Abstract
Child eating and caregiver feeding behaviours are critical determinants of food intake, but they are poorly characterized in undernourished children. We aimed to describe how appetite, food refusal and force‐feeding vary between undernourished and healthy children aged 6–24 months in Nairobi and identify potential variables for use in a child eating behaviour scale for international use. This cross‐sectional study was conducted in seven clinics in low‐income areas of Nairobi. Healthy and undernourished children were quota sampled to recruit equal numbers of undernourished children (weight for age [WAZ] or weight for length [WLZ] Z scores ≤2SD) and healthy children (WAZ > 2SD). Using a structured interview schedule, questions reflecting child appetite, food refusal and caregiver feeding behaviours were rated using a 5‐point scale. Food refusal and force‐feeding variables were then combined to form scores and categorized into low, medium and high. In total, 407 child–caregiver pairs, aged median [interquartile range] 9.98 months [8.7 to 14.1], were recruited of whom 55% were undernourished. Undernourished children were less likely to ‘love food’ (undernourished 78%; healthy 90% p = < 0.001) and more likely to have high food refusal (18% vs. 3.3% p = <0.001), while their caregivers were more likely to use high force‐feeding (28% vs. 16% p = 0.03). Undernourished children in low‐income areas in Nairobi are harder to feed than healthy children, and force‐feeding is used widely. A range of discriminating variables could be used to measure child eating behaviour and assess the impact of interventions.
Highlights
Eating behaviour is ‘the essential link between energy needs and energy intake’ because a child must eat in order to grow and thrive (Parkinson & Drewett, 2001)
It has long been recognized that children with severe acute malnutrition (SAM) are often anorexic, but this is assumed to be a consequence of their nutritional state as appetite usually returns as refeeding proceeds (World Health Organization [WHO], 1999)
There has been little research into how infants and young children eat in low- and middle-income countries (LMICs), especially those with undernutrition, or how their caregivers respond to their eating behaviour (Abebe, Haki, & Baye, 2017; Moore, Akhter, & Aboud, 2006)
Summary
Eating behaviour is ‘the essential link between energy needs and energy intake’ because a child must eat in order to grow and thrive (Parkinson & Drewett, 2001). Treatment and prevention interventions have relied on the provision of fortified supplementary food (WHO, 2012) These have generally, shown only modest effects (Lazzerini, Rubert, & Pani, 2013), which is often attributed to noncompliance by families (Maleta et al, 2004), rather than the possibility that poor child appetite may influence child intake and in turn compliance (Lazzerini et al, 2013; Maleta et al, 2004). Research in more affluent settings has found that infants with weight faltering, a form of MAM, have lower appetite and higher food aversion, suggesting that food refusal may be a factor in the causation of undernutrition (Wright, Parkinson, & Drewett, 2006). The word ‘appetite’ means different things at different ages (Wright et al, 2006) and tends not to have an equivalent term in languages other than English, but other descriptions have been found to correlate with weight gain (Wright, Cox, & Le Couteur, 2011)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
