Caregiver Verbal Encouragement Increases Food Acceptance among Vietnamese Toddlers

Abstract

Responsive feeding, defined as the positive environment and caregiving behaviors that encourage children to eat, is critical to their physical, mental, and social development. However, research and programs designed to foster responsive feeding have been limited. This research tested the hypothesis that caregiver encouragement, caregiver and child behaviors, and other feeding characteristics were associated with acceptance of food. A total of 91 mother/child pairs in rural, northern Vietnam were videotaped during 2 2-h feeding episodes. Children were 12 and 17 mo of age at the time of study. Caregiver and child behaviors were coded at the level of the "intended bite" (7135 bites total). Feeding episodes were marked by few physical actions and minimal verbal encouragement by caregivers. Results from generalized linear mixed models suggest that when caregivers provided children with positive comments, children were 2.4 times as likely to accept bites compared with when no comments were given. Twelve-mo-olds who were in the caregiver's arms [odds ratio (OR) = 0.5] or lap (OR = 0.5) were significantly less likely than those who stood to accept bites. The 17-mo-olds who played were less likely than those with no physical action to accept bites. Play appeared to distract boys more than girls. In Vietnam, programs should help caregivers provide positive verbal encouragement to eat. Program planners and implementers may want to encourage caregivers to avoid force feeding and other forms of physical pressure. Further, mealtime should be seen as an opportunity to develop long-term feeding skills and encourage a healthy appetite.

Responsive Feeding and Child Undernutrition in Low- and Middle-Income Countries

“…Thus, we identified 21 published studies ( Table 1) with a RF exposure and child undernutrition outcome: 15 on child growth (4,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), 4 on dietary intake (14,18,19,23), 3 on disease (5,14,18), and 8 on eating behaviors (3)(4)(5)20,22,(24)(25)(26). Seven studies reported on more than one type of outcome (4,5,14,(18)(19)(20)22).…”

“…Most studies (n = 19) were conducted among children , 36 mo of age (3,4,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(22)(23)(24)(25)(26) and were conducted in the last 10 y (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Over one-half of the studies utilized direct observation to capture RF behaviors (3)(4)(5)9,10,12,15,20,22,(24)(25)(26), 3 used self-report questionnaires (11,13,17), and 6 were interventions that provided education on RF but did not collect data on RF behaviors (14,16,18,…”

“…A key finding across studies was that positive verbalizations were associated with greater child acceptance of food. For example, Dearden et al (26) found that child acceptance of a bite was more likely when the caregiver used positive compared with no verbalization, but less likely when the verbalization was mechanical/direct, such as "open your mouth" or "eat". However, analyses by the type of physical action showed that children were more likely to accept bites when caregivers used pressuring or forceful behaviors compared with direct ones, such as assisting a child in using utensils (26).…”

“…Two studies in Vietnam utilized videotape in the observation of meals and snacks as part of an evaluation of a communitybased nutrition intervention to improve child growth (24,26). While researchers previously used videotaped data to examine variation in infant feeding among urban compared with rural caregivers in central Peru, these are among the first published studies to use the methodology.…”

Infant and Young Child Feeding in Developing Countries

“…The other important and difficult-to-measure aspect of feeding is ''how'' feeding occurs. Positive environment and caregiving behaviors that encourage children to eat (i.e., responsive feeding) can have a significant impact on the quality of feeding and cognitive stimulation of children, and therefore are critical to their physical, mental, and social development (Dearden et al, 2009). Indicators for population-level assessment of these behaviors, however, are not yet available and hence were not measured as part of this study.…”