COMMUNICATION Skills

(Listening and Learning & Building

Confidence and Support)

Source : Infant and Young Child Feeding : An Integrated Counselling

Course (WHO October 2005)

5/1

Listening and Learning

After completing this session
participants will be able to:
List the 6 listening and learning skills
List the 6 building confidence skills
Give an example of each skill
Demonstrate the appropriate use of the
skills

Communication Skills
Good Communication means you
respect the womens own
thoughts, beliefs & culture.

Communication skills maybe used to :

Listen & learn about the womans beliefs,

knowledge, practices
Build her confidence , praise practices
Offer information, suggest changes
Help co-workers who resist changes
Communicate with supportive family
members
Communicate with policy makers

Communication can be:

VERBAL or
NON VERBAL (BODY
LANGUAGE)

1. Use helpful non-verbal

communication

Counseling is a way of working with

people in which you try to understand
how they feel & help them to decide
what they think is best to do in their
situation.

Counseling mothers about feeding their infants

is not the only situation in which counseling is
useful.
Counseling skills are useful
-when you talk to patients or clients in other
situations
-useful with your family & friends or your
colleagues at work.

A mother may not talk easily about her feelings

with someone whom she does not know well.
You will need the skill to listen
-to make her feel that you are interested in
her.
-will encourage her to tell you more.
-less likely to turn off & say nothing.

SKILL 1
USE HELPFUL
NON-VERBAL COMMUNICATION

Non-verbal communication means

showing your attitude through
your posture, your expression,
everything except through
speaking.
Demo 5

Skill 1
Good morning, Susan. How is feeding going for you and you
baby?
Posture:
Hinders: Stand with your head higher than the other
persons
Helps: Sit so that your head is level with hers.
Eye contact:
Hinders: Look away at something else, or down at your
notes
Helps: Look at her and pay attention as she speaks
Barriers:
Hinders: Sit behind a table, or write notes while you talk
Helps: remove the table or the notes

Taking time:
Hinders: Be in a hurry. Greet her quickly, show signs of
impatience, look at you watch.
Helps: Make her feel that you have time. Sit down and
greet her
without hurrying; then; just stay quietly smiling
at her, watching her breastfeed, and waiting for her to
answer.
Touch:
Hinders: Touch her in an inappropriately way.
Helps: Touch the mother appropriately

Helpful Non-verbal Communication

Keep your head level
Pay attention
Remove barriers
Take time
Touch appropriately

Our non-verbal communication often

demonstrates to a mother or caregiver our
approval or disapproval of a situation.
We should be careful to avoid allowing our
own views on certain subjects, e.g. religion,
to be expressed in a counselling situation
where it might appear as though we are
judging a mother.

Verbal communication:
Tone of our voice is important. Always try to
sound gentle and kind when talking to mothers.
Try to find out how people feel. We need to be
interested and to probe beneath the surface if
we wish to learn their real worries & their
concerns.

SKILL 2

ASK OPEN QUESTIONS

To start a discussion with a mother, or to take a

history from her, you need to ask some
questions.
It is important to ask questions in a way that
encourages a mother to talk to you and to give
you information. This saves you from asking too
many questions, and enables you to learn more
in the time available.

Skill 2
2.1 Ask Open Questions:
Health Worker: Good morning, (name). I am
(name), the community midwife. How is (childs
name)?
Mother:
He is well, and he is very hungry.
Health Worker: Tell me, how are you feeding him?
Mother:
He is breastfeeding. I just have to give
him one bottle feed in the evening.
Health Worker: What made you decide to do that?
Mother:
He wants to feed to much at that time, so
I thought that my milk is not enough.

Open questions are usually the most helpful.

To answer them a mother must give you some
information.

Open questions usually start with

How
What
Why
Who
When
where

2.2 Ask Closed Questions:

Health Worker: Good morning, (name). I am (name), the
community midwife. Is (childs name) well?
Mother:
Yes, thank you,
Health Worker: Are you breastfeeding him?
Mother:
Yes
Health Worker: Are you having difficulties?
Mother:
No.
Health Worker: Is he breastfeeding very often?
Mother:
Yes

Closed questions are usually less helpful.

They tell a mother the answer that you
expect ,and she can answer them with a
Yes or No.
Closed questions usually start with words
like Are you? or Did he? or Has he? or
Does he?

If a mother says Yes to this question, you still

need to know if she breastfed exclusively, or if
she also gave some artificial feeds.
If you continue to ask questions to which the
mother can only answer yes or no you become
frustrated, and think that the mother is not willing
to talk, or that she is not telling the truth.

How to use questions to start and to

continue a conversation:
A very general open question is useful to start a
conversation. This gives the mother an
opportunity to say what is important to her. For
example, you might ask a mother of a ninemonth-old baby : How is your child feeding?
Sometimes a general question like this receives an
answer such as, Oh, very well thank you.
So then you need to ask questions to continue the
conversation.

For this, more specific questions are helpful. For

example: Can you tell me what your child ate
for the main meal yesterday?
Sometimes you might need to ask a closed
question. For example: Did your child have any
fruit yesterday?
After you have received an answer to this question
try to follow up with another open question.

SKILL 3.
USE RESPONSES AND GESTURES
WHICH SHOW INTEREST

Skill 3
Using Response and Gestures Which Show Interest
Health Worker:
Good morning, (name). How is (childs
name) now that he has started solids?
Mother:
Good morning. He is fine, I think.
Health Worker:
Mmm. (nods, smiles)
Mother:
Well, I was a bit worried the other day,
because he vomited.
Health Worker:
Oh dear! (raises eyebrows, looks
interested.)
Mother:
I wondered if it was something in the
stew that I gave him.
Health Worker:
Aha! (nods Sympathetically).

If you want a mother to continue talking, you must

show that you are listening and that you are
interested in what she is saying.
Important ways to show that you are listening and
interested are:
With gestures

e.g. look at her, nod & smile.

With simple responses e.g. You say Aha,

Mmm, Oh dear!.

SKILL 4.
REFLECT BACK WHAT THE
MOTHER SAYS

Reflecting Back
Health Worker:
Mother:
Health Worker:
Mother:
Health Worker:
Mother:
Health Worker:
Mother:

Good morning, (name). How are you

and (childs name) today?
He wants to feed too much he is
taking my breast all the time!
(Childs name) is feeding very often?
Yes. This week he is so hungry. I think
that my milk is drying up.
He seems hungrier this week?
Yes, and my sister is telling me that I
should give him some bottle feeds as
well
Your sister says that he needs
something more?
Yes. Which formula is best?

Health workers usually ask mothers a lot of factual

questions. However, the answer to factual
questions are often not helpful. The mother may
say less and less in reply to each question.

It is more useful to repeat back or reflect what a

mother says
-another way to show you are listening
-encourages the mother or caregiver to continue
talking
-say what is important to her
It is best to say it in a slightly different way, so that
it does not sound as though you are copying her.

SKILL 5.

EMPATHIZE- SHOW THAT YOU

UNDERSTAND HOW SHE FEELS

Empathy is a difficult skill to learn. It is difficult for

people to talk about feelings. It is easier to talk
about facts.
When a mother says something which shows how
she feels, it is useful to respond in a way which
shows that you heard what she said, and that
you understand her feelings from her point of
view.

Sympathy:
Health Worker: Good morning, (name). How are you and
(childs name) today?
Mother: (Childs name) is not feeding well. I am worried
he is ill.
Health Worker: I understand how you feel. When my
child was ill, I was so worried. I know exactly
how you feel.
Mother: What was wrong with your child?

Empathy:
Health Worker: Good morning, (name). How are
you and (childs name) today?
Mother:
He is not feeding well, I am worried he is
ill.
Health Worker: You are worried about him?
Mother:
Yes, some of the other children in the
village are ill and I am frightened he may have
the same illness.
Health Worker: It must be very frightening for
you.

For example, if a mother says: My baby

wants to feed very often and it makes me
feel so tired! you respond to what she
feels, perhaps like this: You are feeling
very tired all the time then?
Empathy is different from sympathy. When
you sympathize you are sorry for a person,
but you look at it from your point of view.

If you sympathize, you might say: Oh I

know how you feel. My baby wanted to
feed often too, and I feel exhausted.
This brings the attention back to you, and
does not make the mother feel that you
understand her.

You could reflect back what the mother says

about the baby.
For example: He wants to feed very often?
But this reflects back what the mother said
about the babys behavior, and it misses
what she said about how she feels. She
feels tired.

So empathy is more than reflecting back

what a mother says to you.
It is also helpful to empathize with a
mothers good feelings. Empathy is not
only to show you understand her bad
feelings.

SKILL 6.
AVOID WORDS WHICH SOUND
JUDGING.

Using Judging Words:

Health Worker: Good morning, (name). Is (name)
breastfeeding normally?
Mother:
Well I think so.
Health Worker: Do you think that you have enough
breast milk for him?
Mother:
I dont know.. I hope so, but maybe not..
(she looks worried)
Health Worker: Has he gained weight well this
month?
Mother:
I dont know..
Health Worker: May I see his growth chart?

Avoiding Judging Words:

Health Worker: Good morning, (name). How is
breastfeeding going for you and (childs
name)?
Mother: Its going very well. I havent needed to give
him anything else.
Health Worker: How is his weight? Can I see his growth
chart?
Mother: Nurse said that he gained more than half a kilo
this month. I was pleased.
Health Worker: He is obviously getting learned about the
mothers feelings?

Judging words are words like: right, wrong, well,

badly, good, enough, properly.
If you use judging words when you talk to a mother
about feeding, especially when you ask
questions, you may make her feel that she is
wrong, or that there is something wrong with the
baby. A breastfeeding mother may feel there is
something wrong with her breast milk.

Mothers may use judging words about their

own situation. You may sometimes need to
use them yourself, especially the positive
ones, when you are building a mothers
confidence.
You may have noticed that judging questions
are often closed questions. Using open
questions often helps to avoid using a
judging word.

Summary
LISTENING AND LEARNING SKILLS
Use helpful non-verbal communication
Ask open questions
Use responses and gestures which show
interest
Reflect back what the mother says
Empathize- show that you understand how
she feels
Avoid words which sound judging.

Build Confidence and give support

YOUR communication skills can help a
mother feel good about herself and
confident that she will be a good
mother.
Confidence can help a mother to carry out
her decisions and to resist pressures
from other people.
To build confidence and support we need
additional skills

1. Accept what a mother thinks and feels

Accept mothers ideas and feelings
Without agreeing
Without disagreeing
ACCEPTING is NOT AGREEING that she
is right
ACCEPTING - helps her to trust you

Demo d-e

Skill 1: Accepting what mothers thinks

A.
Mother: My milk is thin and weak, and so I
have to give bottle feeds.
Health Worker: Oh no! Milk is never thin and
weak. Its just looks that way.(nods, smiles)

Skill 1
B.
Mother: My milk is thin and weak, and so I
have to give bottle feeds.
Health Worker: Yes thin Milk can be a
problem

Skill 1
C.
Mother: My milk is thin and weak, and so I
have to give bottle feeds.
Health Worker: I see. You are worried about
your milk

Skill 1: Accepting what mother feels

D.
Mother(crying): It is terrible,(childs name) has
a cold and his nose is completely blocked
and he cant breastfeed. He just cries and I
dont know what to d.
Health Worker: Dont cry its not serious.
(childs name) will soon be better

Skill 1
E.
Mother(crying): It is terrible,(childs name) has
a cold and his nose is completely blocked
and he cant breastfeed. He just cries and I
dont know what to d.
Health Worker: You are upset about (childs
name) arent you.

2. Recognize and acknowledge what is

right
Case study
A baby being weighed, and his mother.
The baby is exclusively breastfed. Beside the
mother and baby is the babys growth chart. His
growth chart shows that he has gained a little
weight over the last month. However, his growth
line is not following the reference curves. It is
rising too slowly. This shows that the babys
growth is slow.

Which of these remarks will help to

build the mothers confidence?
your babys growth line is going up too

slowly.
I dont think your baby is gaining enough
weight.
your baby gained weight last month just
on your breast milk.

3. Give Practical help

Case study
This mother is lying in bed soon after
delivery. She looks miserable and
depressed. She is saying to the health
worker: no, I havent breastfed him yet.
My breasts are empty and it is too painful
to sit up.

Which response is more appropriate

you should let your baby suckle now
to help your breast milk to come in.
Let me try to make you more
comfortable, and then Ill bring you a
drink.

4. Provide relevant information

using suitable language
Find out what she needs to know at
this time.
Use suitable words that the mother
understands
Do not overwhelm her with
information

Case study
This baby is three months old. His mother
has recently started giving some formula
feeds in the bottle in addition to
breastfeeding. The baby has developed
diarrhea. The mother is saying to the
health worker: He has started to have
loose stools. Should I stop
breastfeedings?

Which response gives positive

information
it is good that you asked before

deciding. Diarrhea usually stops

sooner if you continue to
breastfeed.
oh no, dont stop breastfeeding. He

may get worse if you do that.

5. Make suggestions rather than

commands
Provide choices and let her decide
what will work for her.
Do not tell her what she should
do or must not do.
Limit your suggestions to one
or two suggestions that are
relevant to her situation.

Case study
Health worker: good morning
(name). What can I do for you
today?
Mother: can you tell me what you
asked me what foods to give my
baby, now that she is six months
old.

Health worker: I am glad that you asked. Well now,

the situation is this. Most children need more
nutrients than breast milk alone when they are
six months old because breast milk has less
than 1 milligram of absorbable iron and breast
milk has about 450 calories, so less than the
700 calories that are needed. The vitamin, a
needs are higher than are provided by breast
milk and also the zinc and other
micronutrients.

However, if you add foods that arent

prepared in a clean way it can increase
the risk of diarrhea and if you give too
many poor quality foods the child wont
get enough calories to grow well.

6. Arrange follow up and on-going

support
- Learn what help may be available
- Offer a time to see her / talk with her
- Encourage her to see you if she has
doubts or questions.
- Refer her to a community support group
- Refer her for more specialized
counseling.
- Many women are not able to do what they want

to do or what you may suggest they do.

Case study
Amy breast feeds only four times a day,
and she is gaining weight too slowly.
Her mother thinks that she does not
have enough breast milk.
Responses:
You must feed Amy at least 10 times a
day.
It might help if you feed Amy more
often.

Summary
Accept what a mother thinks and feels
Recognize and praise what a mother and baby are doing right
Give practical help
Give a little, relevant information
Use simple language
Make one or two suggestion, not commands