“The battle of feeding”: Awareness and practices of responsive complementary feeding in Anuradhapura, Sri Lanka - a qualitative study

Abstract

Background: Responsive feeding (RF) is an evidence-based behaviour in complementary feeding. Although included in the infant feeding guidelines of Sri Lanka, it is doubtful whether knowledge and practices entailed to RF is established in the Sri Lankan community. Objectives: To explore the knowledge and practices of RF among mothers having nine month old infants and to explore attitudes of public health midwives (PHMs) towards the concept. Method: A qualitative study was conducted using in-depth interviews in caregivers of 9 month old infants and focused group discussions in PHMs of Nuwaragam Palatha Central area in Anuradhapura district. Interviews were tape recorded, transcribed and thematic analysis performed. Results: None of the mothers effectively practised the full concept of RF. Only a few mothers have prepared a separate feeding place. Although signals of hunger and satiety were identified, most mothers did not use them in an appropriate manner in feeding. Letting the child watch television and taking the child round the garden were common suboptimal practices. Mothers stated the difficulty in introducing new food to their children indicating lack of reciprocity between them and children. The public health midwives also had poor understanding on total concept of RF. Conclusions: PHMs and mothers having nine month old infants have poor understanding and practices on the concept of RF.

A comparison of observed feeding practices of infants and young children aged 6–23 months to national responsive feeding recommendations in Sri Lanka

“…Our findings of forceful feeding practices align with those of similar research in Sri Lanka (Agampodi, 2014 ; Dharmasoma et al, 2020 ; Pallewaththa et al, 2019 ). Caregivers in similar South Asian contexts such as Bangladesh have also used force‐feeding to encourage eating, as food refusals are often perceived by caregivers to be associated with undernutrition (Affleck & Pelto, 2012 ; Naila et al, 2018 ).…”

“…To that effect, the Sri Lanka national responsive feeding recommendations indicate that caregivers should feed their children responsively, with specific feeding guidance promoted at national and subnational levels of the health system (Ministry of Healthcare & Nutrition, 2007). To date, the research to understand infant and young child feeding in Sri Lanka has primarily relied on caregiver selfreporting (Dharmasoma et al, 2020;Pallewaththa et al, 2019Pallewaththa et al, , 2021.…”

“…To that effect, the Sri Lanka national responsive feeding recommendations indicate that caregivers should feed their children responsively, with specific feeding guidance promoted at national and subnational levels of the health system (Ministry of Healthcare & Nutrition, 2007 ). To date, the research to understand infant and young child feeding in Sri Lanka has primarily relied on caregiver self‐reporting (Dharmasoma et al, 2020 ; Pallewaththa et al, 2019 , 2021 ). While these studies revealed forceful and indulgent feeding styles among caregivers in Sri Lanka, there has been limited data derived from direct meal observations focused on child feeding to inform related policies and guidelines.…”

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial

“…Similar findings were obtained in a cross-sectional study in Southern Ethiopia (Wondafrash et al, 2012). Our results, however, differ from others such as Kinabo et al (2017), which showed that caregivers in Unguja Islands, Tanzania, rarely practised responsive feeding, and Dharmasoma et al (2020), where none of the caregivers in Sri Lanka practised responsive feeding fully. Other studies suggest that the responsive feeding style may contribute to the healthy growth, development and well-being of children (Black & Aboud, 2011;Daniels, 2019).…”

Complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia: A community-based cross-sectional study

“…Our study indicates that the separate feeding bowl for the child is related to best practice for optimal complementary feeding. Similarly, the study result from Sri Lanka demonstrated that mothers who have separate feeding plates for their children have better complementary feeding practices (Dharmasoma et al, 2020). The safe preparation and storage of complementary foods can prevent contamination and reduce the risk of diarrheal diseases, which has a major impact on children's diet and health (WHO, 2009).…”