Road To Health Booklet

Road to Health
IMPORTANT: Always bring this book when you visit

any clinic, doctor, or hospital.
Nutrition Love Protection Healthcare Extra Care
Child’s name:
Date of birth:
Gender:
SideBySide final layout.indd 1 2018/02/28 9:46 AM

This book is provided at birth by staff at the health facility.
If birth takes place at home this book must be given the first
time a health worker sees the baby.
This book is FREE to ALL BABIES in both public and private

health care. It must be replaced for free if lost or damaged.
This book belongs to:
Place a picture of your child here
CHILD’S NAME:
CHILD’S SURNAME:
DATE OF BIRTH: Y Y Y Y - M M - D D
CHILD’S ID NUMBER:
BIRTH WEIGHT: GESTATIONAL

AGE:
MOTHER’S NAME: FATHER’S
NAME:
MOTHER’S CONTACT FATHER’S

DETAILS: CONTACT
DETAILS:
ii

on the road to health
This book is for you and your child’s health worker.

It gives you advice on how to raise a happy, healthy
Contents
child. It is also a record of your child’s growth and
development, and is used by health workers to make
sure that every child gets the care that they need at Nutrition 4
the right time.
For your child to grow and develop best he/she needs: Love 22
1 Good nutrition
2 Lots of love, playing and talking
3 Protection from disease and injury Protection 26
4 Health care when they are sick or injured
5 Extra care and support if and when they need it
Health care 30
Read this book from cover to cover to learn how
you can help your child grow and develop. Please
keep this book in a safe place and take it with you Extra care 40
every time that your child visits a clinic, hospital,
doctor or other health facility.
Although information from this book may be requested

by your child’s preschool or school, it should always
be kept in your care. These are words that
you may find difficult to
Ask the health worker about your child’s health, growth understand. The meaning
and development at every visit. Speak to your health of these words are explained
at the back of the book.
worker about any concerns.
For health workers …

l Make sure that every child has a Road to Health book.
If they do not have one make sure they are given one.
l Always ask for the Road to Health booklet and encourage parents and
caregivers to bring it with them every time they visit the clinic, doctor, hospital
or any health facility.
l Complete all relevant sections of the booklet at each visit.
l Talk to caregivers about what you are doing and encourage them to ask
questions and share any concerns.
l All mothers should be introduced to the booklet during antenatal care.
1

Clinic Visits
Head circumference p25

Growth monitoring p9
Feeding advice p4
Immunisation p27
Development p23
Consider HIV p40

Oral Health p29
Deworming p28
TB screen p40
Vitamin A p28
Age Date Next date
3 – 6 days
6 weeks
10 weeks
14 weeks
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
14 months
16 months
18 months
20 months
22 months
2 years
2 and a
half years
3 years
3 and a
half years
4 years
4 and a
half years
5 years
6 years
12 years
3 tick once done Not in schedule

2

Danger signs!
Take your child to the nearest clinic
if you see any of the following.
Child is coughing and Child under 2 months old Child is vomiting

breathing fast (more than has a fever and is not everything
50 breaths per minute) feeding
Child has diarrhoea Child is shaking Child has signs of

sunken eyes, and a (convulsions) malnutrition
sunken fontanelle (swollen ankles and feet)
Child is not moving or Child is unable to

does not wake up breastfeed
3

1. Good nutrition to grow and be healthy
Your child needs the right foods to be healthy
a
and grow well. Ask the health worker if your child
is growing well and tell them if you are worried
about anything.
Birth to 6 months
l Breastfeeding is the best way to feed your baby.
It is the ideal food for your baby to grow, develop
and be healthy.
Bring your baby to the breast as
l Give your baby ONLY breast milk for the first opposed to leaning forward to stretch
six months of life. Do not give porridge, water your breast into your baby’s mouth.
or any other liquids. Do not give any other Support your baby’s head and neck.
home or traditional medicines or remedies.
d
Only give your baby medicines they receive
from the clinic or hospital.
l Breastfeed as often as your baby wants,
both day and night.
l Breastfeed your baby at least 8 times in
24 hours. The more your baby feeds the more
milk you will produce. Almost all mothers will
produce enough milk for their baby not to
Place your thumb on the top part of
need anything else for the first six months. where the dark ring around your nipple
l You can express breastmilk for other carers to meets your breast. Place your remaining
give to your baby while you are away. They fingers below where the dark ring around
your nipple meets your breast. To
should use a clean cup, rather than a bottle. express milk, press your pointing finger
Store expressed breastmilk in a clean glass or and thumb together. Make sure that
plastic cup with a lid. Defrost in a fridge or at your hand is pushing your breast
towards, and not away, from your body.
room temperature over 12 hours or
by standing in water. Do not boil or
microwave. How long to store expressed breastmilk?
l It is best not to use bottles or Temperature Duration
artificial teats (dummies). Some Room temperature Up to 8 hours
babies find it difficult to suckle at Fridge Up to 6 days
the breast after using a dummy. Ice box freezer in fridge 3 months
Bottles are also difficult to clean Deep freezer (-18ºC) 3-6 months
and may have germs that can
make your baby sick.
l If you are HIV-positive, remember to always take your HIV or antiretroviral
treatment. This makes breastfeeding safe.
l Breastfeeding mothers should eat healthy food. They must not drink alcohol,
smoke or take other harmful drugs.

b c
Remember:
Before you make the
decision not to
breastfeed, discuss
the matter with a
health worker. If you
are really unable to
Let your baby’s head tip back a Wait until your baby opens their breastfeed, you will
little so their top lip can brush mouth really wide with their need to learn how to
against your nipple. tongue down. You can encourage use formula safely.
them by gently stroking their top
lip. Your baby needs to get a big
mouthful of breast.
Why should I give only breastmilk during the ﬁrst six months of life?
l Breastmilk contains all the nutrients your baby needs for the first 6 months
of life.
l Baby’s tummy (intestine/gut) is not yet ready for any other foods, water or
other liquids before 6 months.
l Babies may get diarrhoea, constipation , infections and allergies if other
foods, or other liquids – including water – are given before the baby is 6
months old.
l Breastmilk contains enough water to quench your baby’s thirst during the
first 6 months of life, even in hot weather.
l Breastmilk contains special properties that keep your baby healthy. Breastfeeding
reduces the chance of your baby getting pneumonia and diarrhoea.
l Giving other foods before six months will cause you to produce less breastmilk
and your baby will not get all the nutrients they need to grow and develop well.
For Health Workers…

l Babies only need breastmilk and nothing else during the first six months of life.
This is called exclusive breastfeeding.
l Mothers need help to start breastfeeding immediately after birth.
l Mothers need support to continue breastfeeding successfully. Help them to get

their baby to attach properly.
l Mothers who are not breastfeeding must be counselled on correct replacement

feeding.
5

6 months to 5 years
Your child’s
age What foods to give How much?
6 – 8 months Continue breastfeeding on demand. Start with 1 – 2 teaspoons, twice
Breastfeed first, then give other foods. a day.
Gradually increase the amount
Your baby needs iron-rich foods (dried
and frequency
beans, egg, minced meat, boneless fish,
of feeds.
chicken or chicken livers, ground mopane
worms). These foods must be cooked and
mashed to make them soft and easy for
your baby to swallow.
Also, give your baby:

l Starches (such as fortified maize meal
porridge, mashed sweet potatoes or
mashed potatoes)
l Mashed, cooked vegetables (such as
pumpkin, butternut, carrots)
l Soft fruit without pips (such as
avocado, bananas, paw-paw, cooked
apples)
Give your baby clean and safe water to

drink from a cup, regularly
9 – 11 months Continue breastfeeding on demand. l About a ¼ cup, then increase

Breastfeed first, then give other foods. to half a cup by 12 months
l 5 small meals a day
l Iron rich foods are very important for
your baby’s growth
l Increase the amount and variety
(different kinds) of foods.
l Food doesn’t need to be
smooth as in the past months.
l Give your child small pieces
of foods they can hold
(bananas, bread, cooked
carrots)
l Avoid small hard foods
that may cause
choking like peanuts.
l Give your baby safe
water to drink from
a cup, regularly

Your child’s
age What foods to give How much?
12 months up to Continue breastfeeding as often as your l About 1 full cup
5 years child wants up to 2 years and beyond. l 5 small meals a day (A child
Give food before breastmilk. has a small stomach, so they
will not eat enough to last
l Give a variety (different kinds) of foods many hours)
(iron rich foods, starches, vegetables,
fruits)
l Give foods rich in vitamin A (liver,
spinach, pumpkin, yellow sweet
potatoes, mango, paw-paw, full cream
milk, maas)
l Give Vitamin C rich foods (oranges,
naartjies, guavas, tomatoes)
l Cut up foods in small pieces so that
your child can eat on their own
l Stay next to your child and
encourage them to eat
l If not breastfeeding, you can start
giving pasteurized full cream cow’s
milk/maas or yoghurt. Follow up
formula is not necessary
l Give your child clean, safe water to
drink from a cup, during the day
Remember:
l From the age of 6 months, give your baby clean, safe-to-drink water from a
cup during the day. Boil the water and cool before you give it to your child.
l Always stay next to your child when they are eating.
l Keep food and cooking utensils very clean to prevent diarrhoea.
l Always wash your hands and your child’s hands with soap and water
before preparing food, before eating, and after using the toilet and
changing nappies.
l It’s not necessary to buy baby food or baby cereals. Homemade foods
are good.
l Don’t give your child Rooibos tea or any other tea, coffee, creamers,
condensed milk, flour water, sugar water, and cold drinks. These foods
and drinks do not contain any nutrients and will not help your child to
grow.
l Avoid giving your child unhealthy foods like chips, sweets, sugar and
fizzy drinks.
l Infant formula increases risk of your baby getting diarrhoea, allergies,
and breathing problems.

The following pages are your child’s growth charts. Your
health worker will measure your child at each visit and
record their growth on these charts.
The charts help your health worker find any problems with
your child’s growth. Ask your health worker to explain to you,
using the charts, how your child is growing.

For Health Workers …
l Remember to tell mothers if their baby is growing well

or if they are not thriving.
l Explain the growth charts to parents and caregivers.

Answer their questions and any concerns that they
may have about their baby’s growth and development.
l A child with a MUAC less than 11.5cm or with a weight

for height plot under the -3 line or with oedema of both
feet is considered to have SEVERE ACUTE
MALNUTRITION and should be referred.
Growth monitoring and counselling

Growth charts assess a child’s nutritional status.
l Wasting is measured by either the mid-upper arm

circumference (MUAC) or weight-for-height (WFH). Both
are good indicators of wasting in children. MUAC
should be done at all home and clinic visits. A child
with a low MUAC or WFH may need hospitalisation or
need therapeutic feeding. A child must be referred if
either the MUAC OR the WFH measurement classifies
the child as having Severe Acute Malnutrition.
l For short-term growth, the weight-for-age chart is used

to monitor weight gain.
l Long-term linear growth faltering (stunting) is best

assessed using the height-for-age chart.

Mid-upper arm circumference (MUAC)
MUAC is used to identify signs of malnutrition. MUAC should be measured at

all clinic visits, and by community health workers during home visits, from
6 months until the child is 5 years old.
Record the MUAC and classify as follows:

MUAC less than 11.5 cm indicates SEVERE ACUTE MALNUTRITION
(REFER URGENTLY)
MUAC between 11.5 cm and 12.5 cm indicates MODERATE ACUTE
MALNUTRITION (Manage as in IMCI guidelines)
MUAC 12.5 cm or more indicates NAM (NO ACUTE MALNUTRITION)
MUAC Assessment Healthcare

Date (cm) (Circle one) Action taken worker name
10

BOYS: Weight-for-height charts
32
31,5
31
30,5
30kg
29,5
29
28,5
ine
28
+3 l
27,5
27 27
26,5 26,5
26 26
25,5 25,5
25kg
ine
25kg
+2 l
24,5 24,5
24 24
23,5 23,5
23 23
22,5 22,5
22 22
21,5 21,5
21
WEIGHT IN KILOGRAMS (kg)
21
n)
20,5 20,5
dia
20kg 80cm 100cm 120
e
85 90 95 105 110
(M
ne
19,5 19,5
0 li
19 19
18,5 18,5
18 18
17,5 17,5
17 17
e
lin
-2
16,5 16,5
16 16
e
lin
15,5 15,5
15kg
-3
15kg
14,5 14,5
14 14
13,5 13,5
13 13
12,5 12,5
12 12
11,5 11,5
11 11
10,5 10,5
10kg 45 50 55 60cm 65 70 75 80cm 85 90 95 100cm 105 110 115 120
9,5 9,5
9 9
8,5 8,5
8 8
7,5 7,5
7 7
6,5 6,5
6 6
5,5 5,5
5kg 5kg
4,5 4,5
4 4
3,5 3,5
3 3
2,5 2,5
2 2
1,5 1,5
1
45 50 55 60cm 65 70 75 80cm 85 90 95 100cm 105 110 115 120
LENGTH/HEIGHT IN CENTIMETRE (CM)
This Weight-for-Length Chart shows body-weight relative to length/height in comparison to

the Median (the green line).
l A boy whose weight-for-length/height is above the +3 (red) line, is obese.
l A boy whose weight-for-length/height is above the +2 line (orange), is overweight.
l A boy whose weight-for-length/height is below the –2 line (orange), is wasted.
l A boy whose weight-for-length/weight is below the –3 line (red), is severely wasted
(SEVERE ACUTE MALNUTRITION). Refer for urgent specialised care.
11

BOYS: Weight-for-age charts
20kg
19.5
19
18.5
18
17.5
17kg 17kg 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 14
13.5 13.5 13.5
13 13 13
+3 line
12.5 12.5 12.5
12 12 12
11.5 11.5 +2 line 11.5
11 11 11
10.5 10.5 10.5
10 10 10
9.5 9.5 9.5
)
9 9 0 Line (median 9
8.5 8.5 8.5
8 8 8
7.5 7.5 -2 line 7.5
7 7 7
-3 line 6.5
6.5 6.5
6 6 6
5.5 5.5 5.5
5 5 5
4.5 4.5 4.5
4 4 4
3.5 3.5 3.5
3 3 3
2.5 2.5
2 2
1.5 1.5
1 1
0.5 0.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14
WEEKS
Birth Weight 4 5 6 7 8 9 10 11 12
1 2 3
Months
Birth to 1 year
12

BOYS: Weight-for-age charts
24kg 24kg
23.5 23.5
23 23
22.5 22.5
22 22
21.5 21.5
21 21
20.5 20.5
20kg 20 + 3 line 20
19.5 19.5 19.5
19 19 19
18.5 18.5 18.5
18 18 e 18
17.5 17.5 +2 lin 17.5
17 17 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 edian) 14
0 Line (m
13.5 13.5 13.5
13 13 13
12.5 12.5 12.5
12 12 12
11.5 11.5 11.5
11 11 -2 line 11
10.5 10.5 10.5
10 10 10
-3 line
9.5 9.5 9.5
9 9 9
8.5 8.5 8.5
8 8 8
7.5 7.5 7.5
7 7 7
6.5 6.5 6.5
6 6 6
5.5 5.5 5.5
5 5 5
4.5 4.5
4 4
3.5 3.5 25 26 27 28 29 30 31 32 33 34 35 36
3 3 Months
13 14 15 16 17 18 19 20 21 22 23 24 2 to 3 years
Months
1 to 2 years
12
Interpretation of lines:
l This Weight-for-Age Chart shows body-weight relative to age in comparison to the Median (green
0-line).
l A boy whose weight-for-age is below the orange -2 line, is underweight.
l A boy whose weight-for-age is below the red -3 line, is severely underweight.
l If his line crosses a z-score line and the shift is away from the median, this may indicate a problem
or risk of a problem.
l If his line shifts away from his birth trend line, this may indicate a problem or a risk of a problem.
13

BOYS: Weight-for-age charts 3 to 5 years
29kg 29kg
28.5 28.5
28 28
27.5 27.5
e
lin
27kg 27kg +3 27kg
26.5 26.5 26.5
26 26 26
25.5 25.5 25.5
25 25 25
24.5 24.5 24.5
24 24 24
line
23.5 23.5 +2 23.5
23kg 23 23kg
22.5 22.5 22.5
22 22 22
21.5 21.5 21.5
21 21 21
20.5 20.5 20.5
20 20 20
19.5 19.5 19.5
19 19 19
18.5 18.5 18.5
18 18 ian) 18
med
17.5 17.5 0Line ( 17.5
17 17 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 14
-2 line
13.5 13.5 13.5
13 13 13
12.5 12.5 12.5
12 12 -3 line 12
11.5 11.5 11.5
11 11 11
10.5 10.5 10.5
10 10 10
9.5 9.5 9.5
9 9 9
8.5 8.5 8.5
8 8 8
7.5 7.5 7.5
7 7 7
6.5
6
5.5 49 50 51 52 53 54 55 56 57 58 59 60
Months
36 37 38 39 40 41 42 43 44 45 46 47 48 4 to 5 years
Months
3 to 4 years
14

BOYS:
BOYS:Height-for-age
Height-for-agecharts
charts
125 birth
birthtoto5 5years
years
120
115
110
105
100
95
90
85
80
75
70
65
60
55
50
45
5 years
30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60
n)
edia
e
line
e
lin
-3 line
-2 lin
e (m
+2
+3
0 Lin
4 years
3 years
24 26 28
2 years
Age (completed months and years)
FOR PERIODIC USE
(every 6 months)
18 20 22
11 12 14 16
1 year
10
9
8
7
6
5
4
3
2
1
Birth
MONTHS
125
120
115
110
105
100
95
90
85
80
75
70
65
60
55
50
45
Length/Height (cm)
INTERPRETATION OF LINES
This Length/Height-for-Age Chart
This Length/Height-for-Age Chart shows
shows height
height relative
relative to
to age
age in
in comparison
comparison to
to the
the Median
Mediangreen (0-line)
whose length/height-for-age is below the orange -2 line, is stunted
A boy (0-line)
green
AA boy
boy whose
whose length/height-for-age
length/height-for-age is
is below
below the
the red -3 line,
orange is severely
-2 line, stunted
is stunted
A boy whose length/height-for-age is below the red -3 line, is severely stunted
15

GIRLS: Weight-for-age charts
20kg
19.5
19
18.5
18
17.5
17kg 17kg 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 14
13.5 13.5 13.5
13 13 13
12.5 12.5 +3 line 12.5
12 12 12
11.5 11.5 11.5
+2 line
11 11 11
10.5 10.5 10.5
10 10 10
9.5 9.5 9.5
9 9 9
8.5 8.5 0 Line (median) 8.5
8 8 8
7.5 7.5 7.5
7 7 -2 line 7
6.5 6.5 6.5
6 6 -3 line 6
5.5 5.5 5.5
5 5 5
4.5 4.5 4.5
4 4 4
3.5 3.5 3.5
3 3 3
2.5 2.5
2 2
1.5 1.5
1 1
0.5 0.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14
WEEKS
Birth Weight 4 5 6 7 8 9 10 11 12
1 2 3
Months
Birth to 1 year
16

GIRLS: Weight-for-age charts
24kg 24kg
23.5 23.5
23 23
22.5 22.5
22 22
21.5 21.5
21 21
20.5 20.5
e
20kg 20 +3 lin 20
19.5 19.5 19.5
19 19 19
18.5 18.5 18.5
18 18 18
17.5 17.5 e 17.5
+2 lin
17 17 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 14
13.5 13.5 n) 13.5
(media
13 13 0 Line 13
12.5 12.5 12.5
12 12 12
11.5 11.5 11.5
11 11 11
10.5 10.5 -2 line 10.5
10 10 10
9.5 9.5 9.5
-3 line
9 9 9
8.5 8.5 8.5
8 8 8
7.5 7.5 7.5
7 7 7
6.5 6.5 6.5
6 6 6
5.5 5.5 5.5
5 5kg 5kg
4.5
4
25 26 27 28 29 30 31 32 33 34 35 36
3.5
Months
3
13 14 15 16 17 18 19 20 21 22 23 24
2 to 3 years
Months
1 to 2 years
12
Interpretation of lines:
l This Weight-for-Age Chart shows body-weight relative to age in comparison to the Median (0-line).
l A girl whose weight-for-age is below the orange (-2 line), is underweight.
l A girl whose weight-for-age is below the red (-3 line), is severely underweight.
l If her line crosses a z-score line and the shift is away from the median, this may indicate a
problem or risk of a problem.
l If her line shifts away from her birth trend line, this may indicate a problem or a risk of a problem.
17

GIRLS: Weight-for-age charts 3 to 5 years
30kg 30kg
29.5 29.5
29kg 29kg
28.5 in e 28.5
+3l
28 28
27.5 27.5
27kg 27kg 27kg
26.5 26.5 26.5
26 26 26
25.5 25.5 25.5
25 25 25
24.5 24.5 24.5
24 24 li ne 24
+2
23.5 23.5 23.5
23kg 23 23kg
22.5 22.5 22.5
22 22 22
21.5 21.5 21.5
21 21 21
20.5 20.5 20.5
20 20 20
19.5 19.5 19.5
19 19 19
18.5 18.5 18.5
18 18 ) 18
ian
17.5 17.5 e (med 17.5
0 Lin
17 17 17
16.5 16.5 16.5
16 16 16
15.5 15.5 15.5
15 15 15
14.5 14.5 14.5
14 14 14
13.5 13.5 13.5
-2 line
13 13 13
12.5 12.5 12.5
12 12 12
-3 line
11.5 11.5 11.5
11 11 11
10.5 10.5 10.5
10 10 10
9.5 9.5 9.5
9 9 9
8.5 8.5 8.5
8 8 8
7.5 7.5 7.5
7 7 7
6.5
6
5.5 49 50 51 52 53 54 55 56 57 58 59 60
Months
36 37 38 39 40 41 42 43 44 45 46 47 48 4 to 5 years
Months
3 to 4 years
18

GIRLS:
GIRLS:Height-for-age
Height-for-agecharts
charts
125 birth
birth toto
55 years
years
120
115
110
105
100
5 years
95
90
85
80
75
70
65
60
55
50
45
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60
)
dian
e
line
e
2 lin
-3 line
-2 lin
e
e (m
+3
0 Lin
4 years
3 years
Age (completed months and years)
2 years
FOR PERIODIC USE
(every 6 months)
11 12 14
1 year
10
9
8
7
6
5
4
3
2
1 MONTHS
Birth
125
120
115
110
105
100
95
90
85
80
75
70
65
60
55
50
45
Length/Height (cm)
This Length/Height-for-Age Chart shows height relative to age in comparison to the Median green (0-line)
A This Length/Height-for-Age
boy whose Chart
length/height-for-age is shows height
below the relative
orange to age
-2 line, in comparison to the Median green (0-line)
is stunted
A Aboy
girlwhose
whoselength/height-for-age
length/height-for-ageisisbelow
belowthe
the orange
red -2isline,
-3 line, is stunted
severely stunted
A girl whose length/height-for-age is below the red -3 line, is severely stunted
19

GIRLS: Weight-for-height chart
32kg
31,5
31
30,5
30kg 30
29,5
29 29
28,5
28 28
27,5
27 27
26,5
26 26
25,5
e
25kg
lin
45 50 55 60 65 70 75
25 85 90 95 100 105
+3
24,5
24 24
e
lin
23,5
+2
23 23
22,5
WEIGHT IN KILOGRAM (kg)
22 22
21,5
21 21
20,5
20kg 20
n)
ia
19,5
ed
19 19
(M
18,5
e
lin
18 18
0
17,5
17 17
16,5
16 16 e
15,5 lin
15kg -2 e
15 lin
14,5 -3
14 14
13,5
13 13
12,5
12 12
11,5
11 11
10,5
10kg 10
9,5
9 9
8,5
8 8
7,5
7 7
6,5
6 6
5,5
5kg 5
4,5
4 4
3,5
3 3
2,5
2 2
1,5
1
45 50 55
60cm 65 70 75
80cm 85 90 95
100cm 105 110 115
120
LENGTH/HEIGHT IN CENTIMETRE (CM)
This Weight-for-Height/Length Chart shows body-weight relative to length/height in comparison to the

Median
(the 0 z-score line).
l A girl whose weight-for-length/height is above the (red) +3 line, is obese.
l A girl whose weight-for-length/height is above the (orange) +2 line, is overweight.
l A girl whose weight-for-length/height is below the (orange) –2 line, is wasted.
l A girl whose weight-for-length/weight is below the (red) –3 line, is severely wasted (SEVERE ACUTE
MALNUTRITION). Refer for urgent specialised care.
20

Nutritional Assessment
Interpretation Health worker

Date Weight Height (IMCI) Action (if any) name

l Complete the table every time the child’s nutritional status is assessed.
21

2. Love, play and talk for healthy
development
Young children need a safe environment and loving caregivers
who can help them explore the world around them. Ordinary
loving things that you do such as holding, talking, playing and
reading to your child are what helps them grow and develop.
There are some basic things you can do to help your child to develop and learn:
l Be there for your child. You are the most important person in your child’s life.
All children want to feel safe, loved and cared for.
l Bond with your child. Keep your baby close to you as much as possible in the
first weeks of life. This will help to calm them and help them to sleep, grow
and feed well.
l Be responsive. Pay attention to your child’s interests, emotions and their likes
and dislikes and respond to them – this will help you to understand them
better and to best meet your child’s needs
l Your baby learns from birth. Hold, hug, sing, and talk to your baby, especially
during feeding, bathing and dressing
l Children learn through playing, exploring and interacting with others. Give
your child the chance to explore and play in a safe space and to play with
clean household objects or toys.
l Tell stories and read to your child. Talk about the pictures, let them ask
questions, allow them to tell you a story or what happened in the storybook
as you go along.
22

Developmental screening
Hearing/ Vision and Cognitive/ Caregiver
communication adaptive behaviour Motor skills concerns
6 weeks
10 weeks
14 weeks Startles to Follows face or Smiles at Holds head
loud sounds close objects people upright when
Date __ /__ /__ with eyes held against
shoulder
Sign_________
Hands are
open most of
the time
6 months Moves eyes or Eyes move Laughs aloud Grasps toy in
head in well together Uses different each hand
Date __ /__ /__ direction of (no squint) cries or Lifts head
sounds Recognises sounds to when lying on
Sign_________
Responds by familiar faces show hunger, tummy
making sounds Looks at own tiredness,
when talked to hands discomfort
9 months Babbles Eyes focus on Throws, bangs Sits without

(‘ma-ma’, far objects toys/objects support
Date __ /__ /__ ‘da-da’) Reacts when Moves objects
Turns when caregiver from hand to
Sign_________
called leaves, calms hand
when she/he
returns
12 months Uses simple Looks for toys/ Imitates Stands with
gestures objects that gestures support
Date __ /__ /__ (e.g. lifts arms disappear (e.g. clapping Picks up small
to be picked up) Looks closely hands) objects with
Sign_________
Has one at toys/objects Understands thumb and
meaningful word and pictures ‘no’ index finger
(dada, mama)
although
sounds may
not be clear
Imitates
different
speech sounds

AT EVERY VISIT: Ask the parents or caregiver if they have any specific concerns about how their
child hears, sees, communicates, learns, behaves, interacts with others and uses their hands,
arms, legs and body.
Tick the boxes above if the caregiver says that the child CAN do the following or if it was
OBSERVED during the visit. Try to elicit the behaviour or movement if not observed through
spontaneous play and interaction.
If the child can complete the task, tick the box 3 . If the child cannot complete the task,
cross the box ✕ . If you were unable to assess the task, indicate ND (not done) next to the
relevant task.
23

Hearing/ Vision and Cognitive/ Caregiver
communication adaptive behaviour Motor skills concerns
18 months Understands Looks at small Follows simple Walks alone

names of at things and commands
Date __ /__ /__ least 2 pictures (e.g. ‘come Uses fingers to
common here’) feed
Sign_________ objects e.g.
cup
Uses at least
3 words other
than names
3 years Child speaks in Sees small Plays with Runs well

simple 3 word shapes clearly other children/
Date __ /__ /__ sentences at a distance adults Eats on own
(across room)
Sign_________ Uses pretend
play (e.g. feeds
doll)
5-6 years Speaks in full No reported/ Interacts with Hops on one

sentences observed children and foot
Date __ /__ /__ vision adults
Caregiver problems Holds with
Sign_________ understands Understands fingers at top
child’s speech (Use illiterate E multiple or middle of
chart if available) commands pencil or stick
(e.g. ‘go to the to draw
kitchen and
bring me your Dresses self
plate’)
REFERRED TO: Speech Doctor Occupational Physiotherapist

therapy therapist
Optometrist Occupational
Audiology Doctor therapist
Ophthalmic
Doctor nurse Psychologist Doctor
Occupational Speech
therapist therapist
If specified health professional not available, refer to one of the following health professionals for an
initial developmental assessment: Doctor/physiotherapist/occupational therapist/speech therapist
24

Always ask a health worker about your child’s development if you are
concerned about any of the following:
Eye problems: l Hearing problems:
l A white pupil/spot on the pupil ¡ Hearing loss
l Eyes are not able to fix on and ¡ Not responding to loud noises
follow a moving object such as a ¡ Seems to hear some sounds and not
finger or toy others
l One or both eyes being bigger l Your child can no longer do tasks that
or smaller than usual they could before
l Crossed eyes or one eye looking in l Your child is not communicating through
another direction speech or gestures at 18 months
l Not walking at 18 months
l Head looks large
l Head looks small
l Does not use both sides of the body/
limbs equally
l Stiff arms and legs
l Floppy arms and legs
Head Circumference
Measure every child’s head circumference at 14 weeks and at 12 months

Record the child’s head circumference, and refer if larger or smaller than the
range shown below.
14 weeks (cm)
Range 38 – 43 cm
12 months (cm)
Range 43.5 – 48.5cm

Children are at a higher risk for development problems if they have any
of the following:
l Born premature/low birth weight
l Birth defect
l HIV
l Severe or moderate acute malnutrition/stunted
l Iron deficiency anaemia
l Recurrent illnesses; frequent hospitalisation
25

3. Protection from preventable
childhood diseases and injuries
Children should NOT only be taken to the clinic when they are ill. You should also
take your child for their full course of immunisations/vaccines and routine
treatments according to the timetables on pages 27 and 28.
l Immunisations are free. They protect your baby from common childhood
illnesses and disease. Make sure your baby gets all his or her immunisations.
l Go to the clinic for your follow-up visits for you and your baby within six days of
birth and at six weeks.
l Make sure that you know when your baby needs to return to the clinic for
immunisations or other care. If you miss the date for your clinic visit, make
sure that you return as soon as possible.
l If you are HIV positive, get your baby tested for HIV at birth and at 10 weeks.
l All children between 6 months and five years should receive Vitamin A and
deworming medicines every six months. This helps to keep them healthy.
l Remember to wash your hands after using the toilet, changing nappies, before
preparing meals and before feeding children. Wash your hands properly - wash
both sides of your hands, between your fingers and your wrists with soap and
clean water.
l Many serious injuries can be prevented if parents and other caregivers
supervise young children carefully and keep their environment safe.
l A child should not be left unattended or unsupervised. Make sure that there is
always a responsible adult taking care of your child and that you know where
your child is at all times.
l Protect yourself too. Decide on a contraceptive method of choice and also use
male or female condoms to prevent both unplanned pregnancy and sexually
transmitted infections (dual protection).
l Good oral health will keep your child’s teeth healthy and strong and prevent
unnecessary pain and discomfort.

l Remember that every visit to the health facility is a chance to provide
preventive health services and health promotion.
l Check the child’s nutritional status and whether any immunisation or treatment
is due.
l Show the caregiver proper hand washing.
l Always give the caregiver a date for their baby’s next visit to the clinic.
l Remember to urgently notify your EPI co-ordinator of any cases of Acute Flaccid
Paralysis (AFP) or suspected measles, as well as adverse events after
immunisation (excluding mild fever and minor local reactions).
26

Immunisations
EPI (Expanded Programme of Immunisation) Schedule
Child’s Name Child’s Date

of Birth
Age Vaccine Route & Site Batch no. Date given Signature
Intradermal
BCG
Birth Right arm
OPV0 Oral
OPV1 Oral
Rotavirus 1 Oral
6 weeks IM
PCV1
Right thigh
Hexavalent IM
(DTaP-IPV-Hib-HBV)1 Left thigh
Hexavalent IM
10 weeks
Rotavirus 2 Oral
IM
PCV2
14 weeks Right thigh
Hexavalent IM
S/C
6 months Measles 1
Left thigh
IM Right
9 months PCV 3
Thigh
12 S/C
Measles 2
months Right arm
18 Hexavalent IM
months (DTaP-IPV-Hib-HBV)4 Left arm
IM
6 years Td
Left arm
IM
12 years Td
Left arm
Additional Vaccinations
Girls HPV1
IM Non-
9 years
HPV2 dominant arm
and older
27

Vitamin A and deworming doses
Vitamin A Date Signature Mebendazole Date Signature

6 100 000IU
months
12 100mg bd for
200 000IU
months 3 days
18 200 000IU 100mg bd for
months 3 days
From 24 months, every child should receive Vitamin A and mebendazole (500mg)
every six months (up to 5 years of age).
Record when these doses are given, and the return date below.
Vitamin A (200 000IU) Mebendazole (500 mg stat)
Date Signature Return date Date Signature Return date
Protect your child’s teeth

l Use a small, clean cloth to clean your baby’s gums before the first
teeth appear.
l Start to clean your baby’s teeth as soon as the first tooth comes through.
l Once teeth appear, use a small, soft toothbrush with a small
fingernail sized amount of child toothpaste to brush teeth.
l Brush teeth and along the gum line twice a day; in the morning
and at night before bed.
l Discourage the giving of sugary snacks and drinks.
l Look in your child’s mouth regularly to spot early signs of tooth
decay and consult a dentist or other health worker if you notice
anything abnormal.
l Never put your baby to sleep with a feeding bottle (remember that
breastfeeding or cup-feeding is always better than bottle-feeding).
28

Frequency of Findings Follow-up Signature
screening (report as upper or
lower, front or back
teeth, right or left side
of mouth)
1st visit on
appearance of
first tooth
(or at 6 months
measles
immunisation)
At age 12
months
(measles
immunisation)
In the 2nd year
In the 3rd year
In the 4th year
In the 5th year

Complete the table at the specified visits, if you observe any oral abnormalities.
29

4. Health care for sick children
Children need health care when they are sick. Look out for the danger signs
listed below. Take your child to the nearest clinic immediately if you see any
of the listed signs.
l If your child is sick and is not able to drink or breastfeed, vomits everything or
has convulsions (shakes) they should be taken to the clinic or hospital
immediately.
l Young babies (especially those less than two months) can become very sick
very quickly. If your young baby is not feeding properly or has a fever, take
them to the clinic immediately.
l If your child has diarrhoea (loose stools) you should give them a Sugar Salt
Solution (SSS) to drink after each stool.
l If your child has diarrhoea or is drinking poorly or has eyes that look sunken or
blood in the stool, take them to the clinic immediately.
l If your child has a cough or cold and has fast or difficult breathing they should
be taken to the clinic immediately.
How to use a sugar-salt solution for children with diarrhoea
+ +
1 litre of cooled 8 level teaspoons half a teaspoon
boiled water of sugar of salt (level)
l Give a sugar-salt solution (SSS) in addition to feeds.

l Give SSS after each loose stool, using frequent small sips
from a cup.
¡ Half a cup for children under 2 years.
¡ 1 cup for children 2 – 5 years.
l If your child vomits, wait 10 minutes then continue, but more slowly.
l If your child wants more than suggested, give more.
l Continue feeding your child.
30

and name
Signature
Clinical notes (assess, classify, counsel,
General clinical notes
signature treat and follow up)

Date and

These notes should be completed for all sick child visits to the clinic or hospital.
Also complete, if the child was referred for further assessment or management
by other health professionals (e.g. therapists, dieticians etc).
31

32
General clinical notes (cntd)
Date Clinical notes (assess, classify, counsel, Signature
treat and follow up) and name
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33
2018/02/28 9:46 AM
34
General clinical notes (cntd)

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35
2018/02/28 9:46 AM
Referrals and follow-up record
Completed by referring HCW Completed at place of referral
Date Reason for Referred Date Feedback to referring Signature

referral to: health worker (include and name
follow-up that is
required)
Hospital admission record

Hospital Date of Date of
Hospital name Discharge diagnosis
number admission discharge
36

Long term health conditions
This table is for treatment facility/specialist clinic staff to record
the main details of the health care for children with long-term health conditions
such as asthma, epilepsy, congenital heart disease, cerebral palsy, etc.
Date Condition Treatment Health worker

contact
37

Antenatal, birth and newborn history
Place of Birth
Birth Weight Length at Birth
Head Circumference Gestational Age
at birth (weeks)
Breastfeeding HIV exposure Prenatal ARVs Infant prophylaxis
Yes £ Yes £
No £
No £
Duration Duration
Unknown £ If PCR test done, place sticker on pg 39 also record follow-up tests on pg 39.
APGARS 1 min 5 min
Antenatal History
RPR result Rhesus Blood Group (if available)
Antenatal (Maternal history) Intrapartum history (including mode of delivery)
Are risk factors present?

Low birthweight £ Mother has died or is ill £
(less than 2.5kg)
Known congenital or £ Infant not exclusively breastfed £
neurological problem
Social risk £ Teenage caregiver £
Other
List newborn problems Follow-up required
(list if resolved or on-going)
Preterm
Low birthweight (< 2.5kg)
ICU admission
Birth defects
Hypoxic brain injury
Convulsions/fits
Jaundice
38

Screening and test results
Action (including date for
Date Test/result
repeat test)
39

5. Special care for children who need
a little more help
Your baby’s development, growth and health depends on so much more

than just good health care. It depends on the daily care and protection you
and your family provide to your baby from the moment that he or she is
born (and in fact from when your baby is still in the womb and even before
your baby was conceived).
HIV – If you are HIV positive, make sure that you get the treatment that you and
your baby need to stay healthy. If you are unsure of your status, ask the health
worker for HIV counselling and testing for you and your baby.
TB – TB is common. Tell the nurse at the clinic if you have a cough lasting longer
than two weeks, weight loss or night sweats, or if there is someone in your
household with TB. If there is, your baby should receive medicine to prevent TB for
six months.
Serious Injuries – Many serious injuries can be prevented if you look after your
child carefully and keep their environment safe.
Supervision – Your child should not be left alone, unattended or unsupervised.

Make sure that there is always a responsible adult taking care of your child and
that you know where your child is at all times.
Disability – Children with mental and physical disabilities need extra care. If your
baby has a disability you will need support with caring for and protecting your
baby. Tell your health worker and they will refer you to a social worker for parenting
support. It is good to join a support group so you can share your experiences.
40

For health workers:
This table incorporates key social risks for children. Complete this table at the 6
or 14 week visit.
Notes (include details of risk,

Are social risk factors present?
referral and/or extra care provided)
Child has a birth certificate

☐ Yes ☐ No ☐ Unknown
Mother has died or is ill

Teenage parent or caregiver

Child receives a child support grant

Child receives a care dependency grant

Child receives a foster care grant

41

Risks to your child’s development
There are some home circumstances that create a risk to the health and
wellbeing of your child. This is because they may limit your ability to care
for, and protect your child. If you are experiencing any of the following
circumstances, tell your community health worker, nurse or doctor and
they will give you advice and refer you to the right support-provider.
l If you are a teen mother or a grandparent looking after a young child

it is important to tell your health worker so that they can refer you for
extra support if you need it.
l If you are exposed to violence or abuse in your home, you must let
your health worker know. They can refer you to a social worker and
the police if necessary to protect you and your baby from physical
harm.
l If you or your partner, use drugs or alcohol, this is a risk to your baby.
Tell your health worker so that they can refer you for support.
l If you are feeling that you are not coping, you are stressed or have
been sad for a long period of time (depressed) , talk to your health
worker so that they can advise you on what to do or refer you for
extra care and support.
42

REMEMBER:
The law says you must
register your baby’s birth
before they turn one month
old. Take your ID and baby’s
Register your baby’s birth father’s ID book to the
It is important to make sure that your baby hospital where you will give
has a birth certificate as soon as he or she
is born. All babies have a right to a birth
birth. Many hospitals offer
certificate, even if you are not South African. a birth registration
service.
This Road to Health book is not proof of identity;
every child has a right to be registered at birth and to
get a birth certificate. Getting a birth certificate for your
child will help you access services and support.
Support and Care Grants

l If you are not working or do not earn enough money every month to
provide food, clothing or transport for your child, you may qualify for the
Child Support Grant (CSG). If you do qualify, you can get the CSG from
when your baby is born. It is important that you get it as early as
possible as this will help provide for good development in the first
months of baby’s life.
l If you have a disability or your baby has a disability, the Government
provides either the Disability Grant for you, or the Care Dependency
Grant for your baby to help cover the costs of the additional care that is
required. Ask your health worker or a social worker about this grant.
l If you are fostering a child in your care, you will be able to claim a
Foster Care Grant to help with the costs of providing for the child.
43

Difficult to understand words
allergy when your body reacts to things around you that
are harmless for most people like food, medicine,
dust, pets, pollen and insects
constipation when you struggle to poo, it takes a long time to
poo and/or your poo is very hard
convulsions sudden uncontrollable shaking of the body, the
person usually “faints” and falls on the ground
depression a mood problem where you feel sad and not
interested in life all the time
diarrhoea having at least three loose or liquid poos each
day
malnutrition when your body doesn’t get enough healthy
things from your food because you’re not eating
the right food or there is a problem with how your
body uses the food you eat
nutrients the things in food that your body needs to grow
and stay healthy
44

Health services
Your local clinic
Your doctor
AIDS Helpline 0800 012 322
Depression/Mental Health 0800 12 13 14/011 262 6396, sms
helplines 31393
Emergency ambulance 10177
From a mobile: 112
Poison information centre 0861 555 777
MomConnect *134*550#
Birth registration and identity documents
Home Affairs Toll Free helpline 0800 601 190
Child protection and safety
Police emergency number 10111
Childline toll free 0800 055 555
0800 123 321
Grants
SASSA Toll Free helpline 0800 601 011
0800 600 160
[email protected]
Child care and education
Your local ECD centre, creche, preschool, child minder
Other numbers
45

Danger signs!
Take your child to the nearest clinic
if you see any of the following.
Child is coughing Child under 2 Child is

and breathing fast months old has a vomiting
(more than 50 fever and is not everything
breaths per minute) feeding
Child has diarrhoea, Child is shaking Child has signs of

sunken eyes, and a (convulsions) malnutrition (swollen
sunken fontanelle ankles and feet)
Child is not moving Child is unable to

or does not wake up breastfeed
46

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Road to Health

IMPORTANT: Always bring this book when you visit

Nutrition Love Protection Healthcare Extra Care

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This book is FREE to ALL BABIES in both public and private

This book belongs to:

Place a picture of your child here

BIRTH WEIGHT: GESTATIONAL

MOTHER’S CONTACT FATHER’S

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This book is for you and your child’s health worker.

Although information from this book may be requested

For health workers …

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Head circumference p25

Consider HIV p40

3 tick once done Not in schedule

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Child is coughing and Child under 2 months old Child is vomiting

Child has diarrhoea Child is shaking Child has signs of

Child is not moving or Child is unable to

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For Health Workers…

l Mothers need help to start breastfeeding immediately after birth.

l Mothers need support to continue breastfeeding successfully. Help them to get

l Mothers who are not breastfeeding must be counselled on correct replacement

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Also, give your baby:

Give your baby clean and safe water to

9 – 11 months Continue breastfeeding on demand. l About a ¼ cup, then increase

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l Remember to tell mothers if their baby is growing well

l Explain the growth charts to parents and caregivers.

l A child with a MUAC less than 11.5cm or with a weight

Growth monitoring and counselling

l Wasting is measured by either the mid-upper arm

l For short-term growth, the weight-for-age chart is used

l Long-term linear growth faltering (stunting) is best

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MUAC is used to identify signs of malnutrition. MUAC should be measured at

Record the MUAC and classify as follows:

MUAC Assessment Healthcare

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This Weight-for-Length Chart shows body-weight relative to length/height in comparison to

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LENGTH/HEIGHT IN CENTIMETRE (CM)

This Weight-for-Height/Length Chart shows body-weight relative to length/height in comparison to the