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

Antonina N Mutoro,Ada L Garcia,Charlotte M Wright

doi:10.3390/ijerph16122197

Antonina N Mutoro, Ada L Garcia + Show 1 more

Open Access

https://doi.org/10.3390/ijerph16122197

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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.

Highlights

Infant and young child feeding is a complex but important aspect of child care that affects child growth and survival
Findings from this study show that poor appetite and non-responsive feeding were common in the undernourished children
Healthy children were slightly older than undernourished children and undernourished children on ready-to-use therapeutic foods (RUTF) had lower anthropometric measurements compared to those on home foods

Summary

Introduction

Infant and young child feeding is a complex but important aspect of child care that affects child growth and survival. Lack of encouragement (positive active physical help and verbalization during meals) and force feeding occur regularly during meals in many low- and middle-income countries (LMIC), where caregivers are faced with challenges such as poverty and food insecurity [4,5,6,7,8,9,10,11]. In a meal observation study in Nicaragua, Engle and Zeitlin [5] used an active feeding and a child demand scale to assess eating and feeding behaviors (EFBs) in moderately undernourished children aged 12–19 months. They observed that caregivers only encouraged children to eat in 39% of feeding events observed and that food refusal occurred in 65%

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