What is the role of responsive feeding in child undernutrition?

March 2011

Responsive feeding (RF), or the interaction between caregiver and child during feeding, has become an important issue for scientific inquiry—and a component of nutrition programming—in response to studies showing an association between caregiver feeding behaviors and child acceptance of food. To assess evidence concerning the role of feeding behaviors and style, a paper published in the Journal of Nutrition in March 2011 reviewed 21 observational and intervention studies addressing the relationship between RF and child eating behaviors, dietary intake, and growth outcomes. Each of the handful of intervention studies that assessed the relationship between RF and dietary intake showed associations, as did the eight (six observation, two intervention) studies assessing RF and eating behaviors. A preponderance of studies (four of six observational studies; six of seven intervention studies) also showed a positive association between RF and child growth outcomes. Despite these findings, the authors found that lack of uniformity in definitions of RF, and the methods for measuring and coding it, complicates interpretation of results and limits the potential for comparisons across studies. Moreover, in intervention studies, the embedding of RF into broader approaches to address child feeding in many cases prevents isolation of the effect of RF.

Based on their review, the authors emphasize the need for a standard definition of RF to allow comparability among studies, and they call for longitudinal studies to account for caregiver modifications of feeding behaviors in response to changing child characteristics (e.g., temperament or weight status). Also needed, according to the authors, are studies highlighting the role of factors that influence caregivers’ ability to practice optimal feeding behaviors, such as maternal nutritional status and time allocation. They conclude that much additional research still is needed to establish an in-depth understanding of how, when, and why caregivers feed as they do.

Responsive Feeding and Child Undernutrition in Low- and Middle-Income Countries