Discussion
This is unfortu-
nate as feeding styles are dynamic and evolve quickly with the age of
the child.
This study aimed to investigate mothers’ feeding practices including
mother-child interactions during feeding and the common factors that
made it difficult to implement the practices. The findings from the
interviews and meal observations at 6, 9 and 12 months indicated that
the complementary foods offered to children were mainly carbohydrates
and leafy vegetables based while the consumption of animal-source foods
was limited. . Similar findings were reported in other studies in
Sub-Saharan African countries [19, 20]. Animal source foods
including eggs, dairy, meats are an important source of proteins and
micronutrients and have been linked to improved nutritional status
including reduced stunting [21]. Future research should consider
understanding the cultural or economic factors that may prevent the use
of animal- source foods.
Our findings revealed that most mothers reported to verbally encourage
the children to eat during feeding. However, this finding was not
supported by our feeding observations as most of the mothers at all
three points (at 6, 9, and 12 months) were observed offering food to
their children without any verbal encouragement. This discrepancy can be
attributed to the fact that mothers are aware of the positive effects of
verbal encouragement, yet they can’t manage to bring it into practice.
This was most noticeable at 6 months, increasing up to almost a half at
9 and 12 months. This latter finding is consistent with the findings of
another meal observation study in Kenya, which indicated that mothers
were usually passive during meals[22]. However, positive
verbalization during feeding is known to be important for greater food
acceptance, higher number of mouthfuls eaten and good nutritional status
in infant and young children [7, 23, 24].Furthermore, positive
mother verbalization during feeding provides a great opportunity to
stimulate the child’s social and mental development, to promote
psychosocial stimulation, and to promote language and cognitive
development in infants [23].Therefore, the findings emphasize the
need for practice change interventions encouraging mothers to combine
feeding and stimulation activities for both better child nutrition and
developmental outcomes. Besides the satisfaction of basic needs for
children’s physical growth during feeding, this is a moment also for
learning and love when it is important to talk and maintain visual
contact with the child. Mother-child interaction during feeding has been
linked to the development of children’s eating patterns and
socialization [25].Social interactions between mother and child such
as speaking to the child, singing, and encouraging him/her also
stimulate connections in the child’s brain and promote cognitive
development [26].Therefore, nutrition interventions should support
mothers in developing skills in specific forms of interaction during
meal time that promote full cognitive, physical and social emotional
development in children.
The findings also indicate that some mothers used negative strategies
such as threatening verbalization during feeding, suggesting that
mothers lacked problem solving strategies to keep on when feeding become
challenging. Similar results have been described in several other
different contexts such as in Kenya [22] and Ghana [27].The use
of such negative strategies is an indication of non- responsive feeding
which results in frequent food refusals by the child [28]. The use
of negative strategies has potential to negatively impact child growth,
particularly in communities where growth faltering is a major child
nutrition problem.
Despite children’s psychomotor ability to feed themselves from the age
of 9 months[6], mealtime observations found that most mothers did
not provide their children the opportunities to self-feed at 9 month
observation. Such non-responsive feeding practices, characterized by the
lack of adaptation to psychomotor abilities for self-feeding can affect
child feeding skills and healthy appetite in the long term[29]. A
possible reason for not allowing their children to self-feed may be that
at that age children need a long time to self-feed while mothers have
competing demands on time due to other responsibilities [30].
Another possible explanation may be avoidance of food wastage, that is
more likely to happen when the infant fed her/himself [31].
The findings of this study also indicate that mothers’ feeding practices
varied with child’ age (age-dependent), from 6 months to 12 months.
Overtime, for instance, there was an increase(continuity)in mothers’
actions that include verbal encouragement, encouragement of self-feeding
and social interactions such as talking to children from 6 months to 12
months. This reflects that maternal feeding practices during infancy
develop over time with respect to child’s developmental stages.
In this study, the experiences of mothers emphasized the common
challenges that made it difficult to implement the responsive practices
for mother-child interaction during feeding. Some mothers considered
lack of time due to the burden of other responsibilities as a barrier to
encourage children to eat more during feeding and as a barrier to
providing psychosocial stimulation. Many mothers reported to spend most
of their time managing the responsibilities of daily living and to have
limited time to mother-child conversation. This finding is similar to
what has been reported by other studies conducted in other countries in
Sub-Saharan Africa [32, 33] and other developing countries such as
Bangladesh [31]. The findings point out the need for interventions
to encourage mothers to reallocate time to childcare or to integrate the
stimulation activities into their daily routines, as even a busy mother
can be given the motivation and confidence to talk with a child during
feeding [34].Additional possible solution is to engage other family
members, males included, into childcare practices to address the barrier
of burden of other responsibilities. This possible solution may also
help to enhance child’s bonding with the father.
Poverty was considered by participants as another challenge for
responsive mother-child interaction during feeding. Mothers stated that
poverty affects their responsive feeding practices because most of the
time, mothers spend time in farming or securing their family finances to
buy foods and hence, have limited time to dedicate to interacting with
children. This is in line with a study by Affleck et al. [31]which
found that household constraints such poverty contributed to mothers
‘practice of force feeding the child when he/she refuses to eat what is
available due to the inability to offer different food items. There is a
need to support mothers in securing their income and access to food so
that they can follow the responsive feeding recommendations.