. Mention the fact that people are not born with good parenting skills. Rather, parenting skills are learned. But these skills don't come naturally, at least not to most people. Ask trainees how new moms and dads learn these skills. How did each of them (who are mothers) learn them? Possible responses:

• Trial and error
• From watching my mother, friend or other family member
• From watching a film or video
• From helping a neighbor (babysitting, etc.)

Being a good parent is hard work, and very time consuming. And yet most people receive no special training for what is probably the hardest (and also, potentially, the most rewarding) job they'll ever have!

5. Discussion. Oftentimes new mothers are not prepared, either emotionally or intellectually, to be a parent. What kind of a challenge does this present to a PSS, working with such a client in her home? Ask participants what they would say or do when faced with a new mom who just "doesn't want to be bothered."

6. Mention that, at the end of this unit, trainees will have time to role play a variety of situations where they will need to make use of all their "old" parenting skills plus some new ones they may acquire during training.

Newborns may look "funny" to a new parent. PSS' can reassure their clients that characteristics of a newborn are normal and will probably disappear in a short time.

1. Discussion and activity. Ask trainees to think back to when they were 9 months pregnant and expecting their baby any day. How did they picture their baby? What did they think their baby would look like? Then ask trainees to take out a piece of paper and write down four things they remembered thinking before their baby was born.

Now show trainees the picture of the two newborn babies--one healthy and one premature--the pictures of newborn babies that you collected. Ask them to write down four words that describe the picture. After a couple of minutes, ask a volunteer to share her description of the baby she "dreamed of." Then ask a volunteer to read her description of the baby in the picture.

Ask trainees what some of the differences in their descriptions were. How do new mothers often feel when they first see their newborns? Possible responses:

• Excited/relieved
• Frightened
• Disappointed
• Nervous or scared they won't be able to take care of the baby
• Overwhelmed

2. Discussion. Ask the trainees if they remember what some of the physical characteristics of a newborn are that make them "funny looking." Possible responses:

• Skin looks wrinkled; may have blue patches, birthmarks, or white pimples.
• Eyes and face are puffy or swollen
• Eyes look crossed
• Head is pointed
• Body is covered with fine hair
• Breasts and genitals are swollen and large

3. Discussion. Emphasize that it's normal for newborns to spend much of the time sleeping. Ask trainees what babies are usually doing when they are not sleeping. Possible responses:

• Crying
• Hungry/eating
• Looking around
• Moving their arms/legs

Show trainees the overhead transparency made from Training Aid #1, Infant States. "Infant states" are the different levels of waking and sleeping that a baby goes through during each day. The different states are:

• Quiet sleep
• Active sleep
• Drowsy
• Quiet Alert
• Active Alert
• Fussy
• Crying

Ask trainees if they think it is important for parents to recognize and be aware of the different states of newborns. Why or why not? Why might it be important to recognize the quiet alert state? What types of signals do newborns give their parents? Possible responses:

• If a parent learns to recognize her baby's states, then she will get to know her baby better.
• If a parent can recognize the quiet alert stage, the parent will know when the best time is for feeding or playing.
• Different signals include looking away after too much stimulation, fussing when hungry or tired, or kicking and waving arms when excited.

3. Activity. Pass out Handout #1, Infant States and Parent Responses. Ask trainees to look at each of the infant states in the left hand column. Then in the right hand column, note what they can recommend that a mother do at the corresponding time. You can do this exercise with trainees, or just go over the first one and let them fill in the rest on their own. For example, during the baby's quiet sleep what can a mother do? Answer: rest or nap. Allow about five minutes to complete the form, then share responses.

Before moving on, recommend that trainees save this handout in their Handbook so they can share it with new mothers.

4. Activity. Distribute Handout #2, What Your New Baby Will Do. Have trainees break into groups of two. Ask them to take turns role playing a home visit and finding a new mother all upset because she does not know what to expect from her newborn. As her PSS, each trainee can use this Handout to review with the new mother what to expect from her baby. After everyone has had a chance to participate, ask the trainees if there was anything missing from the handout that they remembered about their own infants' behavior, or if there was anything they disagreed with. Why? Discuss. Add any suggestions to the handout and ask trainees to save it in their Handbook.

1. Discussion. Ask trainees why they think babies cry. Brainstorm as many reasons as possible, for example:

• To tell us what they need
• Because they are tired, hungry, cold, hot, sick, bored, or want to be held
• They sense that their mother stressed, sad or angry

Emphasize that crying is normal. Babies cry because it is their only way of communicating that they need something or that something is wrong.

2. Ask the trainees if they remember what they did to comfort their crying babies. What seemed to work? What didn't work? Possible responses:

• Baby calmed him/herself down on his/her own by sucking on fingers, fist or pacifier
• Walking the baby
• Rocking
• Singing

If someone mentions pacifiers, take the opportunity to ask the group what they think about the use of pacifiers. You may want to mention that mothers who choose to breastfeed may want to avoid giving their babies pacifiers in the first few weeks as pacifiers may cause the baby to have "nipple confusion." If you do use a pacifier, use more than one regularly so you will have the opportunity to sterilize. Do not put your baby’s pacifier in your mouth to clean it.

3. Project a transparency of Training Aid #2, Calming a Baby, on the wall. Does it list any other responses that trainees might have overlooked? Discuss. Suggest that trainees write any new suggestions in their Resource Mothers Handbook.

4. Not every comforting technique will work with every baby. And the same thing that comforted a baby one day might not do the trick the next day. Parents have to find out what works best for themselves and their babies.

5. Case Study. Read the case study found in Training Aid #3, Helping a Mother Comfort her Baby. Then ask trainees to discuss the questions presented in the case study.

6. Ask trainees how they felt when their baby cried for long periods of time. They may have felt frustrated or even angry. What did they do to give themselves a break? What ideas can they give clients who are feeling frustrated? You may want to tape a crying baby ahead of time and play the tape for a few minutes to stimulate discussion! Possible responses:

• Get help from a friend or family member.
• Go out for a walk with baby, change of scenery.
• Put baby down in a safe place, go in another room and set time for ten minutes. Let baby cry and then return and try more calming techniques.

Trainees can add any new suggestions that they come up with to the list in their Handbook.

Trainees should also know that long periods of crying may mean a baby is sick or in pain. If a mother is unsure, she should call her health care provider. If a mother says she feels she might harm her baby because the baby won't stop crying then she should get help immediately. Ask trainees if they know what the telephone numbers are in their community for someone to call for help in this emergency situation. If not, where will they find this information? They should refer to their notes in Chapter 5 of the Resource Mothers Handbook. Trainees should practice helping clients find the phone numbers, write the phone numbers down and post the numbers by the client's telephone.

7. Discussion on Spoiling a Baby. Begin this discussion by first presenting the following scenario, or a similar one of your own:

"I'm a PSS and I just came back from my first visit with Dana since her baby Shawn was born three weeks ago. When I got to her apartment she was in tears. Her grandmother had just left. Dana's grandmother had yelled at her and said, 'Every time I come over here you are holding that baby of yours. Shawn's going to be real spoiled if you don't put him down and just let him cry.' Dana was devastated since she loves and respects her grandma a lot. She feels like she must be a terrible mother. She doesn't think she does anything right."

Ask trainees what they think about the grandmother's point of view. What do they think about Dana's point of view?

Show transparency, Training Aid #4, To Hold or Not to Hold? Ask trainees for their opinions. Do they think a baby can be spoiled? Why or why not?

8. Video. If time allows, show a video on comforting techniques. One 14 minute video on the topic is "Comforting your Crying Baby." (See overview of Unit for details.)

• Ask them to stand in a circle.

• Anyone who has pointed to her chest is the new leader. This person now gives new commands, making sure she sometimes says one thing but does another.
• After about five minutes, stop and process this exercise by asking trainees what we can learn from it. Someone will probably say that, despite your instructions, people will do what you do, even if it conflicts with what you say.
• End by explaining that as they have seen from this exercise, new mothers will tend to follow their example, not what they may have said. Thus it is important for a PSS to be a good role model, and "practice what you preach." This exercise leads into the session on modeling.

2. Exercise. Which do trainees think is easier, to demonstrate how to do something, or to explain something verbally without the benefit of being able to model the procedure or to show a picture of how it is done? Why?

To demonstrate this, ask for a volunteer to instruct the group in some common procedure, like tying a shoelace, without showing the group what to do. Use words only, no hand motions or demonstrations. If this skill were new would it be possible to copy her behavior from her verbal explanation? Why or why not?

Now ask this same volunteer to demonstrate the procedure (in this case, tying a shoelace) without any commentary. Actions only. Will someone who has never tied a shoe be able to model this behavior? Why or why not?

3. Ask if anyone has any suggestions for the volunteer to make it easier for the learner to follow her instructions. Possible responses might include:

Do both of the above: model and explain

Ask the learner to demonstrate what she has seen/been told

Remind the group that a person's likelihood of remembering new information about how to do something is almost three times greater if they actually do it, than it is if they just hear about it; and almost twice as great as it would be if they heard and saw what to do, but didn't actually do it themselves.

Ask what this tells trainees about what they should do with their clients during postpartum home visits. Responses include:

• Model how to do certain things for the baby.
• Talk to the client at the same time and let her know what you're doing and why.
• If possible, leave her with some pictures material that she can refer back to if she forgets something.

4. Project a transparency of Training Aid #5, a drawing of a newborn. All those marked body parts are going to need attention from the mother. Should the transparency have labeled anything else that needs care? [Note: You can add new labels if the group has additional suggestions.] Discuss the sorts of skills you can model and discuss when training your clients how to care for their babies. What are some of the routines that you can show and explain to a new mother, if you can tell she is nervous and/or doesn't know what to do? Possible responses will include:

• How to bathe an infant
• How to care for the umbilical cord (also the penis, if a male baby has been circumcised)
• How to change a diaper (cloth vs. disposable)
• How to dress an infant
• How to swaddle an infant (only applicable in first month or so)
• How to hold an infant
• How to care for a baby's skin
• How to soothe and comfort a fussy baby (discussed earlier)
• How to take a baby's temperature

Trainees should make sure they can model proper handwashing, and explain to mothers that washing their hands well with soap each time they change a diaper (or go to the bathroom themselves) is the best way to keep germs away from their babies.

[Note: If PSS are working with clients who are at risk of HIV infection or Hepatitis B, you may wish to discuss universal precautions at this time. See Section G on Safety.]

5. Activity. Ask participants to pair off in teams of two. Assign two or more of these baby needs to each team (the number will depend on how many trainees are in the course), and have the team members jot down all the steps they will need to demonstrate and the advice they will need to give, at the same time, to a new mother.

When they have finished, ask team members to report on, and demonstrate to the class how she would instruct a client. For example, how she would demonstrate the steps involved in changing a baby, and what things she should point out to the mother (like wiping a female from front to back or how to carefully pull back the foreskin to clean an uncircumcised male). Have each person use a doll to model the routine that the mother should follow. Remind her to be sure to talk to their "baby" at times, just as they want the mother to do.

[Note: Training Aid #6, Taking Care of a Baby, reviews some of the points that should be covered -- and, if possible, demonstrated -- for each of the procedures. Use it, if needed, to augment anything important that's left out of a presentation. Some of these topics are also covered thoroughly in the Resource Mothers Handbook. Information that is included in the Handbook is not repeated in Training Aid #6.]

When she is finished, ask other participants if she forgot anything or if any part of her demonstration/advice was inaccurate or confusing. Discuss.

Then go on to another team member for another presentation of modeling/explaining. Continue until all the baby needs have been covered. This is a good session to videotape, and play back later on, if you have the equipment.

6. Before going on to the next section, ask if anyone has additional comments or suggestions of "tips" that may help the new mother. Be sure to point out that every client, just like every baby, is unique, and that they will not all need the same amount of help with each skill. By observing mother-baby interactions, the PSS probably will be able to tell just how much "hands-on" help each client needs. Also remind participants that it's not enough to demonstrate a skill; they have to then observe the client as they demonstrate all that they heard and saw.

1. Discussion. Introduce this topic by asking trainees if they have heard the words "preventive medicine" and "curative medicine." Any ideas as to what these terms mean? Do they know any word that sounds like "preventive?" Someone may say "prevent" or "prevention." Ask what it means "to prevent" something. Together the group will probably determine that "preventive medicine" means doing things to prevent illness.

Next have a similar discussion of the word "curative." Someone will probably respond with "cure" or "curing." "Curative medicine" involves some sort of treatment so that a sick person is "cured" or becomes well.

Ask the group which is better: preventive or curative medicine? Why? Discuss. Be sure to point out that all babies are bound to get sick at some time and parents should not feel guilty or blame themselves if their child becomes ill. These things happen. However, there are actions parents can take which will help prevent their child(ren) from becoming ill. Discuss. Possible responses include:

• Take baby for routine physical care (well-baby check-ups)
• Make sure babies get immunized
• Have people wash their hands before touching or holding infants/young babies. (This could be controversial, but it is worth discussing: Is it realistic? Why or why not? What does washing with soap and water do? etc.)
• Keep babies away from others (children and adults) who are sick
• Dress the baby for the weather
• Keep the baby clean, change dirty diapers as soon as needed

Ask trainees to discuss why children are immunized. A possible response includes:

• prevention of life threatening diseases

Ask if it is important that a child gets all the immunizations. Possible responses include:

• Yes, for many of the diseases, a child is not fully protected until he or she gets all the shots. That is why it is very important that mothers make sure their children receive every immunization available to them.
• Also a non-immunized child could catch the disease and spread it to the baby and other children in the community.

Ask how immunizations are given. Possible answers:

• By injection (or shots)
• By mouth (only polio, so far)

Show video: "What Lilly Learned -- Immunizations."

2. Activity. Assign each person one of the nine diseases for which children are immunized in the United States: Tetanus, Diphtheria, Whooping Cough (Pertussis), Polio, Measles, Mumps, Rubella (German Measles), Hepatitis B, and Hemophilus (Meningitis). (If there are more than nine participants, give several people the same disease assignment; if there are less than nine, give some people two. Make sure each disease is covered.)

Say to the group that immunizations are kind of like hopscotch. You need to jump on all of the squares in order to get the prize. [Explain what are the rules of hopscotch if trainees are not familiar with this game.] Ask everyone to come outside or somewhere where you can draw on the floor. Suggest that they bring their Resource Mothers Handbooks and turn to the pages on immunization.

With them, draw a giant hopscotch board on the ground like the one shown below. Make sure that the squares are big enough to jump in. You may want to use a different color chalk for the boxes. Write the months along the side, and write the immunizations that should be given in those months in the large squares.

• Have each person take a small coin or pebble to use as her marker. Ask the group to divide into 2 teams.
• The first player throws the marker and aims for the disease that was assigned to her. If her marker lands within the proper square, she tells the others what this immunization will protect against and at what age(s) children should receive their immunizations. Then her team gets a point, and the first player on the other team throws and "explains" her disease and what could happen in the absence of the complete immunization series for that disease. (If a marker lands on the wrong square, or on a line, if the player cannot explain her disease or her immunization schedule fully, then that player's team does not get a point. In cases of disputed information, the trainer serves as referee.)

[Note: You can make this game a dart board or a dice game and follow a similar procedure.]

Continue taking turns until all players have had at least one turn and all diseases have been discussed. The team with the most points at the end is declared the winner.

Back in the training room, ask if anyone in the group has had a child who has experienced a negative reaction to an immunization.

Discuss possible side effects, such as crankiness, fatigue or a swelling at the area of injection. Tell the PSS' to suggest mothers are usually advised by the health care provider to give the child acetaminophen, (not aspirin), if she feels some relief would do the child good. Discuss possible concerns about immunization safety.

1. Discussion and activity. Ask participants if they remember any of the common problems or illnesses they dealt with when their children were small. Possible responses:

• Diaper rash
• Teething
• Fever
• Thrush
• Colds
• Ear infections
• Diarrhea

Have a volunteer write each of the problems/illnesses on newsprint or the blackboard. Leave space next to each one for writing some common home treatments applicable to these problems. Start with one illness and ask the group how they would treat it. Ask the volunteer (or a new one) to fill in treatments next to each problem/illness as the group discusses them. You may want to have one of the popular child care books available to refer to in case the group has questions. (One example is A. Eisenberg et al, What to Expect the First Year, Workman Publishing, New York, 1989.)

Discuss when a problem becomes so serious that the health care provider should be called, for example, a diaper rash that doesn't go away, or the first signs of an ear infection. Discuss any treatments that the group disagrees with, for example, the best treatment for diaper rash or whether to give babies medicine to numb their gums during teething. Let trainees know that sometimes there will not be one right answer. Different strategies or approaches are okay as long as they are not harmful to the baby. Remind the group that aspirin is not to be given to children because of the link to Reye's Syndrome.

3. Ask participants to name some of the serious signs that a baby is very sick. Possible responses:

• High fever
• Not eating or drinking fluids
• Weak and lifeless
• Persistent vomiting or diarrhea

The Resource Mothers Handbook has guidelines for when a mother should call her health care provider. Review these guidelines and be sure each trainee understands each point. If time allows, ask the group if anyone wants to share any personal experience of having a very sick baby and having to know what to do for the child. Also review your program's policy about PSSs giving medical advice.

4. Discussion. Usually a mother can tell if her baby is sick when the baby is especially cranky or not him/herself. Ask participants if they think parents should know how to take their baby's temperature? If so, why is it important? Possible responses:

• By monitoring the baby's temperature she will know if the baby's fever is getting dangerously high.
• She will know when the fever has gone down.
• Her health care provider or clinic may ask her how long the baby has had a fever and how high the fever has been.

There are two ways to take a baby's temperature, under the armpit (the axillary method), and in the rectum (the rectal method). The trainer should know which method the health clinics where most mothers take their babies recommend and also review both methods with the trainees.

Pass around a rectal thermometer and an oral thermometer. Ask the group if they notice the difference between the two. The oral thermometer has a longer bulb and can be used either in the mouth (but not in babies or small children who might bite down on it) or under the armpit. The rectal thermometer can be used in the rectum or under the armpit.

5. Activity. Ask the group for a volunteer to demonstrate and explain step by step the process of taking an axillary temperature of your baby doll. Have the group assist the volunteer if she asks for help at any point during her demonstration. Then have a second volunteer to demonstrate taking the rectal temperature of your plastic baby. (She may have to "pretend" to insert the thermometer.) Ask the volunteer to include what should be done to the thermometer before and after the thermometer is used. Again, ask the group to help her out or to bring up anything she forgot.

After the demonstrations are over, have the group check in the Resource Mothers Handbook for any steps they forgot. Mention these steps.

Be sure everyone gets a chance to practice reading a real thermometer in case there are any questions about how to read it.

1. Exercise. Distribute Handout #3, Kitchen Hazards, or if it's easier, make a transparency and project it on a screen or the wall. Ask the group what hazards they see in this illustration and how to avoid them. Put an "x" through each one after someone mentions it. Possible answers includes:

• stool next to burners/remove stool
• easy access to open window/put in window guard
• open sockets/use socket plugs
• roach poison in their child's reach/put higher
• knife easy to reach/put higher
• detergents easy to reach/use cupboard latches or move up
• cord dangling/wrap up so child can't pull toaster down
• pot handle easy to reach/move so handle points towards wall
• lighter and cigarettes easy to reach/put higher and have fire extinguisher available
• tub of water on floor/empty when child not being supervised

2. Show video: "Preventing Childhood Injury."

3. Post sheets of paper with the following headings around the room:

• Bathroom Safety
• Infant Seats
• Other Home Safety Tips
• Walkers
• Ways to Prevent Choking
• Toy Boxes and Toy Chests
• Pacifiers
• Controlling Safety Outside the Home
• Poison Prevention
• Baby Carriers
• Preventing Lead Poisoning
• Strollers and Baby Carriages
• Cribs
• Water Safety
• Playpens
• Sun Safety
• Changing Tables
• Safety Around Animals
• Highchairs

4. Give each participant a felt pen and ask the group to go around to the different sheets of paper and write a few suggestions on child safety that are relevant to the particular heading. For example, under the heading "changing tables" someone might write "never leave baby unattended on this." Or, under "infant seats" another person might put "If the baby's in this, put it on the floor, not on a table where he/she might fall." Ask each participant to start on a different piece of paper, and then rotate around the room, until each participant has had a chance to add to the lists made by her predecessors.

5. When they are finished, have one person read each sheet. Then discuss and fill in additional points. Use Chapter 15 of the Resource Mothers Handbook for ideas. Also distribute Handout #4, Home Safety Tips, which participants may want to consult for this exercise, and then keep to share with clients. [Note: Program managers can obtain copies of the original artwork from the National Office of the Healthy Mothers/Healthy Babies Coalition; Tele: (202) 638-5577, if they wish to use it to make clean copies to distribute to program clients.]

6. Role plays. Cut up the roles from Training Aid #7, Safety Role Plays, and put them in a container. Have everyone take a slip of paper from the container, including yourself. Begin by describing (or demonstrating) what your slip of paper says this client is doing incorrectly. Ask for a volunteer to "play" the PSS and say what advice she should give you, the client. When you and the volunteer have finished, ask everyone to provide constructive criticism.

7. Next the person who just played the PSS acts out or describes the situation presented on the slip of paper she selected. Ask for another volunteer to play the PSS and talk to the client about what she has observed or been asked.

Continue in this fashion with each volunteer PSS then becoming the client to present the role play situation she selected from the container. Be sure to process each role play by asking the group to provide feedback/give constructive criticism.

8. Group Discussion. Sometimes children have accidents when they're left with a babysitter or at day care. Ask the group to come up with a list of things that a mother can do to choose a child care provider and help her child care provider take good care of her child. Possible responses include:

• Make sure that the child care provider has experience. Should she be properly certified? Discuss.
• Observe how the child care provider interacts with another child to see that she is treating the child kindly.
• Call up two references on the person or center to find out what other people's experience has been.
• Make a sheet of suggestions for the child care provider so she has specific information about your child.

Distribute and discuss Handout #5, Suggestions for Safety. Is this something the mother should leave with her child when she leaves the child with a new child care provider? Why or why not? Could/should trainees also adapt it for use as a flier that parents can hang or put on their refrigerator door for use by a baby sitter who cares for their child in their home when they are out (at work, at school, at a movie, etc.)? Do they feel this handout would be easy to adapt for a sitter? How might they go about it?

Working as a group, ask trainees what suggestions they would make. For example, instead of "My telephone # is," trainees could put "My mother (parent) is at.....(place) and can be reached at.....(telephone number), or "My mother is at the movies. If you need help, call her sister, my aunt Gladys, at....."

When you have finished, suggest that participants may want to make a copy of this adapted version, so they'll have both to share with clients who need child care for their babies.

1. Case Study. Ask trainees to find a partner. Pass out to each group one of the case studies and the list of discussion questions from Training Aid #8. Explain that each of them has received a "case" that tells about a situation facing a PSS making a home visit. Each case should demonstrate one of the points covered in this unit. Participants should use the discussion questions to talk the case over with each other and decide on a strategy for the PSS.

You may want to begin by using the example case to show the group how the questions should help them form a strategy for the PSS. Then give the group about 15 minutes to go over their cases.

Then ask a pair to present their case to the group. They may choose to discuss or perform their case before the group. Process the situation or role play by discussing the reasons the "PSS" responded the way she did in each case.

1. Ask a person in the group to summarize the session. Or, refer back to the objectives and re-word them as questions, asking trainees to take turns responding.
2. Distribute and ask participants to complete or discuss a post-unit evaluation.
3. Distribute post-unit test.

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