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Session: Innovative Approaches to Global Nutrition Research (Oral 1)

(OR01-03-23) Rethinking Responsive Feeding: Insights From Bangladesh

Saturday, July 22, 2023
10:12 AM – 10:24 AM ET
Location:  Constitution B

    Presenting Author(s)

  • Maureen M. Black, PhD (she/her/hers)

    Professor and Distinguished Fellow
    University of Maryland and RTI International
    Baltimore, Maryland, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • FT

    Fahmida Tofail, MD, PhD

    International Centre for Diarrhoeal Disease Research, Bangladesh, icddrb
    Dhaka, Dhaka, Bangladesh

  • EH

    Eric A. Hodges, PhD

    University of North Carolina at Chapel Hill

  • CB

    Carla M. Bann, PhD

    RTI International
    Durham, North Carolina, United States

  • JH

    Jena D. Hamadani, MD, PhD

    International Centre for Diarrhoeal Disease Research, Bangladesh, icddrb
    Dhaka, Dhaka, Bangladesh

  • SA

    Shirina Aktar, MA

    International Centre for Diarrhoeal Disease Research, Bangladesh, icddrb

  • CL

    Chessa K. Lutter, PhD

    Senior Director, Food Security & Agriculture
    RTI International
    Washington, District of Columbia, United States

Disclosure(s):
Maureen M. Black, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Young children’s growth is influenced by food and feeding behavior. Responsive feeding can promote healthy growth, development, and self-regulation. However, most responsive feeding measures do not incorporate bidirectional mother-infant responsivity and are not validated against observations. The objective was to validate a responsive feeding measure in Bangladesh.

Methods: We enrolled 67 6-18- month infant-mother dyads from an urban community and video-recorded them during feeding. Mothers reported on the child’s dietary intake and responded to a 38-item responsive feeding questionnaire developed through a 2-phase Delphi procedure. Children were weighed and measured. Two trained Bangladeshi research assistants coded the recordings using the Responsiveness to Child Feeding Cues Scale, a validated observational tool that measures maternal-child responsivity. We calculated sensitivity, specificity, positive predictive value, and negative predictive value to identify mother-child dyads with distal vs. proximal responsivity using coded recordings.

Results: Mothers’ mean age was 24.9 years, 49% < 5 years schooling, 37% food secure. Children’s mean age was 12.8 months, 39% females, 6% underweight, 15% stunted. Based on recordings, mother-child dyads were categorized into proximal (43%) and distal (57%) responsivity groups. Using stepwise logistic regression, a 9-item model from the responsive feeding questionnaire had excellent fit (AUC=0.93), sensitivity (90%), specificity (89%), positive predictive value (87%), and negative predictive value (93%). Proximal responsivity was characterized by concerns about children’s dietary intake. Distal responsivity was characterized by perceptions of children’s happy mood during feeding.

Conclusions: Findings support responsive feeding as modulating between proximal and distal responsivity, promoting autonomy and enabling children to acquire and practice healthy eating behaviors. Further research is needed to evaluate findings in other settings.

Funding Sources: RTI International