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To describe the extent to which Sri Lankan caregivers follow current national responsive feeding recommendations and the factors limiting and enabling those behaviours. Study design. This ethnographic substudy was conducted using a four‐phase, mixed methods formative research design across rural, estate and urban sectors of Sri Lanka. Data collection methods. Data were collected using direct meal observations and semistructured interviews. Participants including infants and young children aged 6–23 months (n = 72), community leaders (n = 10), caregivers (n = 58) and community members (n = 37) were purposefully sampled to participate in this study. Data analysis. Observational data were summarized using descriptive statistics while textual data were analysed thematically using Dedoose. Findings were then interpreted vis‐à‐vis six national responsive feeding recommendations. During observed feeding episodes, caregivers were responsive to nearly all food requests (87.2% [34/39]) made by infants and young children. Many caregivers (61.1% [44/72]) also positively encouraged their infant and young child during feeding. Despite some responsive feeding practices being observed, 36.1% (22/61) of caregivers across sectors used forceful feeding practices if their infant or young child refused to eat. Interviews data indicated that force‐feeding practices were used because caregivers wanted their infants and young children to maintain adequate weight gain for fear of reprimand from Public Health Midwives. Despite overall high caregiver knowledge of national responsive feeding recommendations in Sri Lanka, direct observations revealed suboptimal responsive feeding practices, suggesting that other factors in the knowledge‐behaviour gap may need to be addressed.

Objectives To describe typical care practices employed by urban, estate, and rural caregivers during infant and young child feeding episodes in Sri Lanka. Methods Study design. This ethnographic sub-study was conducted using a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods. Data were collected between Sept. 2020 – Sept. 2021 using direct meal observations (4–8 hours each) and semi-structured interviews. Infants and young children aged 6–23 months (n = 72), as well as community leaders (n = 10), caregivers (n = 58) and influencers (n = 37) were purposively sampled to participate in meal observations and interviews, respectively. Data analysis. Observational data were summarized using simple descriptive statistics while textual data were analyzed thematically using Dedoose. Results During 4–8 hour long observations, most caregivers (80.6%, 58/72) gave infants and young children their full attention during feeding. Approximately two thirds of observed caregivers (61.1%, 44/72) used positive encouragement during feeding, while a quarter (26.4%, 19/72) used negative communication approaches (e.g., threatening to give a child medicine if their food is not eaten) during feeding. The majority (81.9%, 59/72) used distractions to encourage eating while 20.8% (15/72) of observed caregivers used forceful feeding practices because they wanted their children to “maintain adequate weight,” and “adhere to a meal schedule". Conclusions Despite caregiver knowledge of Ministry of Health recommendations, observations revealed a proportion of caregivers engaging in sub-optimal care and feeding practices with possible implications for population-level health and nutrition. Funding Sources UNICEF Sri Lanka.