By Catherine Fenner, IBCLC

November's Brilliant Activities for Birth Educators post is all about helping families to understand baby's input and output through the first month of life. It is a fantastic hands-on activity that helps create community as class members work in small groups and encourages learning by manipulation and assessment! It covers several learning objectives succinctly and using engaging techniques. My colleague, Catherine Fenner, IBCLC, teaches breastfeeding classes to new families in our community and is a Lactation Consultant in the Seattle area. To find all of Science & Sensibility's Brilliant Activities for Birth Educators, click here, and add these exciting teaching ideas to your curriculum. - Sharon Muza, Science & Sensibility Community Manager.

Introduction

Parents usually have very practical questions around breastfeeding: How does it work? How do I know my baby is getting enough? This small group, hands on activity answers these, and other related questions by allowing the parents to discover their baby's needs at various stages throughout the first month of life. Through discussion, analyzing clues and making guesses, parents learn about typical baby intake and output needs. Seeing and touching the "evidence" gives families confidence that they will recognize the signs their baby is getting enough enough breastmilk. This activity can be conducted during the breastfeeding portion of a series class or in a stand alone breastfeeding offering.

Materials Needed

1. Five gift bags (consider using baby themed bags)
2. Five cards labeled "Day 1," "Day 2," "Day 3," "Day 7," and "2-3 Weeks"
3. Five small containers with tight lids: each holding water in various volumes: 1 teaspoon, 1 tablespoon, 0.5oz, 1.0 - 1.5 oz, 3 oz (note: clear water works, using food coloring shows the volumes better but it is hard to make it white, or you might consider using a milk source (soy, almond etc) but watch that it doesn't mold!)
4. Three marbles, (one regular size, two shooter size if possible), one ping pong ball, one plastic egg representing stomach volume.
5. 32 infant disposable diapers
6. 12 small cards with a black circle, representing urine, on each one. They are for illustration only. They do not indicate minimum size or quantity of urine per diaper.
7. 20 small cards with a solid color circle (about the size of a quarter, which is the minimum desired volume of stool per diaper),
8. Representing stool, on each one. 1 black, 1 brown, 1 dark green, 16 yellow, 1 light green (added to show normal variation in poopy diapers)

Preparation

Open these files with the urine/stool circles and age cards ready to print. Print in color, laminate and cut the labels into appropriate sizes. Using hot glue, attach the appropriate urine and stool circles in each diaper. Fill the containers with the appropriate amount of liquid. I added yellow food coloring to make it more visible, but do it as you like. The marbles for the stomach volume for Days 1-3 are all the same size because I couldn't find slightly larger marbles to show the gradual change. I explain that during the exercise. Assemble the bags.

Each gift bag and all its contents represents a baby's intake and output for that day of life. Prepare them as follows:

• Day One holds 1 wet diaper, 1 black meconium diaper, a small marble, a small container holding 1 teaspoon of liquid.
• Day Two bag: 2 wet diapers, 2 poopy diapers (1 brown, 1 dark green), a small marble (slightly larger than the Day 1 marble, or pretend it is), a small container holding 1 tablespoon of liquid.
• Day Three bag: 3 wet diapers, 3 yellow poopy diapers, a shooter marble (slightly larger than the Day 2 marble), a small container holding 0.5 oz of liquid.
• Day Seven bag: 6 wet diapers, 2 yellow, 1 green poopy diapers (showing normal variation), a ping pong ball, a bottle holding 1.0 - 1.5 oz of liquid.
• Week 2-3 bag: 8 wet diapers, 3 yellow poopy diapers, a plastic egg, a bottle holding 3 oz of liquid.

When I Introduce this Activity

This activity introduces the discussion on how to know baby is getting enough. We've already talked about how breastfeeding works, identifying baby's hunger cues and how to latch. It has worked well mid-way through class when students are ready to move around and interact with each other.

How to Conduct this Activity

I separate the class into five groups. Students re-arrange their chairs to facilitate discussion. I give each group a bag. At the front of the room I lay out the cards Day 1, Day 2, Day 3, etc so everyone can see them. I tell the class that, using the clues in the bag, they will guess the age of their baby. I explain each item in the bags. The marble/ball/egg represents baby's stomach volume at that age. The bottle of water represents the amount of milk baby will need at each feeding at that age. The wet diapers are represented by a black circle. The stool/dirty/poopy diapers are represented by the solid color circle. Within 5-7 minutes of discussion most groups have a guess.

I bring the class together and ask which group thinks their baby is One Day old? I ask them to share their evidence. They share each item in the bag, and we review what the size, volume and colors each mean. Sometimes the first group actually has the bag for a Two Day old baby. The group with fewer diapers, or smaller milk volume usually says something at this point. We look at their evidence. The class recognizes the smaller the milk volume and diaper count, the younger the baby. We continue this process through all the groups. Each group is given the card with their baby's age on it when their age is confirmed by the group.

Take Aways

By the end of the activity students have discovered, and we have discussed several key learning objectives:

• Students can hold diapers, and differentiate urine from stool. They know baby's minimum urine and stool output, colors, and how they change over time. This gives them confidence that they can read and interpret one key sign baby is getting enough. This leads to sharing the other signs baby is getting enough.
• Students see how much milk a baby needs at each feed, and how their stomach volume increases gradually at a similar rate. Parents are more confident, and patient, in the early days, knowing their baby only needs small amounts of milk. This can prevent over-feeding, or introducing formula unnecessarily.
• Students see how quickly baby's needs change. This helps parents be flexible and responsive to their baby.

Conclusion

This is a fun activity to teach. Parents seem to have fun discovering what is in their, and other groups' bags. I see curiosity and awe about how their baby will grow and change from the first day. I also see their fears about not feeding their baby enough decrease while their confidence that they can care for their baby increases.

Would you consider giving this activity a try with the famiiles you work with? If you are a doula or lactation consultant or health care provider, you could use these activities for teaching moments one to one. Let us know what you think and how it goes? - SM.

About Catherine Fenner

Catherine Fenner, IBCLC is a private practice Lactation Consultant with Nurture New Life in Shoreline, WA. In addition to providing in-home consultations, she co-facilitates a weekly breastfeeding group, and teaches prenatal breastfeeding classes. She is President of the Breastfeeding Coalition of Snohomish County which sponsors an annual conference for lactation professionals. Her passion for supporting families grew from overcoming her own over-confidence, and under-preparedness, and the challenges that came up while learning to nurse her children. She enjoys figuring out how to balance work and family with a husband and three amazing kids. For more information visit her website NurtureNewLife.com