Child Feeding Recommendations Research Articles

Minimum acceptable diet and associated factors among 6–23 months old children enrolled in outpatient therapeutic program in the Tulla district, Sidama region, Ethiopia: a community-based cross-sectional study

BackgroundImproving the minimum acceptable diet (MAD) is essential for ensuring optimal growth and development of children, as well as preventing malnutrition and its consequences. Previous studies in Ethiopia have focused on the magnitude and determinants of a minimum acceptable diet. However, much emphasis was not given to minimum acceptable diet and its associated factors among 6–23 months old children enrolled in Outpatient therapeutic programs (OTP), particularly, in the study area. This study determines the minimum acceptable diet and associated factors among 6–23-month-old children enrolled in OTP.MethodsA community-based cross-sectional study was conducted among 346 randomly selected mothers with children aged 6–23 months who were admitted to the OTP. The data were collected using interviewer-administered structured questionnaires. The data were entered, cleaned, coded into Epidata version 4.6, and exported to SPSS version 26 for further analysis. Multivariate logistic regression was used to assess the determinants of MAD.ResultsThe overall prevalence of minimum Acceptable diet among children aged 6–23 months enrolled to OTP was 14.5% (95% CI: 12.02-19%). The odds of MAD were 1.9 times higher among children aged 18–23 months compared to children aged 6–11 months (AOR = 1.9, 95% CI ((1.2 3.9). The odds of MAD were 2.9times higher in children whose mothers had a good knowledge on recommended feeding (AOR = 2.9, 95% CI (1.2, 6.35). Mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to their counterpart.(AOR = 1.94, 95% CI = 1.24, 4.19).ConclusionThe practice of a minimum acceptable diet is inadequate. Nutrition education should be emphasized to improve the mothers’ nutrition knowledge regarding infant and young child feeding recommendations, to support mothers in overcoming barriers to feeding their children with adequate diets, and to foster complementary feeding practices for malnourished children.

Counseling parents about child feeding: a qualitative evaluation of French doctors and health/childcare professionals' experiences and perception of a brochure containing new recommendations.

Parents are crucial in establishing their children's eating habits, and doctors and health/childcare professionals (HCCPs) can provide meaningful and trusted guidance on feeding, especially in the 0-3-year-old period. With the upcoming release of the official brochure containing the new child feeding recommendations in France, this study aims to: (1) assess professionals' practices and perceptions regarding their communication with parents on child feeding and (2) evaluate their perception of the draft of the new brochure. A 15-page draft brochure (without pictures) containing updated child feeding recommendations for children 0-3 years old was developed by Santé publique France (the French public health agency). Online semi-structured interviews were conducted with professionals (n = 21), including 13 pediatricians and general practitioners (doctors) and eight healthcare or childcare professionals (HCCPs) two weeks after they were provided with this draft brochure to read. The interview guide was developed and piloted with other professionals (n = 3) prior to these interviews. Interview data were transcribed verbatim and analyzed thematically using an inductive approach. While doctors and HCCPs mostly communicate orally with parents, both acknowledged that the brochure might be a helpful supplement, especially for HCCPs to legitimize their advice to parents. For doctors, giving the brochure to parents may help provide systematic advice and save time during consultations. Professionals serving parents of lower socioeconomic status would prefer a supplement with less text and more illustrations. In general, the messages were perceived to be easily understandable but providing detachable cards to distribute according to the child's age would facilitate information dissemination and might be more useful to parents. Professionals reported that lack of training, the circulation of contradictory information, and language barriers were common challenges. French professionals welcomed the new official brochure as a means to spread updated child feeding recommendations. However, this brochure could be modified and specific tools developed to better adapt to professionals' needs of communication with parents and to facilitate the relay of information. Providing updated and consistent information to parents should be considered a priority for public health stakeholders toward increased adherence to new recommendations.

Patterns in Mothers’ Recollection of Health Care Providers’ Young Child Feeding Recommendations

ObjectiveCharacterize feeding guidance mothers recall receiving from their child's health care provider (HCP). DesignCross-sectional study of mothers participating in the 2017–2019 National Survey of Family Growth. ParticipantsUS mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years). Variables MeasuredWeighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics. AnalysisLogistic regression assessing the relationship between recall of feeding guidance and demographics. ResultsIn this sample, 36.9% of mothers (95% confidence interval, 32.3–41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4–5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined. Conclusion and ImplicationsMothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.

Fruit Juice and Sugar-Sweetened Beverage Related Knowledge and Feeding Practices Among Parents of Infants and Young Toddlers

ObjectivesCurrent infant and young child feeding recommendations include a focus on sugar-containing beverages (SCBs). The American Academy of Pediatrics recommends delaying the introduction of fruit juice (FJ) until after age 12 months and limiting toddler consumption to 4 ounces/day, and the U.S. Dietary Guidelines advise avoiding sugar-sweetened beverages (SSBs) prior to age 2 years. Well-Child Visits (WCV) provide an opportunity to educate parents and promote recommended feeding practices. We aimed to describe the SCB-related knowledge and feeding practices of a sample of parents and the potential for using short videos during WCVs to provide early feeding related education.MethodsA convenience sample of parents attending 4–15 month WCVs at a busy metro area clinic in Georgia completed a self-administered survey to assess their infant/young toddler feeding practices and their knowledge of SCB-related feeding recommendations. A sub-sample also reported on their perceptions of a 3-minute educational video viewed during the visit.ResultsRespondents (n = 105) were primarily women (87%), non-Hispanic/Latino (93%), and Black/African-American (95%). Some parents: 12% and 77% respectively, believed it OK to give infants FJ before 6 months and 12 months of age; 6% reported introducing FJ before 4 months. Among those with children ≥ 12 months (12–18 months; n = 36), 81% reported having given them FJ before 12 months; 25% reported giving them > 4 ounces FJ/day; and 56% had already given their child SSBs. Age of FJ introduction was not modified by presence of older sibling or age of parent. Few (5%) parents were aware of any expert recommendation related to FJ consumption. Most parents who viewed an education video during the WCV (n = 47) reported being able to focus on (74%), enjoy (85%), and learn something (83%) from it; 96% liked the video length, 74% felt watching it was a good use of their time, 45% perceived a change in their thinking after viewing the video.ConclusionsOur findings demonstrate that consumption of FJ among infants and SSBs among young toddlers is common, that parents are unaware of expert recommendations related to FJ consumption, and short videos present an opportunity to support parent education efforts during WCVs.Funding SourcesThe Global Center for Diabetes Translation Research, pilot grant program.

Increasing Parental Knowledge About Child Feeding: Evaluation of the Effect of Public Health Policy Communication Media in France.

BackgroundUnhealthy eating behaviors are risk factors for non-communicable diseases. Parents largely influence the development of eating behaviors during childhood through their feeding practices. Parental feeding practices in line with recommendations are more likely to turn into healthier outcomes in children. From a public health perspective, it should be first ascertained whether providing parents with recommendations about child feeding is a useful approach for increase parental knowledge. Recently, the French health authorities developed a brochure covering updated child feeding recommendations. The present study aims to evaluate the short-term effects of reading this brochure on parental knowledge about child feeding, distinguishing knowledge accuracy and certainty.MethodsA brochure containing updated child feeding recommendations for 0–3 years old was developed by the French public health agency. A representative sample of French parents (n = 400) was targeted to complete an online questionnaire (T0) comprising 30 statements regarding child feeding. For each statement, parents indicated whether it was true/false and how certain they were of their answer (4-point scale). After receiving and reading the brochure, the same parents completed the same questionnaire 3 weeks later (T1). Accuracy (number of correct answers) and certainty (number of mastered answers: correct answers given with the maximal degree of certainty) were compared at T1 vs. T0 using paired t-tests. Knowledge evolution based on parental age, parity and education level was tested with linear models.ResultsA total of 452 parents responded at T0 and T1 and were considered for analysis. Between T0 and T1, the number of correct answers [median 22–25, t(451) = 17.2, p ≤ 0.001] and mastered answers [median 11–17, t(451) = 18.8, p ≤ 0.001] significantly increased. The median of the difference between T1 and T0 was larger for mastered than for correct answers. The observed evolution in knowledge was independent of parental age, parity or education level.ConclusionsA brochure containing child feeding recommendations has the potential to increase the accuracy and, to an even greater degree, the certainty of parental knowledge. This increase was observed even for younger or less educated parents.

Responsive Feeding Recommendations: Harmonizing Integration into Dietary Guidelines for Infants and Young Children.

ABSTRACTResponsive feeding (RF) involves reciprocal nurturing feeding practices between the caregiver and the child that encourage the child to develop preferences for healthy foods and beverages and to eat autonomously. In this commentary, we summarize RF-related findings from a recent US National Academies of Sciences, Engineering, and Medicine (National Academies) consensus study report examining consistency in infant and young child feeding (IYCF) recommendations in guidelines from high-income countries, and we discuss implications for future IYCF guidelines. Although existing guidelines included generally consistent messages about several RF behaviors, such as the importance of encouraging self-feeding and self-regulation in infants and toddlers, they generally did not present the recommendations as part of a cohesive RF interdisciplinary framework. Moving forward, evidence-based RF recommendations should be routinely incorporated and identified in dietary guidance for IYCF based on a consensus definition of RF grounded in sound responsive parenting and feeding frameworks. We recommend replicating the National Academies’ scoping review in low- and middle- income countries and mixed-methods implementation science research to improve our understanding of how best to disseminate and implement RF-related recommendations across settings (e.g., home and early care and education centers), taking the social determinants of health into account.

Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda

BackgroundMothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life.MethodsThis qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4th, 6th, 9th and 12th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically.ResultsCoping strategies included improving mothers’ own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers’ anticipatory behaviors such as preparing child’s food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role.ConclusionIn challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers’ capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.

Mothers\u2019 knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet

BackgroundComplementary feeding is critical for optimal nutrition in infants and young children as it ensures their growth, health and development to attain their full potential. However, evidence shows that children from developing countries do not meet the core indicators for appropriate complementary feeding. We evaluated mothers’ knowledge and attitudes regarding child feeding recommendations and the determinants of adequate diet among children aged 6–23 months.MethodsThis cross-sectional study included 200 children aged 6–23 months and their mothers/care givers recruited during child welfare clinics of two health facilities in Ghana. Data was collected using a structured questionnaire. Multivariate logistic regression was used to assess determinants of adequate diet.ResultsSixty-eight percent of the mothers knew the recommended duration of continued breastfeeding, 56.5% how to ensure dietary diversity and enrich their children’s diets and 94% (n = 188) had positive attitude towards recommended infant and young child feeding practices. Majority of the mothers (92%, n = 183) practiced continued breastfeeding, 10.5% of the children met minimum diet diversity score, 39.5% minimum meal frequency and 8.5% received minimum adequate diet. Determinants of receipt of minimum adequate diet were: having high knowledge in child feeding recommendations (100% vs. 0.0, p < 0.001) and child’s father reportedly earning adequate income to cater for the family (AOR = 12.1 (1.32–109.72, p = 0.027).ConclusionMotherss knowledge levels regarding infant and young child feeding recommendations had notable deficiencies although they generally had a positive attitude towards child feeding recommendations. Knowledge regarding infant and young child feeding recommendations as well as the child’s father having adequate income were important determinants of adequate diet. Nutrition education should emphasize on improving mothers’ nutrition knowledge regarding infant and young child feeding recommendations and supporting mothers to overcome barriers to feed their children with adequate diets.

Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets.

A child's diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In‐depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child's diet. The community regarded carbohydrate‐based meals as food, but considered protein, vitamins and mineral‐based foods as nonessential elements of a child's diet, and important sources of these nutrients were regarded as treats.

Self-monitoring improved child feeding among low educated slum mothers in Bangladesh, a pilot study

Abstract Issue Child undernutrition in urban slums is the most serious but least addressed health problem in many LMICs including Bangladesh. Slum children are deprived of adequate feeding as advocated by WHO. Face-to-face contact to monitor adherence to child feeding recommendations is costly. We aimed to identify if a visual aid for self-monitoring, in the form of a pictorial calendar, could assist illiterate slum mothers to self-regulate their child feeding behaviours and increase adherence to recommended child feeding practices. Description of the practice: A mixed method study was conducted (Randomised Controlled Trial + semi-structured qualitative interviews) over four weeks in a slum area of Dhaka city. Thirty-four mothers to child aged 6-23 months having &amp;lt;5 years of education were recruited. Mothers randomized to intervention arm (n = 17) received an hour of complementary feeding education along with a pictorial calendar and color-coded stickers representing food groups. The control arm received the education session only. The primary outcome was Minimum Dietary Diversity (MDD: ≥4 food groups in past 24 hours); the Generalised Estimation Equations (GEE) with a log link and binomial family was used to test treatment by time interactions. Results The proportion of achieving MDD was more common (RR 1.2, 95%CI 0.8, 1.8) among mothers from intervention arm compared to control mothers. Intervention mothers were more likely to identify the appropriate food groups compared to control mothers. More than 80% of the mothers completed the calendar for all 28 days of study duration. During qualitative interviews, most mothers (4/5) stated that the pictorial calendar acted as a reminder for them. Lessons An encouraging tendency towards better complementary feeding and better knowledge was seen among the intervention mothers compared to controls. Future research with a larger sample is needed to establish the significance of effect size. Key messages Pictorial calendar appeared to help sustain knowledge and improve feeding practices. Self-monitoring using a pictorial calendar could be a good visual aid for low-educated mothers from low socio-economic status.

National Recommendations for Infant and Young Child Feeding in the World Health Organization European Region.

ABSTRACTObjectives:Complementary feeding should provide a healthy diet with critical nutrients for growth and development. Information is limited on child and infant feeding recommendations within the World Health Organization (WHO) European Region.Methods:The WHO Regional Office for Europe and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) performed a survey of national recommendations on infant and young child nutrition aimed at national government departments of health and national paediatric experts. Questions addressed national recommendations on breast-feeding and complementary feeding.Results:Information was available from 48 of the 53 Member States. Forty-five of 48 countries (94%) have national recommendations on infant and young child feeding, of which 41 are endorsed by official public health authorities. Regarding introduction of complementary feeding, 25 countries (out of 34, 74%) recommend 6 months of age as the ideal age. The earliest age of introduction recommended varies from 4 to 5 months in (31/38 countries, 82%) to 6 months (6/38, 16%) and 7 months (1/38, 2.6%). The recommended meal composition varies widely; introduction of iron-rich foods (meat, fish, eggs) at the age of 6 months is recommended in 30 out of 43 countries, whereas 13 (30%) recommend later introduction.Conclusions:National infant feeding recommendations vary widely between studied countries and partly differ from international recommendations. Too early introduction of complementary feeding can reduce duration of exclusive breast-feeding (EBF). Too late introduction of iron-rich complementary foods might increase anemia risk and adversely affect child development. A review and further harmonization of national recommendations appears desirable.

Prevalence of Exclusive Breastfeeding Practice and Its Associated Factors Among Mothers with Children Aged 6 - 12 Months in Hargeisa City, Somaliland

Breastfeeding has many health benefits for both mother and infant. Breast milk contains all the nutrients an infant need in the first 6 months of life. Exclusive breastfeeding is the most widely known and effective intervention for preventing early-childhood deaths. Optimum breastfeeding practices can prevent 1.4 million deaths worldwide among children under five every year. The aim of this study was to assess the prevalence of exclusive breastfeeding and associated factors among mothers who have an infant six months up to one year old in Hargeisa, Somaliland. A community based cross-sectional study was conducted from November to December, 2019. A cluster along with simple random sampling technique was used to select sample population. A total of 357 mothers with children aged six months to one year old were included in this study. Data were collected using questionnaires administered at interview. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with exclusive breastfeeding. The prevalence of exclusive breastfeeding was 68%. Those mothers who were heard information on EBF [AOR=14.243 CI (4.630, 43.816)], attend ANC service [AOR=25.412 (3.506, 184.179)], received breastfeeding counseling during antenatal care (ANC) [AOR=6.037 (2.878, 12.666)], aware that breastfeeding is enough the child up to six months [AOR=3.411 (1.536, 7.577)], and had fed colostrum [AOR=4.663 CI (2.107, 10.321)] were more likely to practice EBF than their counterparts. The proportion of exclusive breastfeeding in the city was below WHO Infant and Young Child Feeding recommendations. The practice of exclusive breastfeeding in mothers of under 6 months children was influenced by receiving information about EBF, colostrum discharging, awareness of breast feeding is enough the child up to six month and antenatal care visit were significantly associated with EBF practice (P < 0.05).

When Does It All Begin: What, When, and How Young Children Are Fed.

The first 2 years of life are a critical period to promote nutrition and dietary behaviors for optimal growth and development. Exclusive breastfeeding is recommended until 6 months with the addition of safe, nutritionally adequate complementary foods thereafter. Caregiver adherence to international guidelines for feeding infants and toddlers varies depending on the setting, access to information, quality of food, and cultural beliefs. Caregiver feeding style also plays an important role in what foods and drinks are offered and whether young children accept those foods. Feeding guidelines often include what is called "responsive feeding," which is the importance of caregiver attention to child cues of hunger and satiety. While there are data on food consumption and dietary diversity in early childhood, the literature on early childhood beverage consumption is limited. With the increased consumption and availability of sugar-sweetened beverages, future research should aim to understand the status of global beverage consumption among children under 2 years old and its impact on growth and development. This chapter highlights current infant and young child feeding recommendations, what young children eat and drink, and the role that parental feeding styles can have on diet and early childhood outcomes.

Trends in Mean Nutrient Intakes of US Infants, Toddlers, and Young Children from 3 Feeding Infants and Toddlers Studies (FITS)

ABSTRACTBackgroundMany updates to young child feeding recommendations have been published over the past decade, but concurrent intake trends have not been assessed.ObjectiveThe aim of this study was to evaluate adequacy and trends in energy and nutrient intakes of US infants and children aged 0–47.9 mo through use of Feeding Infants and Toddlers Study (FITS) data from 2002, 2008, and 2016.MethodsFITS are cross-sectional surveys of parents/caregivers of infants and young children (FITS 2002, n = 2962; FITS 2008, n = 3276; FITS 2016, n = 3235). Dietary intakes were assessed by telephone with trained interviewers using the Nutrition Data System for Research. Mean ± SE nutrient intakes were calculated. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 17 nutrients and the corresponding mean adequacy ratio.ResultsEnergy and macronutrient intakes were generally stable across surveys, but significant decreases for saturated fat and total sugars and an increase in fiber were observed among 6–11.9-mo-olds and 12–23.9-mo-olds (P-trend < 0.0001). Mean sodium intakes exceeded Adequate Intakes (AI) for all ages, whereas fiber intakes were universally below the AI. Nutrients with the lowest NAR values were vitamin D (range 0.41–0.67/1.00) and vitamin E (range 0.60–0.79/1.00 for 2008 and 2016). For iron, infants aged 6–11.9 mo had the lowest NAR values at 0.77–0.88/1.00, compared to 0.85–0.89/1.00 for 12–47.9-mo-olds. Potassium was low from 12 to 47.9 mo (NAR range 0.55–0.63/1.00 across survey years). The nutrients with the greatest decline in mean intakes were iron and vitamins D and E among 6–11.9-mo-olds, and vitamin D and potassium among 12–23.9-mo-olds in 2016 compared to 2002.ConclusionsThe diets of US infants and young children were generally adequate for most micronutrients and stable over time, but sodium intakes were too high, and nutrient gaps still existed, especially for vitamins D, E, and fiber across ages and for iron among infants.

Minimum Acceptable Diet and Factor Associated with It Among Infant and Young Children Age 6-23 Months in North Shoa, Oromia Region, Ethiopia

Appropriate complementary feeding Practice is essential in the first two years of life for satisfactory growth and development of children and for prevention of childhood illness. Insufficient quantities, frequency and inadequate quality of complementary foods have a detrimental effect on health and growth in this critical period. The aim of this study was to assess minimum dietary diversity and meal frequency practice and determinants among infant and young children age between 6 and 23 months in Shoa, Oromia Region, Ethiopia. Institution-based cross-sectional study was carried out to select 200 mothers/caregivers with 6–23 months of children reside in Sheno health center from July 25 to August 25, 2017. An interviewer-administered questionnaire was used to gather information on socio-demographic, child feeding practices and health-related characteristics. Data were entered to Epi-Data version 3.02 and transported to SPSS version 21 for further analysis. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify independent predictors of minimum acceptable diet. The study revealed that the percentage of 6–23 months of children who meet the recommended level of minimum dietary diversity and meal frequency were 45 and 33%, respectively. Proportion of children who received composite indictor minimum acceptable diet was only 13.3%. Mothers/caregivers who had postnatal care visit, having good knowledge about child feeding practice, getting media exposure and mothers who had growth monitoring follow up were positively associated with minimum acceptable diet. Even though the study showed better progress as compared to the national prevalence of complementary feeding practices, child feeding practices in the study area were inadequate and not achieving national and WHO infant and young child feeding recommendations. Strengthening the available strategies and creating new intervention measures to improve maternal and child health services and giving behavioral change communication on child feeding practice using local media are compulsory actions for the government and policymakers.

Remembering food insecurity: Low-income parents’ perspectives on childhood experiences and implications for measurement

The objective of this study was to explore how low-income parents recall and describe childhood experiences with food insecurity. Little is known about how adults remember food insecurity experienced in childhood, yet there are potential implications for subsequent behavior including parents' willingness and ability to adopt recommended child feeding practices. To guide development of a measure of previous childhood food insecurity for research and screening purposes, we conducted interviews exploring parents' emic perspectives on these early life course experiences and reactions to potential survey items. A diverse group of 27 low-income mothers in New York State was interviewed in depth; data were coded and analyzed qualitatively for emergent themes. In recounting childhood memories, participants expressed strong emotions and strove to portray their parents positively, emphasizing that parents did their best to ensure that children “always had something to eat.” Rather than dwell on food insecurity, participants preferred to share memories of family strategies to mitigate food shortages (e.g., asking relatives for money, “stretching” meals). Participants' memories of these strategies to increase food access and acceptability and adequacy of meals were summarized in a framework integrating key themes. The emotional salience of childhood food insecurity memories suggests that these experiences could have significant implications for parental adoption of child feeding recommendations and should be considered when designing nutrition interventions. Measurement challenges identified included adults’ limited recall and awareness of food insecurity during childhood, stigma, and desire to portray parents positively. Qualitative analysis of rich, emic data on food insecurity experiences offered insights on the most relevant constructs to address in survey measures of this potential antecedent of current practices.

Factors associated with mothers\u2019 knowledge on infant and young child feeding recommendation in slum areas of Bahir Dar City, Ethiopia: cross sectional study

BackgroundMalnutrition is a public health concern in Ethiopia. This might be correlated with inappropriate infant and young child feeding practice. This in turn is affected by Mothers’ knowledge on feeding practice. However, information on mothers’ knowledge on infant and young child feeding recommendation was scarce in Ethiopia. Therefore, this study was designed to assess mothers’ knowledge on infant and young child feeding recommendation and associated factors in slum areas of Bahir Dar City, Ethiopia.MethodsA community based cross-sectional study was conducted from May 1–26/2015. Systematic sampling technique was used to select respondents. Data were collected by pretested, structured, interviewer administered questionnaire. Data were entered and analyzed by SPSS version 20 software. Knowledge score was computed. Binary and multivariable logistic regression analysis were used to identify factors associated with maternal knowledge.ResultsOnly 28.7% of mothers had sufficient knowledge on infant and young child feeding recommendation. Factors associated with mothers, knowledge were above primary education [AOR 2.5, 95% CI (1.5, 3.9)], possession of radio [AOR 1.7, 95% CI (1.1, 2.7)], attending antenatal care [AOR 2.4, 95% CI (1.5, 4.0)], and having employed husband [AOR 2.3, 95% CI (1.2, 4.4)].ConclusionMothers’ knowledge on infant and young child feeding recommendation was very low. Hence, education on infant and young child feeding recommendation should be strengthened during antenatal care visit and using mass media especially for mothers with lower educational status to fill up of this gap.

Gaps in international nutrition and child feeding guidelines: a look at the nutrition and young child feeding education of Ghanaian nurses.

To examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana's Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0-5 years. A qualitative study of semi-structured one-on-one and group interviews (n 21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions. KEEA public health clinics (n 12). Nurses (n 41) purposefully recruited from KEEA clinics. A model capturing nurses' nutrition and YCF education emerged with five major themes: (i) adequacy of nurses' basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses' delivery of nutrition and YCF information; (iii) nurses' evaluation of children's health status to measure education effectiveness; (iv) nurses' perceived barriers of caregivers' ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2-5 years. Nurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2-5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines.

Meal frequency and dietary diversity feeding practices among children 6\u201323\xa0months of age in Wolaita Sodo town, Southern Ethiopia

BackgroundChild feeding practices are multidimensional, and they change rapidly within short age intervals. Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of undernutrition in children in the age of 6–23 months. Information on child feeding practices among urban resident is limited in Ethiopia. The aim was to measure minimum meal frequency and dietary diversity and associated factors among children 6–23 months of age in Wolaita Sodo, Ethiopia.MethodsA community-based cross-sectional study was carried out to select 623 mothers/caregivers with 6–23 months of children reside in Wolaita Sodo town using systematic sampling from March 02 to 20, 2015. An interviewer-administered questionnaire was used to gather information on socio-demographic, child feeding practices and health-related characteristics. Data were entered to Epi-Data version 3.02 and transported to SPSS version 21 for further analysis. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify independent predictors of minimum dietary diversity and meal frequency.ResultsThe study revealed that the percentage of 6–23 months of children who meet the recommended level of minimum dietary diversity and meal frequency were 27.3 and 68.9%, respectively. Mothers/caregivers who were housewives and government employees feed their children more diversified foods as compared to mothers who were private workers. As compared to children 17–23 months of age, children in the age group of 6–8 and 9–11 months had better probability to meet minimum dietary diversity. Government-employed and illiterate mothers were less likely to feed their children to fulfil the minimum requirement of meal frequency. Children in the age of 9–11 months were also less likely to be fed frequently.ConclusionsEven though the study showed better progress as compared to the national prevalence of complementary feeding practices, child feeding practices in the study area were inadequate and not achieving WHO infant and young child feeding recommendations. Strengthening the available strategies and creating new intervention measures to improve socioeconomic status, maternal literacy and occupation opportunity for better practices of child feedings are compulsory actions for the government and policymakers.

Providers' Perceptions of Child Feeding and Activity Recommendations Related to Early Childhood Obesity Prevention

Early childhood obesity prevention from birth to 24 months of age (B‐24) is a growing public health concern. However, the child feeding and activity information provided to parents is limited and inconsistent which may contribute to confusion regarding obesity prevention for their children. This is partially due to the lack of uniform dietary guidelines to promote healthy weight in children from B‐24. The objective of this qualitative study was to identify common resources and recommendations used by health and education providers and any misconceptions or barriers faced when educating parents on early childhood feeding and activity practices. One‐on‐one interviews were conducted with health and education providers (n=14) working with families of young children from a variety of demographic and socioeconomic backgrounds. Interviews were audio‐taped, transcribed verbatim, and analyzed using the classic analysis approach. The study results revealed several important themes including how only healthcare providers, but not education providers, working with children B‐24 directly address childhood obesity prevention with parents. Providers reported confusion from parents about when to transition to solid foods and how much or what to feed their child as commonly perceived barriers to optimal child feeding. Parental misconceptions about feeding were often due to cultural, family and media influences, as well as lack of personal knowledge or experience. Screen time and physical activity of children B‐24 were much less of a concern to providers. Sources of child feeding information used by providers to educate parents were derived mainly from online sites and often from non‐evidence based sources. Providers indicated a need for consistent feeding and childhood obesity prevention messaging and free, non‐commercial sources of online information to provide to parents.Support or Funding InformationThe Child Health and Development Institute of Connecticut, Inc.