Non verbal language in mothers with malnourished infants. A pilot study

A measurement scale to assess responsive feeding among Cambodian young children

The caregiver-child interaction during mealtime, which refers to responsive feeding (RF), influences child's dietary intake. In Cambodia, given the level of malnutrition, getting better knowledge of RF among young children is essential, but to do so, using an appropriate assessment tool is necessary. We aim to develop and to validate a measurement tool to assess RF in two different situations (before and after an intervention) among children 6-23 months old. This research is part of a larger trial assessing the impact of nutrition education combined or not with the provision of complementary foods on child nutritional status. The "Opportunistic Observation Form" from the Process for the Promotion of Child Feeding package was used to collect data on RF through direct observations of child's meal episodes. Data were used to define an initial scale composed of four constructs and 15 indicators. Confirmatory factor analyses (CFA) and Hancock and Mueller's H reliability indices were computed to assess the validity and reliability of the scale. The final tool was applied to baseline and endline data. At baseline, the sample included 243 pairs and, at endline, 248 pairs. The final scale included two latent constructs (RF and active feeding) that comprise three indicators for active feeding and five for RF. Criteria for fit indices of CFA were met for both constructs though better at baseline. Reliability coefficients were above 0.80 for each construct at baseline and endline. This research proposes a scale that could be used to assess active feeding and RF. Further validation is warranted in different contexts.

Psychosocial Aspects of Care and Nutrition

The quality of psychosocial care provided the young child is reflected in the caregiver's responsiveness, warmth and affection, involvement with the child, and encouragement of autonomy and exploration. First, research was examined linking the quality of psychosocial care to a child's development of mental abilities, and to his or her growth and nutrition status. There is considerable correlational evidence and some experimental evidence for this linkage. Second, the barriers to adequate psychosocial care were explored, including maternal beliefs and confidence, stress and depression, social support, and autonomy and control of resources. Third, a number of strategies to enhance psychosocial care as a mechanism for increasing the child's nutrition status are described, at the level of the child, the caregiver, the child-caregiver relationship, and the community. All of the work was interpreted in terms of an interactive or transactional model of child development.

Targeting the Good Target

A person’s judgeability, or the extent to which a person is easy to understand, plays an important role in how accurately a target will be perceived by others. Research on this topic, however, has not been systematic or well-integrated. The current review begins to remedy this by integrating the available research on judgeability from the fields of personality perception, nonverbal communication, and social cognition. Specifically, this review summarizes the characteristics that are likely to promote judgeability and explores its potential consequences. A diverse range of characteristics are identified as predictors of judgeability, all relating to three broader categories: psychological adjustment, social status, and socialization. Furthermore, being judgeable has a variety of potential, largely positive, consequences for the target, leaving good targets poised for greater personal and interpersonal well-being. Nevertheless, many questions on this topic remain and it is crucial for this relatively understudied topic to receive more systematic empirical attention.

Responsive feeding and child undernutrition in low- and middle-income countries

Growth faltering and nutritional deficiencies continue to be highly prevalent in infants and young children (IYC) living in low- and middle-income (LAMI) countries. There is increasing recognition that feeding behaviors and styles, particularly responsive feeding (RF), could influence acceptance of food and dietary intake and thus the growth of IYC. This paper presents the evolution of RF research and the strength of the evidence for RF on child undernutrition in LAMI countries. Multiple approaches were used to identify studies, including keyword searches in many databases, hand searches of retrieved articles, and consultation with experts in the field. Articles were included if they contained a RF exposure and child undernutrition outcome. In total, we identified 21 studies: 15 on child growth, 4 on dietary intake, 3 on disease, and 8 on eating behaviors. Most studies were conducted among children <36 mo of age and were published in the last 10 y. Cross-study comparisons were difficult due to multiple definitions of RF. One-half of the studies were observational with cross-sectional designs and few interventions were designed to isolate the effect of RF on child undernutrition. Overall, few studies have demonstrated a positive association between RF and child undernutrition, although there is promising evidence that positive caregiver verbalizations during feeding increase child acceptance of food. Recommendations for future research include consensus on the definition and measurement of RF, longitudinal studies that begin early in infancy, and randomized controlled trials that isolate the effect of RF on child undernutrition.

Scholastic achievement: a multivariate analysis of nutritional, intellectual, socioeconomic, sociocultural, familial, and demographic variables in Chilean school-age children

OBJECTIVE

We determined relative effects of nutritional status, intellectual ability, exposure to mass media, and socioeconomic, sociocultural, familial, demographic, and educational variables on scholastic achievement (SA).

METHODS

This was a cross-sectional study. Exposure to mass media and nutritional, intellectual, socioeconomic, sociocultural, familial, demographic, and educational factors, including approximately 2000 variables, were measured in a representative and proportional sample of 4509 school-age children from elementary and high schools in Chile's Metropolitan Region. The field study was carried out between 1986 and 1987, and data processing, which lasted 15 y, was completed in 2002.

RESULTS

Within the total sample, intellectual ability, level of maternal schooling, head circumference-for-age Z score, book reading, in-door plumbing, level of paternal schooling, type of school, quality of housing, height-for-age Z score, and calcium intake were the independent variables with the greatest explanatory power in SA variance (r(2) = 0.508). In most grades, IA was the independent variable with the greatest explanatory power in SA variance. In adolescents in their fourth year of high school and whose physical growth and intellectual development processes are consolidated, intellectual ability, age, head circumference-for-age Z score, book reading, type of school, and level of paternal schooling were the independent variables with the greatest explanatory power in SA variance (r(2) = 0.60).

CONCLUSIONS

These findings show that SA is conditioned by multiple factors depending on the characteristics of school-age children, their families, and the educational system. Nutritional indicators of past nutrition are significantly associated with SA, especially head circumference-for-age Z score. This information may be useful for health and educational planning.

Poverty, underdevelopment and infant mental health

Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein-energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment.

Long-term effects of severe undernutrition during the first year of life on brain development and learning in Chilean high-school graduates

The objective of this study was to assess the relative impact of undernutrition during the first year of life on brain development, intellectual quotient (IQ), and scholastic achievement (SA) of poor Chilean high-school graduates (mean age = 18.3 +/- 0.9 y). A comparative study of two groups of high-school graduates from a low socioeconomic stratum was carried out. The undernourished group (n = 16), who had suffered from severe undernutrition during the first year of life, was compared with the non-undernourished group (n = 16). The final sample consisted of 32 right-handed high-school graduate students born at term who had no history of alcoholism or symptoms of brain damage, epilepsy, or heart disease and whose mothers had no history of smoking, alcoholism, or drug intake before and during pregnancy. Socioeconomic status was measured by using Graffar's modified method. Birth weight was used as the prenatal nutritional status index, and postnatal nutritional status was assessed by the body mass index, Z score for head circumference, and brachial anthropometry. IQ was determined with the Wechsler Intelligence Scale for Adults, and SA was determined with test in language and mathematics with the academic aptitude test. Brain development was evaluated by magnetic resonance imaging. Statistical analysis included variance tests, Scheffe's test for comparison of means, correlation, and multiple regression. Maternal schooling, brain volume, and undernutrition were the independent variables, with the greatest explanatory power in IQ variance (r(2) = 0.714). Only IQ explained SA variance (r(2) = 0.860); IQ, corpus callosum length, anteroposterior diameter, and maternal schooling were the independent variables, with the greatest explanatory power in the academic aptitude test variance (r(2) = 0.949). Results show that the long-term effects of malnutrition at an early age may affect brain development, IQ, and SA in school-age children. These findings are useful for nutrition and educational planning.

Nutritional resilience in a hostile environment: positive deviance in child nutrition

The term "positive deviance" applies to the study of children who demonstrate above-average growth in impoverished environments. Favorable values on known malnutrition correlates and attentive child care characterize positive deviants. Best-growing children do not necessarily mirror the malnourished; for example, best- and worst-nourished infants may both get more breast-milk substitutes than middle growers. Positive deviants receive more high-quality foods, physical interaction, affection and praise, and verbal and environmental stimulation. Factors that influence child growth through care quality also predict cognitive development, health, and social adjustment. They include: the type of society; parental education, mental health, initiative, and work burden; family and community structure; and the value of children to parents. Feeding practices related to growth include: permitting the child to control the length of feeding, encouraging eating while avoiding a power struggle, actively spoon- or hand-feeding, not displacing appetite by giving frequent sweets, and timely introduction of appropriate foods.

[Infant malnutrition, development rate and its relation to the environment: a pilot study]

The socio-cultural factors that might be influencing the normal psychomotor development of the undernourished infant are studied. The sample consisted of 32 mother-infant dyads: 16 having normal DQ (Group A) and 16 having a below normal DQ (Group B) according to Bailey's Test applied to infants who entered a Nutritional Recuperation Center. Results showed that there were some differences in the infants' backgrounds: infants of Group A were the product of a wished-for pregnancy (p less than .05), and were separated less from their mother's side (p less than .007) than was the case in Group B. No differences were found in the socio-cultural and demographic background of the mothers. The infants' external environment was different in aspects observed within the neighborhood: there were fewer negative aspects in Group A than in Group B (p less than .003) and more positive in Group A than in B (p less than .001). The infant's internal environment as related to the mother was also different. Mothers of Group A perceived more affection from their partner (p less than .008), were more sensitive (to feelings of joy and suffering) (p less than .003) and stimulated their infant (p less than .004) more than those of Group B. These results show that the internal and external environments in which the infant with normal and below normal DQ evolves were different between the two groups. This could explain the differences in psychomotor development among undernourished infants belonging to the lower socioeconomic strata.