Development of Responsive Feeding Indicators for Young Children Maureen Black, Ph.D. University of Maryland School of Medicine mblack@peds.umaryland.edu http://www.medschool.umaryland.edu/growth
What is Responsive Feeding? Recognition of infant cues Developmentally ll appropriate response to infant cues
What is non-responsive feeding? Excessive maternal control Forceful Restrictive Lack of maternal control Indulgence Uninvolved, neglectful
FEEDING INTERACTIONS: BALANCE BETWEEN MOTHER AND CHILD Responsive Mother Child Controlling Mother Child Indulgent Uninvolved Mother Child Mother Child
Utility of Indicators: Measure What We Treasure/ Treasure What We Measure Compare across countries/regions Focus resources Track progress Ensure the health h and well-being of children hld
Criteria for Indicators Scientifically valid (predictive) Reliable Understood by policymakers Measure easily, low cost, quickly Applicable across contexts/culturally sensitive Developmentally sensitive Consider positive/negative indicators
Developmental-Ecological Theory Influence of context, parents, child Characteristics of Parent Meal Context Interaction Betweeneen Parent-Child Child WllBi Well-Being Characteristics of Child Healthy growth & development
Responsive Feeding: Includes context and interaction Food Position Distractions Child/Caregiver Interaction Routine Others eating Expectations Opportunities to self-feed Developmental-Ecological Theory
Characteristics of Infant Health and Nutrition Infant Temperament Fussy/Sick Happy/Healthy Timid/Weakid/W
Characteristics of Caregiver Mental Health Positive Mood Depressed Mood
Responsive Feeding How does responsive feeding work? Caregiving Environment Mother offers a bite of food Mother offers another bite Mother waits, smiles, finger food Child Child opens mouth and accepts Child looks away, mouth shut Child picks up food and eats...time...
Responsive Feeding How does responsive feeding work? Caregiving Environment Mother offers a bite of food Mother offers another bite Mother holds child s mouth & forces Child Child opens mouth and accepts Child looks away, mouth shut Child cries and spits out food...time...
Consequence of non-responsive feeding Poor growth (stunting) Negative mother-child interactions Threat to health and development
Excessive Control Reduced preference for food that is being forced Pressure to eat at age 5 associated with lower BMI at age 7 (Farrow & Blisset, 2006) Increased desire for food that is being restricted (Fisher, 2002) Restrictive feeding at age 5 associated with greater BMI at age 7 (Faith, 2004)
Why parents use excessive control Concern that child is too thin or too heavy Concern that child does not eat enough or eats too much Perception that child requires parent control Difficult temperament Child sick Child unable to self-feed
Why parents use excessive control Concern regarding food availability, waste, spillage, time Use authoritarian style overall Maternal mental health (anxiety, stress, depression) Demographics (young, multiple children, low g p (y g, p, SES)
Strategies To Promote Responsive Feeding Context (Setting/Food) Mother Child
PREPARE P R Pleasant Routine and Rules E Expectations - clear P A Position Comfort, use of hands Ability to see and model R Responsive E Eliminate distractions (TV)
FAVORITE F Family eats together A Avoid sweetened/salty snacks V Variety O Optimal portions R Rich in nutrients t I Involve child T Tasty E Energy balance
Mother Attention to child Interpret child s cues Respond to child guided by Developmental Appropriateness Balanced Control Positive Affect
Child Hungry Ready to eat Clarity of cues
Potential Indicators of Responsive Feeding Multiple Step Child Growth within normal limits Acquisition i i of independent d feeding skills Parent Recognition of hunger/satiety Satisfaction with child s feeding skills
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