What Can Meal Observations Tell Us about Eating Behavior in Malnourished Children?

Abstract

Responsive feeding is an important aspect of child care, yet little is known about child eating and caregiver feeding behavior in Kenya. This study aimed to develop a mealtime observation methodology and assess child eating and caregiver feeding behavior in healthy and undernourished children in Nairobi. Healthy (n = 6) and undernourished (n = 13) children aged 6–24 months were observed during a meal, with standardized rating of child interest in food, mood, distraction and caregiver responsiveness. Eating and feeding behavior varied with the stage of the meal. Child interest in food decreased and child and caregiver distraction increased as the meal progressed. Healthy children were happy and interested in food during meals, but undernourished children often had low interest in food (7/13). The 7 undernourished children eating home food were distracted (3) and unhappy (5) but children eating ready-to-use therapeutic foods (6) were all happy and undistracted. Caregivers of healthy children offered encouragement more often during meals than caregivers of undernourished children (5/6 healthy, 3/13 undernourished). Meal observations were resource intensive and could give only a snapshot of the child feeding experience. More efficient research methods that can capture a general assessment of infant eating behavior are needed.

Eating and feeding behaviours in children in low‐income areas in Nairobi, Kenya

“…For example, most caregivers reported encouraging their children when they refused to eat, but our observation studies in a similar setting (Mutoro et al, 2019) and in other LMICs (Bentley, Stallings, et al, 1991, Engle & Zeitlin, 1996, Moore et al, 2006, Mutoro, 2018 suggest that caregivers are usually passive during meals. However, conducting meal observations in this setting has already proved difficult (Mutoro et al, 2019) and may not reflect typical, habitual behaviour. Other survey-based studies have demonstrated that parental reports are generally valid.…”

“…We planned to examine a wider range of novel behavioural and dietary variables between three subgroups and findings from preliminary meal observations suggested large differences in interest in food between healthy and undernourished children and in the proportion becoming upset during meals (Mutoro et al, 2019). We therefore aimed for a sample size sufficient (80% power, alpha 0.05) to detect a prevalence of 15% for any behaviour in one group compared with 30% in another (relative risk = 2).…”

Development of a Scale to Measure Infant Eating Behaviour Worldwide

“…Observational studies have found undereating in stunted children [ 6 ] and that moderately malnourished children did not finish meals [ 28 ]. However, assessment via observation is highly labour-intensive [ 11 ], but two previous studies have shown that caregiver reports predict observed behaviour [ 7 , 28 ], suggesting that they are a valid alternative. As far as we know, ours is the first scale to be applied in an LMIC setting that has been shown to have predictive validity in terms of weight gain.…”

“…The World Health Organization (WHO) treatment protocol for severe acute malnutrition (SAM) includes an ‘appetite test’, an observation of the child’s immediate willingness to take a prescribed food supplement. Direct observation is labour-intensive and may be unrepresentative [ 11 ], but there is no other standard means of assessing eating behaviour in the LMIC context [ 12 ]. Parental-report-based measures of feeding and eating problems have been developed for use in more affluent clinic settings, although these do not relate specifically to undernutrition and are mainly aimed at older children [ 13 ].…”

The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia

“…In order to code behavioral variables from our recordings, we have developed a culturally appropriate coding scheme for family mealtimes, using an adapted version of a coding scheme developed by Mutoro et al [ 31 ] for children living in low-income areas in Nairobi. Mutoro’s original scheme was developed for younger children; hence, our coding scheme was adapted to suit the behaviors and interactions of older children.…”