The role of care in nutrition programmes: current research and a research agenda

Abstract

The importance of cultural and behavioural factors in children's nutrition, particularly with regard to feeding, has been recognized only recently. The combination of evidence regarding the importance of caregiving behaviour for good nutrition, and improved strategies for measuring behaviour have led to a renewed interest in care. The UNICEF conceptual framework suggests that care, in addition to food security and health care services, are critical for children's survival, growth and development. The present paper focuses on the care practice of complementary feeding, specifically behavioural factors such as parental interaction patterns, feeding style and adaptation of feeding to the child's motor abilities (self-feeding or feeding by others). Three kinds of feeding styles (Birch & Fisher, 1995) are identified: controlling; laissez-faire; responsive. Probable effects of each feeding style on nutrient intake are described. A number of studies of feeding behaviour have suggested that the laissez-faire style is most frequently observed among families and communities with a higher prevalence of malnourished children. Nutrition interventions that have been able to show significant effects on outcomes, such as the Hearth Model in Vietnam (Sternin et al. 1997), have usually incorporated behavioural components in their intervention. At this time, there have been no tests of the efficacy of behavioural interventions to improve feeding practices. Research is needed to understand behavioural factors in complementary feeding, and to identify and test intervention strategies designed to improve nutrient intake of young children. Finally, the paper concludes with a discussion of how nutrition programmes might change if care were incorporated. Care and child nutrition: Complementary feeding: Child development: MalnutritionIt is well known that inadequate food intake in the first 2 years of life is responsible for stunting and underweight in millions of children around the world (United Nations Children's Fund, 1998). Poor breast-feeding patterns, low nutrient density and poor quality of the foods that complement breast-feeding accounts for much of the nutrient deficiency (Brown et al. 1998). These patterns of feeding are not simply the result of low food availability in the household. In the present paper we suggest that caregivers' behaviours during feeding of complementary foods (those foods ingested by the child while the child is still being breast-fed, theoretically between the ages of 6 months and 2 years. Even though many children are not still breast-fed at this time, the term continues to be useful to describe this transitional period of food consumption (Brown et al. 1998)) contribute significantly to the adequacy of children's nutrient intake, and therefore to their nutritional status. The present paper will discuss four issues: (1) why there is an interest in feeding practices and care for nutrition; (2) the definition of care and its conceptual framework; (3) examples of research that illustrate the importance o...

Assessment of infant feeding styles among low-income African-American mothers: Comparing reported and observed behaviors

“…The classification matrix and scale are unique instruments specifically tailored for the evaluation of feeding styles at these very young ages, and draw upon a firm theoretical basis of considerable previous research (Birch et al, 2001;Engle, Bentley, & Pelto, 2000;Lederman et al, 2004), qualitative data analysis (Bentley et al, 1999) and the widely-used NCAST feeding scale (Sumner and Spietz, 2004). They also offer the opportunity to examine the effects of both controlling and less controlling reported and observed feeding styles on infant outcomes from a very young age.…”

“…The present study focuses on a broader range of feeding styles in a sample of low-income African-American infants, drawing on our own previous research and experience in infant feeding (Engle, Bentley, & Pelto, 2000;Ha et al, 2002;Lederman et al, 2004). A comparison of observed and reported feeding styles using qualitative methods provides rich detail on infant feeding styles in this population, within the framework of the parenting style classification proposed by Maccoby and Martin (1983).…”

Looking for cues – infant communication of hunger and satiation during milk feeding

“…deciding what the cue means such as hunger or satiety and (3) Responding to this by either continuing to offer food or pausing/stopping (Black and Aboud. 2011;Engle et al, 2000). To feed responsively the caregiver must first identify the feeding cues which are communicated by the infant and decide if these indicate hunger or satiation.…”

Saudi Arabian Mothers’ Child Feeding Practices, Autonomy, and Concern about Child Weight

“…Women's autonomy is important to ensure healthy child outcomes. To the contrary, low women's autonomy is one major factor that affects child health outcomes and thus, may disturb mothers' feeding practices [23,24].…”