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.