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Rossiter MD, Young M, Dickson E, Campbell JE, Caldwell S, Mcisaac JL. CELEBRATE Feeding: A Responsive Approach to Food and Feeding in Early Learning Settings. CAN J DIET PRACT RES 2024; 85:169-173. [PMID: 39056484 DOI: 10.3148/cjdpr-2024-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Early learning and child care (ELCC) settings in Canada follow nutrition standards that outline food provisions, with many also encouraging responsive feeding practices that help to create a supportive environment for children. Caregivers who lack confidence in children's ability to regulate their own intake, or those who feel stressed about mealtime, may unknowingly engage in less responsive feeding practices. The CELEBRATE Feeding Approach is a flexible framework, driven by behaviour change theory, that builds on previous definitions and concepts of responsive feeding in ELCC environments. Through this approach, there is an intentional focus on supporting early childhood educators to implement feeding practices that are more responsive. The approach incorporates 13 target educator behaviours related to the three overlapping categories of CELEBRATE language, CELEBRATE Mealtime, and CELEBRATE Play. These practices recognize and support the development of a child's sense of autonomy, confidence, and self-regulation not only at mealtimes but also through play-based exploration and language that is used throughout the day around food and feeding. The goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.
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Affiliation(s)
- Melissa D Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE
| | - Margaret Young
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE
| | - Elizabeth Dickson
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, NS
| | - Julie E Campbell
- School of Health and Human Performance, Dalhousie University, Halifax, NS
| | - Sarah Caldwell
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE
| | - Jessie-Lee Mcisaac
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, NS
- Faculty of Education and Department of Child and Youth Study, Early Childhood Collaborative Research Centre Mount Saint Vincent University, Halifax, NS
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Han Y, Hoddinott J, Kim J, Pelletier D. Behaviour change communication to improve complementary feeding practices in Ethiopia: Couples' beliefs concerning paternal involvement in childcare. MATERNAL & CHILD NUTRITION 2024; 20:e13628. [PMID: 38334313 PMCID: PMC10981480 DOI: 10.1111/mcn.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender-equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother-father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender-equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender-equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices.
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Affiliation(s)
- Yaeeun Han
- Department of International StudiesKyung Hee UniversitySeoulSouth Korea
| | - John Hoddinott
- Department of Global Development, Division of Nutritional Sciences, Charles H. Dyson School of Applied Economics and ManagementCornell UniversityIthacaNew YorkUSA
| | - JiEun Kim
- Department of Healthcare Management and Policy, Graduate School of Public HealthSeoul National UniversitySeoulSouth Korea
| | - David Pelletier
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Kishino M, Hida A, Ishikawa-Takata K, Tada Y, Kariuki L, Maundu P, Matsuda H, Irie K, Morimoto Y. Relationship of dietary intake between children aged 12-59 months and their mothers in rural Kenya: a cross-sectional study in two seasons. J Hum Nutr Diet 2024; 37:491-502. [PMID: 38130112 DOI: 10.1111/jhn.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the quantitative association between the dietary intakes of children and their caregivers. METHOD In this cross-sectional study, a non-consecutive 2-day 24-h dietary recall was conducted in two seasons. Participants comprised 142 pairs of 12-59-month-old children and their female caregivers from rural areas of Kenya. Energy and micronutrient adequacy, food group intakes and food allocation were assessed. Differences and correlations between caregiver and child diets were examined, and multiple regression analysis was used to investigate the relationship between the children's and caregivers' dietary intakes. RESULTS The child's diet was significantly lower in energy and higher in micronutrient adequacy than was the caregiver's diet (p < 0.001). Specifically, the child's diet contained more fruits, dairy products, sugar and confectionaries per 4184 kj. Children were allocated relatively more dishes containing nutrient-rich foods than staple foods. The correlation coefficients between the dietary intake of caregivers and children were stronger among 24-59-month-old children. After controlling with covariates, caregiver energy intake was significantly associated with child energy intake (standardised beta [β] = 0.512, p < 0.001), and caregiver micronutrient adequacy was associated with child micronutrient adequacy (β = 0.679 and β = 0.262 after energy adjustment, p < 0.001). CONCLUSIONS The dietary intakes of caregivers and children were closely related. The children had a more nutrient-rich diet compared to that of their caregivers. Differences in food group intakes and food allocation may contribute to the higher nutrient adequacy of children. There is a need to improve the diet of caregivers, which would contribute to improving the diet of children.
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Affiliation(s)
- Madoka Kishino
- Department of Food and Nutritional Science, Graduate School of Applied Bioscience, Tokyo University of Agriculture, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Azumi Hida
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, Tokyo, Japan
| | - Kazuko Ishikawa-Takata
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, Tokyo, Japan
| | - Yuki Tada
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, Tokyo, Japan
| | - Lucy Kariuki
- Food Environment and Consumer Behavior Program, Alliance of Bioversity International and International Center for Tropical Agriculture - CIAT, Nairobi, Kenya
| | - Patrick Maundu
- Food Environment and Consumer Behavior Program, Alliance of Bioversity International and International Center for Tropical Agriculture - CIAT, Nairobi, Kenya
- Kenya Resource Center for Indigenous Knowledge, National Museum of Kenya, Nairobi, Kenya
| | - Hirotaka Matsuda
- Department of Agricultural Innovation for Sustainable Society, Faculty of Agriculture, Tokyo University of Agriculture, Kanagawa, Atsugi, Japan
| | - Kenji Irie
- Department of International Agricultural Development, Faculty of International Agriculture and Food Studies, Tokyo University of Agriculture, Tokyo, Japan
| | - Yasuyuki Morimoto
- Food Environment and Consumer Behavior Program, Alliance of Bioversity International and International Center for Tropical Agriculture - CIAT, Nairobi, Kenya
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Wu Q, Meng N, Wang X, Li L, Zhang J, Huang Y, Zhang Y. Complementary feeding practices for children aged 6-23 months in early childhood education institutions in urban China: A cross-sectional study. J Glob Health 2024; 14:04043. [PMID: 38454879 PMCID: PMC10921127 DOI: 10.7189/jogh.14.04043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background Appropriate infant and young child feeding (IYCF) plays a crucial role in promoting the healthy growth of children. Currently, many Chinese urban parents are seeking care of children from the early childhood education (ECE) institutions, however, little is known about the feeding practices of infants and young children in ECE institutions. This study aims to investigate the complementary feeding practices for Chinese urban children aged 6-23 months in ECE institutions and explore potential factors influencing their feeding practices. Methods This cross-sectional study was conducted among primary caregivers of children aged 6-23 months in ECE institutions across 31 provinces in China from 1 March to 30 April 2023. Convenience sampling was used to recruit caregivers from centres of Gymboree Play & Music (an ECE institution). Self-administered questionnaires were designed using the online survey tool Sojump and distributed through WeChat platform, which collected information on 1) children's complementary feeding practices; 2) food frequency of seven food groups; 3) caregivers' feeding knowledge and practices; 4) frequency of children attended ECE classes and the primary caregivers' daily nurturing care time; 5) source of information on complementary feeding. Results A total of 2731 children and their caregivers were surveyed, with 416 children aged 6-11 months and 2315 children aged 12-23 months. The prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) was 59.4, 60.6, and 39.2%, respectively. Only 17.3% caregivers believed that continued breastfeeding should be at two years or above, and 29.5% children were continuously breastfed at 12-23 months (CBF). The proportion of non-responsive feeding practices among caregivers ranged from 28 to 64%. Except for CBF, the prevalence of other key complementary feeding practices was higher among children who attending ECE classes than those not attending ECE classes (all P < 0.05). Moreover, children aged 12-23 months who received long-nursing care time (≥4h/d) had significantly higher MMF and MAD prevalence than those in short-nursing care time group (MMF = 66.2 vs. 58.8%, P = 0.0003; MAD = 44.2 vs. 38.3%, P = 0.0047). Conclusions The complementary feeding practices of children aged 6-23 months in ECE institutions in urban China remained suboptimal, and non-responsive feeding practices among caregivers were common. The attendance of ECE classes and the caregivers' daily nurturing care time could be beneficial in ensuring children to comply with complementary feeding recommendations.
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Affiliation(s)
- Qiong Wu
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Na Meng
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Xiaotong Wang
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Lin Li
- Beijing KidsHome Children Development Centre, Beijing, China
| | - Jian Zhang
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Yiwen Huang
- Child Healthcare Center, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
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Schwendler TR, Na M, Keller KL, Jensen L, Kodish SR. Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review. Nutrients 2024; 16:288. [PMID: 38257180 PMCID: PMC10820610 DOI: 10.3390/nu16020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.
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Affiliation(s)
- Teresa R. Schwendler
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Muzi Na
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kathleen L. Keller
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
- 202 Rodney A. Erickson Food Science Building, Department of Food Science, The Pennsylvania State University, University Park, PA 16802, USA
| | - Leif Jensen
- Armsby Building, Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA 16802, USA
| | - Stephen R. Kodish
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
- 219 Biobehavioral Health Building, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
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Long JM, Gatica‐Domínguez G, Westcott JE, Taren D, Tejeda G, Diba TS, Mastiholi SC, Khan US, Garcés A, Figueroa L, Lokangaka A, Goudar SS, Aziz Ali S, Hambidge KM, Krebs NF. Infant and young child feeding indicators are positively associated with length and family care indicators in the children of the Women First trial participants. MATERNAL & CHILD NUTRITION 2024; 20:e13572. [PMID: 37817452 PMCID: PMC10750017 DOI: 10.1111/mcn.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
This research describes the proportion of children in four low- and middle-income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z-scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud-Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04-0.22) and MMF (β = 0.10; 95% CI = 0.03-0.17) were positively associated with length-for-age z-score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02-1.07), MMF (PR = 1.02; 95% CI = 1.01-1.04), MAD (PR = 1.05; 95% CI = 1.02-1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices.
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Affiliation(s)
- Julie M. Long
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Giovanna Gatica‐Domínguez
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Jamie E. Westcott
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Douglas Taren
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Gabriela Tejeda
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Tshilenge S. Diba
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivanand C. Mastiholi
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Umber S. Khan
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Ana Garcés
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Lester Figueroa
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Sumera Aziz Ali
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Nancy F. Krebs
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
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Liu Y, Chang C. The relationship between early childhood development and feeding practices during the dietary transitional period in rural China: a cross-sectional study. Front Public Health 2023; 11:1202712. [PMID: 37637814 PMCID: PMC10450922 DOI: 10.3389/fpubh.2023.1202712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Early childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described. Method This study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD. Results The results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53-0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52-0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50-0.88). Discussion According to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention.
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Affiliation(s)
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
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Zhao F, Sun Y, Zhang Y, Xu T, Wang N, Yan S, Zeng T, Zhang F, Gao J, Yue Q, Rozelle S. Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods. BMC Public Health 2023; 23:444. [PMID: 36882770 PMCID: PMC9993530 DOI: 10.1186/s12889-023-15325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods. METHODS A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators. RESULTS We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01-2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure. CONCLUSION EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.
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Affiliation(s)
- Fenghua Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Yijie Sun
- Qingdao Maternal and Child Health and Family Planning Service Center, Shandong, 266072, China
| | - Yue Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Nianrong Wang
- Chongqing Health Center for Women and Children, Chongqing, 401147, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Hospital, Anhui, 243011, China
| | - Ting Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Guangxi, 545001, China
| | - Fenghua Zhang
- Qingdao Maternal and Child Health and Family Planning Service Center, Shandong, 266072, China
| | - Jie Gao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Qing Yue
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Scott Rozelle
- Stanford University Freeman Spogli Institute for International Studies, Stanford, CA, 94305-6055, USA
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Vázquez-Frias R, Ladino L, Bagés-Mesa MC, Hernández-Rosiles V, Ochoa-Ortiz E, Alomía M, Bejarano R, Boggio-Marzet C, Bojórquez-Ramos MC, Colindres-Campos E, Fernández G, García-Bacallao E, González-Cerda I, Guisande A, Guzmán C, Moraga-Mardones F, Palacios-Rosales J, Ramírez-Rodríguez NE, Roda J, Sanabria MC, Sánchez-Valverde F, Santiago RJ, Sepúlveda-Valbuena N, Spolidoro J, Valdivieso-Falcón P, Villalobos-Palencia N, Koletzko B. Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:57-70. [PMID: 36737343 DOI: 10.1016/j.rgmxen.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Abstract
Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.
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Affiliation(s)
- R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Salud Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Grupo de Nutrición, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica, SLAGHNP/LASPGHAN.
| | - L Ladino
- Grupo de Nutrición, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica, SLAGHNP/LASPGHAN; Facultad de Medicina, Grupo de Nutrición, Genética y Metabolismo, Universidad El Bosque, Bogotá, Colombia
| | - M C Bagés-Mesa
- Grupo de Nutrición, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica, SLAGHNP/LASPGHAN; Facultad de Medicina, Grupo de Nutrición, Genética y Metabolismo, Universidad El Bosque, Bogotá, Colombia
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Salud Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Grupo de Nutrición, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica, SLAGHNP/LASPGHAN
| | - E Ochoa-Ortiz
- Grupo de Nutrición, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica, SLAGHNP/LASPGHAN; Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Departamento de Nutrición, Mexico City, Mexico
| | - M Alomía
- Posgrado de Pediatría, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - R Bejarano
- Servicio de Gastroenterología y Nutrición, Hospital de Especialidades Pediátricas, Ciudad de Panamá, Panama
| | - C Boggio-Marzet
- Grupo de Trabajo en Gastroenterología y Nutrición Pediátrica, Hospital General de Agudos "Dr. I. Pirovano", Buenos Aires, Argentina
| | | | - E Colindres-Campos
- Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - G Fernández
- Departamento de Gastroenterología, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - E García-Bacallao
- Sección de Pediatría, Instituto de Gastroenterología, Universidad de Ciencias Médicas, La Habana, Cuba
| | - I González-Cerda
- Servicio de Pediatría, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, Nicaragua
| | - A Guisande
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - C Guzmán
- Hospital La Católica, San José, Costa Rica
| | - F Moraga-Mardones
- Unidad de Nutrición, Servicio de Pediatría, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - J Palacios-Rosales
- Facultad de Medicina, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - N E Ramírez-Rodríguez
- Facultad de Medicina, Departamento de Medicina y Salud Mental, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - J Roda
- Gastroenterología e Nutrição Pediátrica, Hospital Pediátrico - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M C Sanabria
- Cátedra y Servicio de Pediatría, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - F Sánchez-Valverde
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Universitario de Navarra, NAVARRA BIOMED, Pamplona, Navarra, Spain
| | - R J Santiago
- Departamento de Pediatría y Unidad de Gastroenterología, Hepatología y Nutrición, Hospital Universitario de Valera "Dr. Pedro Emilio Carrillo", Universidad de Los Andes, Valera, Venezuela
| | - N Sepúlveda-Valbuena
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Spolidoro
- Escuela de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - P Valdivieso-Falcón
- Departamento de Pediatría, Servicio subespecialidades pediátricas, Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru
| | | | - B Koletzko
- Departamento de Pediatría, Medical Centre of LMU Munich, Ludwig Maximilian University of Munich, Dr. von Hauner Children's Hospital, München, Germany
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Vázquez-Frias R, Ladino L, Bagés-Mesa M, Hernández-Rosiles V, Ochoa-Ortiz E, Alomía M, Bejarano R, Boggio-Marzet C, Bojórquez-Ramos M, Colindres-Campos E, Fernández G, García-Bacallao E, González-Cerda I, Guisande A, Guzmán C, Moraga-Mardones F, Palacios-Rosales J, Ramírez-Rodríguez N, Roda J, Sanabria M, Sánchez-Valverde F, Santiago R, Sepúlveda-Valbuena N, Spolidoro J, Valdivieso-Falcón P, Villalobos-Palencia N, Koletzko B. Consenso de alimentación complementaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica: COCO 2023. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2023. [DOI: 10.1016/j.rgmx.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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11
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Espinoza-Bernardo S, Bartolini R, Creed-Kanashiro H, Delgado-Pérez D, Haycraft E. Strategies and behaviors used by mothers in interactions with their young children during a mealtime in peri-urban areas of Huánuco, Peru. DIALOGUES IN HEALTH 2022; 1:None. [PMID: 36569813 PMCID: PMC9767413 DOI: 10.1016/j.dialog.2022.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 02/02/2023]
Abstract
This study aimed to gain an in-depth understanding about different strategies used by mothers to feed their 6-23-month-old children, as well as to learn about mothers' behaviors in response to situations of food refusal by her child, in order to generate evidence that contributes to the information gap on responsive feeding in Peru. The study was conducted in the city of Huánuco, a peri-urban area of Peru, with mothers of children in the complementary feeding stage participating. An in-depth 5-hour home observation was conducted in eight mother-child dyads. Both the mothers' and children's mealtime and food-related behaviors were coded and an inductive thematic analysis was applied. The primary objective of many of the strategies used by the mothers was to get their child to eat a little more. Six strategies were identified: pressure, encouragement, facilitating intake, acceptance, negotiation and reasoning. Certain differences were found in the strategies employed by the mother according to the age of her child, with mothers of younger children using more encouragement and mothers of older children using more pressure for their child to eat. The mothers' behavior in response to the child's refusal of food was both responsive and non-responsive (controlling), depending on the reason for the refusal. The findings are of great value for understanding about the feeding interactions of mother-child dyads in Peru and they start to address the information gap and can support the development of nutritional intervention strategies for use with children.
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Affiliation(s)
- Sissy Espinoza-Bernardo
- Departamento de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Peru
| | | | | | - Doris Delgado-Pérez
- Instituto de Investigación de Bioquímica y Nutrición, Departamento de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Peru
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, UK,Corresponding author at: School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
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12
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Khalsa AS, Copeland KA, Kharofa RY, Geraghty SR, Dewitt TG, Woo JG. The Longitudinal Relation between Infant Feeding Styles and Growth Trajectories among Families from Low-Income Households. J Nutr 2022; 152:2015-2022. [PMID: 35641195 DOI: 10.1093/jn/nxac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parental feeding styles, including the emotional environment parents create to modify a child's eating behaviors, have been associated with measures of adiposity in cross-sectional studies. The longitudinal relation between parental feeding styles in early infancy and adiposity in later infancy/toddlerhood are scant and have shown mixed results, particularly in families from low-income households. OBJECTIVES This study examined the relation between parental feeding styles and infant BMI z-score trajectories between 6 and 18 mo in families from low-income households. METHODS Parent-infant dyads were recruited during the infant's 6-, 9-, or 12-mo well-child visit. Feeding styles were assessed using the Infant Feeding Style Questionnaire (IFSQ). Infant anthropometrics from birth through 18 mo were extracted from the electronic medical record. BMI z-score slopes were estimated for each infant between 0-6 mo and 6-18 mo. Associations between feeding styles and BMI z-score slopes were examined using mixed models controlling for demographic, clinical, and feeding covariates. RESULTS The final analytic sample included 198 dyads (69% Black; median infant age: 9.0 mo; IQR: 6.8-10.3 mo). The predominant parent feeding styles included the following: laissez-faire (30%), restrictive (28%), responsive (23%), and pressuring (19%). In adjusted models, the predominant feeding style at enrollment was associated with the BMI z-score slope between 6 and 18 mo, with the responsive feeding style exhibiting a steeper increase in BMI z-score than other feeding styles. Infant feeding style was not associated with BMI z-score slope between birth and 6 mo of age. Infants of parents who exhibited restrictive feeding styles were more likely to have a BMI ≥85th percentile at their last measurement. CONCLUSIONS The predominant parent feeding style during infancy in a low-income population was associated with infant BMI z-score between 6 and 18 mo of age, but not earlier. Further studies are needed to better understand how predictive factors collectively contribute to BMI increase in the first 2 y.
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Affiliation(s)
- Amrik Singh Khalsa
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Primary Care Pediatrics and Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Roohi Y Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.,Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sheela R Geraghty
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Thomas G Dewitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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13
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Mcisaac JLD, Richard B, Turner J, Rossiter MD. Comparison of Responsive Feeding Practices in Child Care and Home Environments in Nova Scotia. CAN J DIET PRACT RES 2022; 83:168-174. [PMID: 36004728 DOI: 10.3148/cjdpr-2022-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The values, beliefs and practices between the family home and child care environment can play a role in shaping a responsive food environment for young children, but few studies have explored the differences across these settings. The purpose of this study was to compare responsive feeding practices in child care and home environments through the framework of the 2019 Canada Food Guide healthy eating recommendations.Methods: Nova Scotia families and child care providers completed an online survey on responsive feeding. Independent-samples t-tests explored the differences between family and child care respondents on variables related to the 2019 Canada's Food Guide, including: food variety, mindfulness, eating with others, cooking more often, and enjoyment of food. A directed content analysis was used to code the open-ended qualitative questions.Results: Family respondents (n = 603) were more likely to report offering a variety of foods, repeated exposures to new foods, and asking children about fullness. Child care respondents (n = 253) were more likely to sit with children during meals and less likely to encourage children to finish their food.Conclusions: The results identify potential points of intervention, including the importance of increasing communication to ensure mutually supportive messages and environments for healthy eating.
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Affiliation(s)
- Jessie-Lee D Mcisaac
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Nova Scotia.,Faculty of Education, Mount Saint Vincent University, Halifax, Nova Scotia.,Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Nova Scotia
| | - Brenna Richard
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Nova Scotia.,Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Nova Scotia
| | - Joan Turner
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Nova Scotia.,Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Nova Scotia
| | - Melissa D Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island
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14
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Rethinking Responsive Feeding: Insights from Bangladesh. Nutrients 2022; 14:nu14153156. [PMID: 35956330 PMCID: PMC9370268 DOI: 10.3390/nu14153156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Young children’s growth is influenced by food and feeding behavior. Responsive feeding has been shown to promote healthy growth and development, to prevent under- and overfeeding, and to encourage children’s self-regulation. However, most measures of responsive feeding do not incorporate bidirectional mother-infant responsivity or early learning principles and have not been validated against observations. To overcome these gaps, we laid the groundwork for a responsive feeding measure based on a community sample of 67 mothers and their 6–18-month-old children in Bangladesh. Children were weighed and measured. Mothers reported on their child’s dietary intake and responded to a 38-item responsive feeding questionnaire developed through a 2-phase Delphi procedure. Based on a video-recorded feeding observation, mother-child dyads were categorized into proximal (43%) and distal (57%) responsivity groups. Using stepwise logistic regression, a 9-item model from the responsive feeding questionnaire had excellent fit (AUC = 0.93), sensitivity (90%), specificity (89%), positive predictive value (87%), and negative predictive value (93%). Proximal responsivity was characterized by maternal concerns about children’s dietary intake. Distal responsivity was characterized by maternal perception of children’s happy mood during feeding. Findings support responsive feeding as modulating between proximal and distal responsivity, promoting autonomy, self-regulation, and enabling children to acquire and practice healthy eating behaviors.
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15
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Bliznashka L, McCoy DC, Siyal S, Sudfeld CR, Fawzi WW, Yousafzai AK. Child diet and mother-child interactions mediate intervention effects on child growth and development. MATERNAL & CHILD NUTRITION 2022; 18:e13308. [PMID: 34905648 PMCID: PMC8932723 DOI: 10.1111/mcn.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022]
Abstract
This study examined whether child diet and mother-child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0-24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother-child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother-child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother-child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms.
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Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Dana C. McCoy
- Harvard Graduate School of EducationHarvard UniversityCambridgeMassachusettsUSA
| | - Saima Siyal
- Harvard Graduate School of EducationAga Khan UniversityKarachiPakistan
| | - Christopher R. Sudfeld
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Wafaie W. Fawzi
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Aisha K. Yousafzai
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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16
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Maryati S, Yunitasari P, Punjastuti B. The Effect of Interactive Education Program in Preventing Stunting for Mothers with Children under 5 Years of Age in Indonesia: A Randomized Controlled Trial. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stunting is still a major public health issue that has had a direct impact on the country’s growth and development. Parents play a significant role in tackling the nutritional intake of children, considering their impact on the selection and quantities of food products obtainable to children. However, there is currently no specific parenting education program targeted at stunting prevention in Indonesia.
AIM: This study aimed to assess the effect of interactive education programs on preventing stunting for mothers with children under 5 years of age in Indonesia.
METHODS: This study was conducted using a randomized controlled trial single-blinded at the Public Health Center Bantul, Yogyakarta, Indonesia, from January to November 2019. The participants included the mothers of children under 5 years of age and reported the main role of feeding the child at home. The parenting program comprises 12 session workshops, biweekly within 6 months. Regression models were used to evaluate the effect of the intervention on the outcome by intervention group over time (from baseline to follow-up).
RESULTS: This study enrolled 64 people, 32 in the intervention group and 32 in the control group. There were substantial main effects or interactions for sickness in the past week and .an increase in age; children across all categories grew less stunted. Dietary diversity showed improvement for intervention caregivers compared to control. This was evidenced by improved ratings in the practice of more varied diets. The magnitudes of the effects on dietary diversity ranged from 0.30 to 0.53.
CONCLUSION: This study highlighted the effectiveness of educational programs on preventing stunting among children under 5 years of age. This study provides a new approach to stunting prevention, which can provide basic evidence of healthcare policy improvements in prevention programs in the local community.
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Pallewaththa P, Agampodi TC, Agampodi SB, Pérez-Escamilla R, Siribaddana S. Measuring Responsive Feeding in Sri Lanka: Development of the Responsive Feeding Practices Assessment Tool. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:489-502. [PMID: 33775569 DOI: 10.1016/j.jneb.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop and validate a tool focusing on responsive feeding (RF) practices among mothers and infants aged between 6 and 12 months in Sri Lanka. DESIGN A comprehensive review, an in-depth qualitative study, and a cross-sectional study were carried out. SETTING Anuradhapura District, Sri Lanka. PARTICIPANTS Sample of mother-infant pairs (n = 170). VARIABLES MEASURED Items were developed by extracting data from a previous in-depth qualitative study on RF, informed by currently available RF items. ANALYSIS Content validation was performed among experts using standard techniques, followed by cognitive interviews among mothers. Structural validity was assessed using principal component analysis. Test-retest reliability was done with a sample of 50 mothers. RESULTS Cognitive validation with mothers confirmed the applicability and comprehensiveness of the tool. The tool possessed good reliability with an intraclass correlation of 0.80 and internal consistency of 0.79. The principal component analysis showed a clear 3 factor solution. The 3 factors were interpreted as responsive communication during feeding, appropriate feeding, attentive to child's signals, and proactive preparation of the feeding environment. The final version of the tool consisted of 15 items. CONCLUSIONS AND IMPLICATIONS The 15-item Responsive Feeding Practices Assessment Tool is a valid tool to assess RF.
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Affiliation(s)
- Prabhath Pallewaththa
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka.
| | - Thilini C Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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18
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Pérez-Escamilla R, Jimenez EY, Dewey KG. Responsive Feeding Recommendations: Harmonizing Integration into Dietary Guidelines for Infants and Young Children. Curr Dev Nutr 2021; 5:nzab076. [PMID: 34104850 PMCID: PMC8178105 DOI: 10.1093/cdn/nzab076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Responsive feeding (RF) involves reciprocal nurturing feeding practices between the caregiver and the child that encourage the child to develop preferences for healthy foods and beverages and to eat autonomously. In this commentary, we summarize RF-related findings from a recent US National Academies of Sciences, Engineering, and Medicine (National Academies) consensus study report examining consistency in infant and young child feeding (IYCF) recommendations in guidelines from high-income countries, and we discuss implications for future IYCF guidelines. Although existing guidelines included generally consistent messages about several RF behaviors, such as the importance of encouraging self-feeding and self-regulation in infants and toddlers, they generally did not present the recommendations as part of a cohesive RF interdisciplinary framework. Moving forward, evidence-based RF recommendations should be routinely incorporated and identified in dietary guidance for IYCF based on a consensus definition of RF grounded in sound responsive parenting and feeding frameworks. We recommend replicating the National Academies' scoping review in low- and middle- income countries and mixed-methods implementation science research to improve our understanding of how best to disseminate and implement RF-related recommendations across settings (e.g., home and early care and education centers), taking the social determinants of health into account.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, NM, USA
| | - Kathryn G Dewey
- Department of Nutrition and Institute for Global Nutrition, University of California at Davis, Davis, CA, USA
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19
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Pradana Putri A, Rong JR. Parenting functioning in stunting management: A concept analysis. J Public Health Res 2021; 10. [PMID: 33855428 PMCID: PMC8129738 DOI: 10.4081/jphr.2021.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/22/2022] Open
Abstract
Stunting, a global issue, is the retarded growth and development of children resulting from inadequate nutrition, frequent infection, and insufficient psychosocial stimulation. It is usually an indicator of poor parenting. The role of parents is important for children's growth, development and learning. Parenting functioning is a concept health care professionals use to describe parenting activities for the purpose of intervention. But, the health professionals and patients have different understanding on parental functioning. There is a need to have a consistent definition of parenting functioning, and therefore this study aims to analyze the concept. Walker and Avant's method of concept analysis was used to study parenting functioning for the purpose of improving management of stunting. The attributes of parenting functioning are knowledge, competency, effort, responsibility, partnership, caring, teaching and communicating. Antecedents for parenting functioning are relationship, children's characteristics, careful observation and vicarious experiences. The consequences are positive child-rearing practice, less psychological stress and children's wellness. The empirical referents for parenting functioning are Keys to Interactive Parenting Scale (KIPS) and Parenting Interaction with Children: Checklist of Observations Linked to Outcomes (PICCOLO). In conclusion, this analytical concept can provide insights into nursing and public health colleagues to improve understanding of parenting functioning and to facilitate development of instrument to improve to an advance stage and to improve the stunting management.
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Affiliation(s)
- Anggie Pradana Putri
- International Nursing PhD Program, National Taipei University of Nursing and Health Sciences, Taipei.
| | - Jin-Ru Rong
- International Nursing PhD Program, National Taipei University of Nursing and Health Sciences, Taipei.
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20
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Kurnia ID, Krisnana I, Rahmadhani TD. Perceived barriers of nutritional feeding related to severe stunting. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Lutter CK, Grummer-Strawn L, Rogers L. Complementary feeding of infants and young children 6 to 23 months of age. Nutr Rev 2021; 79:825-846. [PMID: 33684940 DOI: 10.1093/nutrit/nuaa143] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.
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Affiliation(s)
- Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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22
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Dickin KL, Litvin K, McCann JK, Coleman FM. Exploring the Influence of Social Norms on Complementary Feeding: A Scoping Review of Observational, Intervention, and Effectiveness Studies. Curr Dev Nutr 2021; 5:nzab001. [PMID: 33718753 PMCID: PMC7937492 DOI: 10.1093/cdn/nzab001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
The influence of social norms on child feeding is recognized, but guidance is lacking on how to address norms and related perceptions that hinder or support positive nutrition practices. We reviewed recent peer-reviewed and grey literature to summarize social norms relevant to complementary feeding (CF), intervention approaches that address norms, and their impacts on social norms and CF outcomes. Many reports described various norms, customs, and perceptions related to appropriate foods for young children, parenting practices, gender, and family roles, but rarely explored how they motivated behavior. Community engagement and media interventions addressed norms through facilitated discussions, challenging negative norms, portraying positive norms, engaging emotions, and correcting misperceptions. Evaluations of norms-focused interventions reported improved CF practices, but few assessed impacts on social norms. Although multiple contextual factors influence CF practices, evidence suggests the feasibility and effectiveness of addressing social norms as one component of programs to improve CF practices.
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Affiliation(s)
- Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Juliet K McCann
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Fiona M Coleman
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Fernandez Rao S, Bentley ME, Balakrishna N, Griffiths P, Creed‐Kanashiro H, Vazir S, Johnson SL. A complementary feeding and play intervention improves the home environment and mental development among toddlers in rural India. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e13066. [PMID: 33347725 PMCID: PMC7752118 DOI: 10.1111/mcn.13066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants (n = 521) were assessed for development (Bayley-II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F(2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales 'Opportunities for Variety in Daily Stimulation' and 'Caregiver Promotion of Child Development' (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F(2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group (P < 0.04); no differences were noted in psychomotor development index (PDI) scores (P = 0.48). The subscales of HOME associated with MDI at 15 months were 'CPCD' and 'Cleanliness of Child' (R2 = 0.076). 'CPCD' was also associated with PDI (R2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months.
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Affiliation(s)
- Sylvia Fernandez Rao
- Behavioral Science Unit, Extension and Training DivisionNational Institute of Nutrition (ICMR)HyderabadIndia
| | - Margaret E. Bentley
- Department of Nutrition and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Paula Griffiths
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | | | - Shahnaz Vazir
- Behavioral Science Unit, Extension and Training DivisionNational Institute of Nutrition (ICMR)HyderabadIndia
| | - Susan L. Johnson
- Children's Eating Laboratory, Department of Pediatrics, Section of NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Abstract
The Gusii in rural Kenya represent a particularly interesting community for the study of sensitivity, as they have previously been described as not showing sensitive care. This study focuses on the observation of sensitivity in seven families with a 7-to 23-month-old infant, with extensive naturalistic video observations (ca. 2-4 hours per infant) described qualitatively and quantitatively. Sensitivity ratings showed substantial individual variation, ranging from low (2) to high (8). Sensitivity was mostly expressed non-verbally in the form of (subtle) physical responsiveness by a variety of caregivers, and seen to a high extent during infant feeding. Insensitivity was seen when caregivers were occupied with chores, and during infant bathing. Both warmth and harshness were observed, but infrequently. Results are discussed in terms of the nature of sensitive caregiving among the Gusii, and factors that might explain within-group differences.
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Affiliation(s)
- Judi Mesman
- Institute for Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Nobert Basweti
- Department of African Languages, Stellenbosch University, Stellenbosch, South Africa.,Department of Communication Skills and Studies, University of Nairobi, Nairobi, Kenya
| | - Joseph Misati
- Department of Community Development & Environmental Planning, The Cooperative University of Kenya, Kenya
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Effect of maternal nutritional education and counselling on children's stunting prevalence in urban informal settlements in Nairobi, Kenya. Public Health Nutr 2020; 24:3740-3752. [PMID: 32693855 DOI: 10.1017/s1368980020001962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether the prevalence of stunting differed between an intervention group and a control group and to identify factors associated with the children's linear growth. DESIGN This was a follow-up study of mother-child pairs who participated in a 2012-2015 cluster randomised controlled trial. Linear mixed effects models were performed to model the children's linear growth and identify the determinants of child linear growth. SETTING The study was conducted in two slums in Nairobi. The intervention group received monthly nutrition education and counselling (NEC) during pregnancy and infancy period. PARTICIPANTS A birth cohort of 1004 was followed up every 3 months after delivery to the 13th month. However, as a result of dropouts, a total of 438 mother-child pairs participated during the 55-month follow-up. The loss to follow-up baseline characteristics did not differ from those included for analysis. RESULTS Length-for-age z-scores decreased from birth to the 13th month, mean -1·42 (sd 2·04), with the control group (33·5 %) reporting a significantly higher prevalence of stunting than the intervention group (28·6 %). Conversely, the scores increased in the 55th month, mean -0·89 (sd 1·04), with significantly more males (16·5 %) stunted in the control group than in the intervention group (8·3 %). Being in the control group, being a male child, often vomiting/regurgitating food, mother's stature of <154 cm and early weaning were negatively associated with children's linear growth. CONCLUSIONS Home-based maternal NEC reduced stunting among under five years; however, the long-term benefits of this intervention on children's health need to be elucidated.
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Sall NS, Bégin F, Dupuis JB, Bourque J, Menasria L, Main B, Vong L, Hun V, Raminashvili D, Chea C, Chiasson L, Blaney S. A measurement scale to assess responsive feeding among Cambodian young children. MATERNAL & CHILD NUTRITION 2020; 16:e12956. [PMID: 31999399 PMCID: PMC7296795 DOI: 10.1111/mcn.12956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Ndèye S. Sall
- École des sciences des aliments, de nutrition et d'études familialesUniversité de MonctonMonctonNew BrunswickCanada
| | - France Bégin
- Programme Division (Early Childhood Nutrition)UNICEFNew York, New York
| | - Jérémie B. Dupuis
- Faculté des sciences de l'éducationUniversité de MonctonMonctonNew BrunswickCanada
| | - Jimmy Bourque
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Lylia Menasria
- École des sciences des aliments, de nutrition et d'études familialesUniversité de MonctonMonctonNew BrunswickCanada
| | | | - Lenin Vong
- Independent ConsultantPhnom PenhCambodia
| | | | | | - Chhorvann Chea
- National Institute of Public Health (NIPH), Ministry of HealthPhnom PenhCambodia
| | - Lucie Chiasson
- Ministère du développement socialMiramichiNew BrunswickCanada
| | - Sonia Blaney
- École des sciences des aliments, de nutrition et d'études familialesUniversité de MonctonMonctonNew BrunswickCanada
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Pérez-Escamilla R, Segura-Pérez S, Hall Moran V. Dietary guidelines for children under 2 years of age in the context of nurturing care. MATERNAL AND CHILD NUTRITION 2020; 15:e12855. [PMID: 31240831 DOI: 10.1111/mcn.12855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Dietary guidelines provide advice on what to eat to different subsets of the population but often do not take into account the "how" to eat. Responsive feeding is a key dimension of responsive parenting involving reciprocity between the child and caregiver during the feeding process and is characterized by caregiver guidance and recognition of the child's cues of hunger and satiety. Evidence indicates that providing responsive feeding guidance to mothers on how to recognize and respond appropriately to children's hunger and satiety cues can lead to improved feeding practices and weight status and developmental outcomes among infants and young children. In addition, early and nurturing exposures to foods with different tastes and textures and positive role modelling help children to learn to eat healthy foods. The importance of improving caregiver's responsive feeding behaviours to ensure the adequate introduction of complementary foods is becoming increasing recognized, but responsive feeding principles have not been taken into account in a comprehensive way in the development of dietary guidelines. The incorporation of all responsive feeding principles into dietary guidelines has a strong potential to enhance their impact on early childhood development outcomes for infants and young children but will require adaptation to the different contexts across countries to ensure that they are culturally sensitive and grounded in a deep understanding of the types of foods and other resources available to diverse communities.
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Pérez-Escamilla R, Segura-Pérez S. Can a pragmatic responsive feeding scale be developed and applied globally? MATERNAL AND CHILD NUTRITION 2020; 16:e13004. [PMID: 32297476 PMCID: PMC7296815 DOI: 10.1111/mcn.13004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
Responsive feeding (RF) has been recognized as necessary to prevent all forms of malnutrition including stunting and childhood obesity. Specific RF guidelines have been developed, but it is unclear how RF behaviours can be monitored systematically. Therefore, developing valid and reliable abbreviated and pragmatic RF scales is an important global priority. This is challenging, as RF is a construct with multiple dimensions including recognizing and responding to hunger and satiety cues, providing a nurturing environment during feeding episodes, and understanding how feeding needs evolve as a function of the developmental stage of the young child. Further, RF is embedded within the responsive parenting framework that in addition to RF includes sleep, soothing and play routines and the interconnections between them. A recent pioneer study conducted in a rural area of Cambodia validated an 8‐item RF scale through direct feeding observations of 6‐ to 23‐month‐old infants at home, as part of two cross‐sectional surveys conducted before and after a complementary feeding intervention. It is important for similar research to be conducted elsewhere to find out if it is possible or not to develop a core RF scale that is valid and reliable and that has adequate specificity and sensitivity for application in community studies and population surveys globally. As highlighted in this article, different definitions of RF have been used in the field; thus, it is important to reach consensus on a single definition to help move this research area forward.
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Jacob Arriola KR, Ellis A, Webb-Girard A, Ogutu EA, McClintic E, Caruso B, Freeman MC. Designing integrated interventions to improve nutrition and WASH behaviors in Kenya. Pilot Feasibility Stud 2020; 6:10. [PMID: 32042436 PMCID: PMC6998333 DOI: 10.1186/s40814-020-0555-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/23/2020] [Indexed: 01/05/2023] Open
Abstract
Background Child stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya. Methods This intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility. Results Using authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages. Conclusions This study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.
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Affiliation(s)
- Kimberly R Jacob Arriola
- 1Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Anna Ellis
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Amy Webb-Girard
- 3Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emily Awino Ogutu
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emilie McClintic
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Bethany Caruso
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Matthew C Freeman
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Ahishakiye J, Bouwman L, Brouwer ID, Matsiko E, Armar-Klemesu M, Koelen M. Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:43. [PMID: 31831068 PMCID: PMC6907215 DOI: 10.1186/s41043-019-0207-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/02/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6-23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. METHODS Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. RESULTS Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women's heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. CONCLUSION Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.
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Affiliation(s)
- Jeanine Ahishakiye
- Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands
- Human Nutrition and Dietetics Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Laura Bouwman
- Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands
| | - Inge D. Brouwer
- Nutrition and health over the life course chair group, Wageningen University, Wageningen, The Netherlands
| | - Eric Matsiko
- Nutrition and health over the life course chair group, Wageningen University, Wageningen, The Netherlands
- Human Nutrition and Dietetics Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Margaret Armar-Klemesu
- Nutrition Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Maria Koelen
- Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands
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Norlyk A, Larsen JS, Kronborg H. Infants' transition from milk to solid foods - the lived experiences of first-time parents. Int J Qual Stud Health Well-being 2019; 14:1693483. [PMID: 31746275 PMCID: PMC6882487 DOI: 10.1080/17482631.2019.1693483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: During the transition from ingesting milk to ingesting solid food, infants substantiate their eating habits. The present study focuses on this transition. Specifically, it aimed to explore first-time parents’ lived experiences of their infants’ transition from milk to solid foods. Method: The study is based on the descriptive phenomenological approach Reflective Lifeworld Research (RLR). Ten mothers and ten fathers were interviewed twice; when the infants were aged four to five months and again at seven to eight months of age. Data were analysed according to RLR principles. Results: The findings show that the transition from milk to solid food is a demanding in-between phase. The physically intimate feeding situation is replaced by unfamiliar situations in which parents and infant are physically separated and new types of food are introduced. The process of feeding requires parents’ full attention and sensitivity towards the infant’s reactions. Conclusion: The study highlights how shared parental experiences were reflected in frames for how a meal should normally proceed, including parents’ desire to create healthy eating habits and uphold harmony duringfamily meals We suggest for health professionals to present parents with a wider frame of normality, especially as concerns the concept of what constitutes “normal” eating patterns.
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Affiliation(s)
- Annelise Norlyk
- Research Unit for Nursing and Health Care, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Hanne Kronborg
- Research Unit for Nursing and Health Care, Department of Public Health, Aarhus University, Aarhus C, Denmark
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Briaux J, Fortin S, Kameli Y, Agboka Y, Romedenne M, Boko J, Martin‐Prevel Y, Becquet R, Savy M. Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo. MATERNAL & CHILD NUTRITION 2019; 15:e12843. [PMID: 31102494 PMCID: PMC6859998 DOI: 10.1111/mcn.12843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Abstract
Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6-23 months and investigates their relationships with length-for-age z-score (LAZ) and stunting, using cross-sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6-11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18- to 23-month-old children, only the consumption of iron-rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12-17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9-23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.
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Affiliation(s)
- Justine Briaux
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
- UMR 1219 Bordeaux Population Health Research Center, team IDLIC, Institut National de la Santé et de la Recherche Médicale (INSERM), University of BordeauxBordeauxFrance
| | - Sonia Fortin
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Yves Kameli
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Yawavi Agboka
- Projet de Développement Communautaire et Filets Sociaux, Ministère du Développement à la BaseLoméTogo
| | - Magali Romedenne
- Child Survival and Development, UNICEF, Togo country officeLoméTogo
| | - Joachim Boko
- Social Protection and Labor Global Practice, The World Bank, Benin country officeCotonouBenin
| | - Yves Martin‐Prevel
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Renaud Becquet
- UMR 1219 Bordeaux Population Health Research Center, team IDLIC, Institut National de la Santé et de la Recherche Médicale (INSERM), University of BordeauxBordeauxFrance
| | - Mathilde Savy
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
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Suboptimal feeding and caring practices among young Indian children ages 12 to 24 mo living in the slums of New Delhi. Nutrition 2019; 69:110553. [PMID: 31539814 DOI: 10.1016/j.nut.2019.110553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 05/08/2019] [Accepted: 07/12/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Inappropriate infant and young child feeding and caring practices affect nutritional status, increases the risk for growth faltering, and ultimately, affect child survival. The aim of this study was to characterize the feeding and caring practices of disadvantaged urban Indian children 12 to 24 mo of age in relation to the World Health Organization (WHO) and Pan American Health Organization (PAHO) recommendations. METHODS This cross-sectional study was conducted in self-selected households in a South Delhi slum. A household survey was administered to the mother/primary caregiver of 120 eligible children. We collected child anthropometry, 2-d weighed food records (n = 69), and compliance to WHO and PAHO recommended feeding, caring, food safety, and hygiene practices. RESULTS Of the children, 39% were stunted, 31% underweight, and 10% wasted; none were overweight. Despite 88% achieving minimum meal frequency (more than three to four meals daily), only 50% consumed at least four food groups (minimum dietary diversity), and 44% a minimum acceptable diet (composite score of minimum meal frequency and minimum dietary diversity). Consumption of iron-rich or iron-fortified foods, vitamin A-rich fruits and vegetables, and eggs was low (<25%) and flesh foods were negligible (1.4%), whereas consumption of both sugary and snack foods was >60%. Reported compliance to responsive feeding indicators was generally ∼50%, but there was a wide range (13-98%) for food safety and hygiene practices, which were not always consistent with home observations. CONCLUSIONS Complementary feeding and caregiving practices were suboptimal among these disadvantaged young Indian children and education interventions focused on infant and young child feeding, responsive feeding, food safety, and hygiene practices are urgently needed.
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Luo R, Emmers D, Warrinnier N, Rozelle S, Sylvia S. Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Soc Sci Med 2019; 239:112545. [PMID: 31568997 DOI: 10.1016/j.socscimed.2019.112545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/26/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition-or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8-12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6-30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.
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Affiliation(s)
- Renfu Luo
- China Centre for Agricultural Policy (CCAP), School of Advanced Agricultural Sciences (SAAS), Peking University (PKU), Beijing, China
| | | | | | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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Joshi MN, Raut AV. Maternal depression and its association with responsive feeding and nutritional status of infants: A cross-sectional study from a rural medical college in central India. J Postgrad Med 2019; 65:212-218. [PMID: 31204726 PMCID: PMC6813688 DOI: 10.4103/jpgm.jpgm_479_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Globally, around half of all under-5 deaths are attributable to undernutrition. The magnitude of child undernutrition in India is one of the highest in the world. Responsive feeding that has the potential to optimize nutrition and development depends on a "healthy mother". Objectives The objective of this study was to find out the magnitude and determinants of maternal depression among mothers of infants who attended immunization clinic in a rural medical college in central India and observe its association with infant-feeding practices and nutritional status of infants. Study Design This was an analytical cross-sectional study. Materials and Methods Study was conducted among consecutively chosen 300 mothers and their infants who visited the immunization clinic of hospital during May-September, 2016. Data were collected individually by interviewing each mother, and anthropometry of her infant was done. The mothers with depression were diagnosed according to the 10-item Edinburgh Postnatal Depression Scale. Magnitude of depression has been reported using frequency and percentage, whereas association has been studied using prevalence odds ratio with 95% confidence interval (CI) and logistic regression at 0.05 significance level. Results The magnitude of maternal depression was 19% (95% CI 14.4-23.5). Mothers with depression had significantly higher odds for not indulging in responsive feeding. Maternal education had significant association with maternal depression after adjusting for other variables. Conclusions Burden of maternal depression is high among mothers of infants who attended immunization clinic in a rural medical college in central India and is significantly associated with nonresponsive feeding practices.
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Affiliation(s)
- M N Joshi
- Department of Community Medicine, MGIMS, Sewagram, Wardha, Maharashtra, India
| | - A V Raut
- Department of Community Medicine, MGIMS, Sewagram, Wardha, Maharashtra, India
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Khalsa AS, Woo JG, Kharofa RY, Geraghty SR, DeWitt TG, Copeland KA. Parental intuitive eating behaviors and their association with infant feeding styles among low-income families. Eat Behav 2019; 32:78-84. [PMID: 30658288 DOI: 10.1016/j.eatbeh.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Feeding styles, the attitudes and behaviors parents use to direct their child's eating, shape a child's ability to self-regulate food intake and affects their future risk of obesity. This study examined how parental intuitive eating, where parents follow their own hunger and satiety cues, relates to infant feeding styles in a low-income, predominately Black population. METHODS Parents of healthy infants aged 5.5-12.5 months were recruited during well-child visits at two urban primary care clinics. Parent's intuitive eating behaviors and infant feeding styles were measured using the Intuitive Eating Scale-2 (IES-2) and the Infant Feeding Style Questionnaire (IFSQ), respectively. Multivariable regression analysis, controlling for maternal and child demographic variables, was conducted to determine the relationship between parent intuitive eating behaviors and five infant feeding styles: restrictive, pressuring, indulgent, laissez-faire, and responsive. RESULTS 201 parents completed the study, 90% were mothers and 69% were Black. Average infant age was 8.8 ± 2.0 months. Parents who reported relying on their own hunger and satiety cues when eating were more likely to feed their infant in a responsive style (β 0.10 ± 0.04, p < 0.05). Parents who reported eating unconditionally, not labeling foods as forbidden, were more likely to feed their infant in a laissez-faire (β 0.16 ± 0.06, p < 0.05) and indulgent (β 0.09 ± 0.03, p < 0.05) feeding style. CONCLUSIONS Parental intuitive eating behaviors are associated with both responsive and non-responsive infant feeding styles. Future studies should examine how parental intuitive eating and infant feeding styles affect infant growth trajectories.
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Affiliation(s)
- Amrik Singh Khalsa
- Division of Ambulatory Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA.
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 5041, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Roohi Y Kharofa
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Sheela R Geraghty
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Thomas G DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
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Michaelsen KF, Grummer-Strawn L, Bégin F. Emerging issues in complementary feeding: Global aspects. MATERNAL AND CHILD NUTRITION 2018; 13 Suppl 2. [PMID: 29032617 DOI: 10.1111/mcn.12444] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/21/2022]
Abstract
The complementary feeding period (6-24 months) is a window of opportunity for preventing stunting, wasting, overweight, and obesity and for improving long-term development and health. Because WHO published its guiding principles for complementary feeding in 2003, new knowledge and evidence have been generated in the area of child feeding. The aim of this paper is to highlight some of the emerging issues in complementary feeding and potential implications on the guidelines revision. Evidence on the effect of the quality and quantity of protein and fat intake on child growth during the complementary feeding period is summarized. The increased availability of sugar-containing beverages and unhealthy snack foods and its negative effect on young child's diet is described. Negative effects of nonresponsive feeding and force feeding are also discussed, although few scientific studies have addressed these issues. There are several emerging research areas that are likely to provide a better understanding of how complementary feeding influences growth, development, and health. These include the effect of the young child's diet on body composition, gastrointestinal microbiota, and environmental enteric dysfunction. However, at present, findings from these research areas are not likely to influence guidelines. Several emerging issues will be relevant to address when complementary feeding guidelines will be updated. With the increasing prevalence of obesity globally, it is important that guidelines on complementary feeding address both prevention of undernutrition and prevention of overweight, obesity, and noncommunicable diseases later in life.
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Affiliation(s)
- Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Laurence Grummer-Strawn
- Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - France Bégin
- Nutrition Section, Programme Division, UNICEF Headquarters, New York, New York, USA
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Rahmadiyah DC, Setiawan A, Fitriyani P. Responsive Feeding-Play (Resfeed-Play) Intervention on Children Aged 6-24 Months with Malnutrition. JURNAL NERS 2018. [DOI: 10.20473/jn.v13i1.4610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Toddlers are at risk to health problems, one of which is malnutrition. One of the important determinants to toddlers’ growth is nutrition. Giving solid foods to toddlers can be done by active/responsive feeding combined with the method that best suits the stage of playing toddlers. This paper aimed to provide an overview of the intervention of Resfeed-Play as a form of community nursing intervention on 32 children aged 6-24 months with malnutrition. Implementation of the intervention Resfeed-Play was performed in families and in society in nutrition support activities.Methods: The method was quasi-experimental with one group pre-post-test design. The inclusion sample criterion was family with toddlers who suffered from malnutrition.Results: The results of evaluation of Resfeed-Play shows an increase in knowledge (24.2%), attitude and skills by 30.3% and 42.4%, respectively. After intervention of six months, the mean weight gain for toddler was 0.95Kg. Based on paired sample t-test, the weight gain is significant with a P value of 0.001 (P <0.05). Resfeed-Play intervention can increase body weight in toddlers and can address the problems of malnutrition in children under five.Conclusion: Based on the results of this study, Resfeed-Play intervention is recommended to increase community empowerment through positive activities such as post-activity nutrition in order to prevent and mitigate the problem of malnutrition in toddlers.
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Oddo VM, Surkan PJ, Hurley KM, Lowery C, de Ponce S, Jones‐Smith JC. Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala. MATERNAL & CHILD NUTRITION 2018; 14:e12455. [PMID: 28464549 PMCID: PMC5668210 DOI: 10.1111/mcn.12455] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/25/2017] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Abstract
The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.
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Affiliation(s)
- Vanessa M. Oddo
- Center for Human NutritionDepartment of International Health Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Pamela J. Surkan
- Social & Behavioral Interventions Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Kristen M. Hurley
- Center for Human NutritionDepartment of International Health Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Caitlin Lowery
- Social & Behavioral Interventions Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Silvia de Ponce
- Asociación para la Prevención y Estudio del VIH/SIDARetalhuleuGuatemala
| | - Jessica C. Jones‐Smith
- Center for Human NutritionDepartment of International Health Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Nutrition Sciences Program & Department of Health ServicesUniversity of Washington School of Public HealthSeattleWashingtonUSA
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40
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Shi C, Li N, Dong J, Wang L, Li X, Ji C, Wang X, Chi X, Guo X, Tong M, Zhang M. Association between maternal nonresponsive feeding practice and child's eating behavior and weight status: children aged 1 to 6 years. Eur J Pediatr 2017; 176:1603-1612. [PMID: 28890989 DOI: 10.1007/s00431-017-3007-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED The purposes of this study are to investigate the prevalence of nonresponsive feeding practice (NRFP) and child's eating behavior (CEB) and to explore the hypothetical association between child's weight status, NRFP and CEB for 1- to 6-year-old children. In this study, 2423 caregivers of 1- to 6-year-old children are from the Nanjing Maternal and Child Health Hospital who completed the self-report questionnaires about their NRFP and CEB as well as their children's sociodemographic data. Chi-square test and multiple regression analyses were used to examine the correlation between child's weight status and NRFP and CEB. The total prevalence of overweight and obesity was 15.2 and 7.3%, respectively. High prevalence of CEB problems and NRFP was detected at 2- and 5-year-old children. Moreover, maternal NRFP was significantly positively associated with CEB. The regression and correlation analysis revealed CEB and maternal NRFP are closely associated with BMI. For instance, refusing new food (OR = 3.57, 95%CI, 1.37-9.33, 1.5-year-old) and restriction (OR = 3.01, 95%CI, 1.34-6.76) are likely to be associated with underweight. Preferring junk food (OR = 4.892, 95%CI, 1.71-14.01, 1-year-old) and inattention (OR = 2.24, 95%CI, 1.16-4.35, 1-year-old) are prone to be overweight and obese, and pressure (OR = 0.23, 95%CI, 0.06-0.91, 1-year-old) is less likely to be associated with underweight. CONCLUSION The findings provide strong evidence for the correlation between NRFR and CEB, and this indicates that prevention and intervention of unhealthy weight should start in early life. However, further research is necessary to gain an understanding of the impact of NRFP on CEB and weight. What is known: • Responsive feeding practice is crucial to the formation of eating behavior, and poor practice is associated with the current epidemics of childhood obesity and underweight. What is new: • The findings provide a strong evidence for the correlation between NRFR and CEB. • This finding indicates that NRFR and CEB are associated with child's unhealthy weight.
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Affiliation(s)
- Chunmei Shi
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Nan Li
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Jing Dong
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Li Wang
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Xiling Li
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Chenbo Ji
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Xingyun Wang
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Xia Chi
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China.,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China
| | - Xirong Guo
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China. .,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China.
| | - Meiling Tong
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China. .,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China.
| | - Min Zhang
- Department of Child Health Care, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, 210004, China. .,Department of Child Health Care, Nanjing Maternal and Child Health Care Hospital, 123 Tianfei Road, Qinhuai, Nanjing, 210004, China.
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Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr 2017; 38:665-679. [PMID: 28746059 DOI: 10.1097/dbp.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.
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Abebe Z, Haki GD, Baye K. Child feeding style is associated with food intake and linear growth in rural Ethiopia. Appetite 2017; 116:132-138. [DOI: 10.1016/j.appet.2017.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 04/05/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
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Naila N, Nahar B, Lazarus M, Ritter G, Hossain M, Mahfuz M, Ahmed T, Denno D, Walson J, Ickes S. "Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28730705 DOI: 10.1111/mcn.12473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/31/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023]
Abstract
Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.
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Affiliation(s)
- Nurun Naila
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Monica Lazarus
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Gaelen Ritter
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Donna Denno
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Judd Walson
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA.,Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Scott Ickes
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
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Baye K, Tariku A, Mouquet-Rivier C. Caregiver-infant's feeding behaviours are associated with energy intake of 9-11 month-old infants in rural Ethiopia. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28675690 DOI: 10.1111/mcn.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022]
Abstract
Inappropriate complementary feeding, both in quantity and quality, is a major determinant of undernutrition. However, little is known about how infant-caregiver's feeding behaviours affect infants' energy intake. Therefore, the objective of this study was to characterize infant-caregiver feeding behaviours and investigate their association with infants' energy intake. The study involved 106 mother-child pairs recruited from seven randomly selected kebeles of Mecha district, West Gojam, Ethiopia. The feeding styles were assessed through observations of 1-day, in-home, feeding episodes that were videotaped and coded into self-feeding, responsive, active, distracting, and social feeding behaviours. Infants' haemoglobin and anthropometric measurements were taken. The association between feeding behaviour scores and energy intake per meal was investigated. The mean food intake of the infants was very low (11.4 ± 7.0 g/kg body weight per meal) compared to the minimum theoretical gastric capacity (30 g/kg body weight per meal). Infants' haemoglobin concentration was negatively associated with energy intake (ρ = 0.178, p = .03). Infants' responsive and active positive feeding styles were positively associated with energy intakes (ρ = 0.258 and 0.432, p = .004 and p < .001, respectively) as well as caregivers' responsive positive feeding styles (ρ = 0.237, p = .007). Both haemoglobin concentrations and feeding styles were associated with infant's energy intake. Anaemia prevention and control measures should be reinforced. Current nutrition education programmes should give emphasis on ways to effectively incorporate culturally adapted responsive feeding messages in this and similar settings.
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Affiliation(s)
- Kaleab Baye
- Center for Food Science and Nutrition, College of Natural Sciences, PO Box 1176, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tariku
- Center for Food Science and Nutrition, College of Natural Sciences, PO Box 1176, Addis Ababa University, Addis Ababa, Ethiopia
| | - Claire Mouquet-Rivier
- UMR Nutripass, French Research Institute for Sustainable Development, IRD, UM, Montpellier SupAgro, Montpellier, France
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Brown N, Finch JE, Obradović J, Yousafzai AK. Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth. Child Care Health Dev 2017; 43:577-587. [PMID: 28480514 DOI: 10.1111/cch.12466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under-stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height-for-age at 2 and 4 years. METHODS The Pakistan Early Child Development Scale-up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4 years of age. In total, 1302 children were followed up from birth to 4 years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height-for-age at 4 years, including maternal depressive symptoms, mother-child interaction quality, diarrhoeal illness and height-for-age at 2 years. RESULTS Our final model had excellent model fit (comparative fix index = 0.999, Tucker-Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother-child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height-for-age at 4 years via its longitudinal stability from 2 years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1 year post partum on children's height-for-age at 4 years via the longitudinal stability of height-for-age z-score from 2 years of age onwards (β = -0.007, p = 0.019). CONCLUSIONS The quality of early caregiving experience mediated the association between both interventions and height-for-age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors.
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Affiliation(s)
- N Brown
- Department of Paediatrics, Salisbury District Hospital, Salisbury, UK.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - J E Finch
- Graduate School of Education, Stanford University, Stanford, CA, USA
| | - J Obradović
- Graduate School of Education, Stanford University, Stanford, CA, USA
| | - A K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
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de Groot R, Palermo T, Handa S, Ragno LP, Peterman A. Cash Transfers and Child Nutrition: Pathways and Impacts. DEVELOPMENT POLICY REVIEW : THE JOURNAL OF THE OVERSEAS DEVELOPMENT INSTITUTE 2017; 35:621-643. [PMID: 31363343 PMCID: PMC6667168 DOI: 10.1111/dpr.12255] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Childhood malnutrition remains a significant global problem, with an estimated 162 million children under the age of five suffering from stunted growth. This article examines the extent to which cash transfer programmes can improve child nutrition. It adopts a framework that captures and explains the pathways and determinants of child nutrition. The framework is then used to organize and discuss relevant evidence from the impact evaluation literature, focusing on impact pathways and new and emerging findings from sub-Saharan Africa to identify critical elements that determine child nutrition outcomes as well as knowledge gaps requiring further research, such as children's dietary diversity, caregiver behaviours and stress.
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Affiliation(s)
- Richard de Groot
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Tia Palermo
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Sudhanshu Handa
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
- department of Public Policy, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | - Amber Peterman
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
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Kerr RB, Chilanga E, Nyantakyi-Frimpong H, Luginaah I, Lupafya E. Integrated agriculture programs to address malnutrition in northern Malawi. BMC Public Health 2016; 16:1197. [PMID: 27894303 PMCID: PMC5126822 DOI: 10.1186/s12889-016-3840-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi. METHODS A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions. RESULTS Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms. CONCLUSIONS Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women's roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.
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Affiliation(s)
| | | | | | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
| | - Esther Lupafya
- SFHC Organization, Ekwendeni Hospital, Ekwendeni, Malawi
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Sjarif DR, Yuliarti K, Wahyuni LK, Wiguna T, Prawitasari T, Devaera Y, Triyuniati HW, Afriansyah A. Effectiveness of a comprehensive integrated module using interactive lectures and workshops in understanding and knowledge retention about infant feeding practice in fifth year medical students: a quasi-experimental study. BMC MEDICAL EDUCATION 2016; 16:210. [PMID: 27538528 PMCID: PMC4991091 DOI: 10.1186/s12909-016-0705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/01/2016] [Indexed: 05/13/2023]
Abstract
BACKGROUND Sixty percent of the 10.9 million under-5 deaths every year are related to malnutrition. More than two thirds of malnutrition is caused by inappropriate infant feeding practice. Only 35 % of mothers worldwide provide 4 months of exclusive breast-feeding, while complementary feeding is often untimely, nutritionally inadequate, hygienically poor, and improperly delivered. The existing pediatric nutrition module in our institution does not include proper delivery of food that involves oral-motor skills and feeding behavior. To scale up the knowledge and skill of medical students regarding evidence-based infant feeding practice, we designed a new module composed of comprehensive and integrated lectures with additional multidisciplinary lectures on oral-motor skill development and feeding behavior. METHODS A quasi-experimental study was conducted to evaluate the efficacy of the new module compared to the previous module. Fifth year medical students of Universitas Indonesia were divided into intervention and control groups. The control group received lectures and a paper-based workshop. The intervention group received comprehensive and integrated interactive lectures with additional multidisciplinary lectures on oral-motor skill development and behavioral approaches to feeding problems. A hands-on workshop using real cases shown on recorded video and role-play sessions was also presented to the intervention group. A pre-/post-test, 3-month retention test, and Observed Structured Clinical Examination (OSCE) were performed to evaluate understanding, knowledge retention, and counseling skills. RESULTS A linear mixed effect model with a random intercept analysis for pre-test, post-test, and retention test scores showed significant higher result for intervention group compared to control group (p < 0.001). Comprehensive knowledge and counselling skills were better in the intervention group than in the control group as shown by the OSCE score (68.6 vs 59.3, p < 0.001). CONCLUSIONS Our comprehensive integrated infant feeding practice module, which incorporates multidisciplinary learning processes and an interactive hands-on workshop with a role-play session yields better knowledge understanding and counseling skills compared with the existing module. Comprehensive knowledge and good counseling skills of medical students as future doctors are a pre-requisite to provide effective education to parents to support successful infant feeding practices.
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Affiliation(s)
- Damayanti Rusli Sjarif
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Klara Yuliarti
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Cipto Mangukusumo Hospital, Jakarta, 10430 Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, 10430 Indonesia
| | - Titis Prawitasari
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Yoga Devaera
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Henni Wahyu Triyuniati
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Andika Afriansyah
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
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Silva GAP, Costa KAO, Giugliani ERJ. Infant feeding: beyond the nutritional aspects. J Pediatr (Rio J) 2016; 92:S2-7. [PMID: 26997355 DOI: 10.1016/j.jped.2016.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To draw attention to the importance of interaction between caregiver and child during feeding and the influence of parenting style on dietary habit formation. SOURCE OF DATA A search was performed in the PubMed and Scopus databases for articles addressing responsive feeding; the articles considered most relevant by the authors were selected. SYNTHESIS OF DATA The way children are fed is decisive for the formation of their eating habits, especially the strategies that parents/caregivers use to stimulate feeding. In this context, responsive feeding has been emphasized, with the key principles: feed the infant directly and assist older children when they already eat on their own; feed them slowly and patiently, and encourage children to eat but do not force them; if the child refuses many types of foods, experiment with different food combinations, tastes, textures, and methods of encouragement; minimize distractions during meals; and make the meals an opportunity for learning and love, talking to the child during feeding and maintaining eye contact. It is the caregiver's responsibility to be sensitive to the child's signs and alleviate tensions during feeding, and make feeding time pleasurable; whereas it is the child's role to clearly express signs of hunger and satiety and be receptive to the caregiver. CONCLUSION Responsive feeding is very important in dietary habit formation and should be encouraged by health professionals in their advice to families.
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Affiliation(s)
- Giselia A P Silva
- Postgraduate Program in Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
| | - Karla A O Costa
- Postgraduate Program in Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Elsa R J Giugliani
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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