“Those Who Care Much, Understand Much.” Maternal Perceptions of Children's Appetite: Perspectives from Urban and Rural Caregivers of Diverse Parenting Experience

Abstract

BackgroundAppetite in children is an important determinant of nutritional intake and growth. Reduced appetite is related to acute illness and systemic inflammation in infants and young children, and is common in settings where high rates of undernutrition coexist with inadequate water, sanitation, and hygiene. The loss of appetite is an indicator of declining health status, and improvement in appetite is an early signal of recovery. Therefore, understanding caregiver's awareness of children's appetite during illness and recovery is important to maximize opportunities for targeting interventions to improve growth and reduce morbidity and mortality risk in young children.Objective1) To understand maternal perceptions and responses to children's appetite; and 2) to identify how these factors differ by type of caregiver, level of maternal experience, and by urban and rural context.MethodsWe conducted twelve focus groups among mothers (nulliparous and multiparous) and alternate caregivers in urban and rural setting in Bangladesh (n=81). All participants were currently providing care for a child under 5 years.ResultsCaregivers most often monitor children's dietary patterns to understand children's appetite, and to a lesser extent physical and emotional signs, and other cues. Healthy appetite, or “taste” and “delight in their mouths” was commonly observed by a child's willingness to eat a diversity of foods, finish offered portions, and by their acceptance of foods without excessive prompting. Child illness was a commonly cited reason for children's lack of appetite, which was manifested through fussiness and crying, coupled with the avoidance of commonly consumed foods, or a heightened preference for comfort foods. Mothers described a limited set of feeding practices (offering diverse foods, playing with children, cheering children with videos) to encourage food consumption among children who lacked appetite. Maternal time stress due 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 more access to informational support (nutrition counseling, child care centers, literature) than mothers in the rural setting.ConclusionsCaregiver recognition of child appetite during healthy and ill periods appears to be a critical component of optimal nutritional caregiving. Understanding caregivers' perceptions of children's appetite, and the signs and cues that mothers and caretakers use to identify the presence and absence of appetite in children, may inform the development of tools to assess changes in appetite as early indicators of change in health or nutrition status among high risk children.Support or Funding InformationSupported by the Bill and Melinda Gates Foundation (OPP1136759).