JMIR Publications

ABSTRACT

Background:

Responsive feeding is an integral component of nurturing care under the umbrella of early childhood development, and has been recommended in infant and young child feeding practices globally. The feeding practices can be evaluated by survey and observation methods.

Objective:

This study used these two methods in combination, to gain a comprehensive understanding of caregivers’ responsive and non-responsive feeding practices among children aged 6-35 months in China. Factors influencing responsive/non-responsive feeding were further explored.

Methods:

This study was conducted in Hebei Province from August to October 2020, with the use of convenience sampling to recruit participants. A cross-sectional survey was conducted among 409 caregivers, to measure their responsive/non-responsive feeding using a pre-validated questionnaire (5-point Likert scale). The overall score and seven individual dimension scores were calculated. Multiple linear regression was performed to explore demographic factors associated with responsive/non-responsive feeding practices. Video observation was conducted among 42 caregiver-child pairs, to record the dinning episodes of main meals (2-3 times a day) at participants’ home. Videos taken were coded, and the practices of responsive/non-responsive feeding were extracted. The occurrence and number of times observed of each feeding practice were calculated. Results from two methods were complementary and confirmatory to each other.

Results:

In the survey, the overall score of responsive feeding was 3.52 (median). For responsive feeding practices, the medians for responsiveness to cues, modeling, and active communication and interaction were 4.00, 3.67 and 3.88, respectively. For non-responsive feeding practices, the medians for controlling, pressure to eat, food reward, and emotional feeding were 3.33, 2.33, 3.00, and 2.67, respectively. Video observation revealed that the occurrence of responsive feeding (75.6%-97.6%) were higher than that of non-responsive feeding (0.0%-46.3%), and the score of creating a good meal environment was high (median score of 4). There was no significant difference in the occurrence/score of each practice across breakfast, lunch and dinner. Multiple liner regression analysis of the survey data demonstrated that non-parents (β=0.13, 95%CI: 0.05, 0.21) and caregivers whose families had a monthly income of >5000 RMB (β=0.07, 95%CI: 0.01, 0.14) had a higher score for overall responsive feeding, while unemployed caregivers (β=-0.07, 95% CI: -0.13, -0.01) had a lower score, in comparison to their counterparts.

Conclusions:

The combined approach indicates that caregivers are more likely to use responsive feeding than non-responsive feeing practices. Interventions and education to promote responsive feeding might target caregivers who are parents, unemployed and had a relatively low household income. This study might serve as a reference in the comprehensive assessment of responsive feeding practices. Clinical Trial: This study is an observational study and does not fall within the scope of clinical trials that require mandatory registration, so no trial registration was conducted