Background
Child undernutrition remains a public health concern in low- and middle-
income countries. It has long been documented that one of the major
causes of child undernutrition relates to inadequate infant and young
child feeding practices [1]. Yet, optimal feeding practices not only
depend on what and when to feed the child (the quality, the quantity and
the frequency) but also on how the child is fed, the quality of
interaction between the mother and the child during feeding [2].
Undernutrition may be due as much to difficulties in the interactions
between mothers and children as to a lack of high-quality foods [3].
The interactions between mother and child that lead to a positive
feeding experience, adequate dietary intake and enhanced developmental
opportunities are referred to “responsive feeding” [4].Preferably,
children should be fed responsively [5]. Components of the
responsive feeding practices as recommended by the Word Health
organization (WHO) include: 1) feeding infants directly and assist older
children when they feed themselves, being sensitive to their hunger and
satiety cues; 2) feeding slowly and patiently and encouraging children
to eat, but not forcing them to eat; 3) Trying other encouragement
strategies when children refuse food, experimenting with different food
combinations, tastes, textures, and methods of encouragement; 4)
minimizing distractions during meals; and 5) remember that feeding times
are periods of learning, love and talking to children during feeding,
with eye-to-eye contact [5].
Responsive feeding practices are known to promote children’s physical,
mental and social development [6]. Previous studies in low- and
middle-income countries show that responsive feeding practices during
the complementary feeding period are linked to increased child
acceptance of food [3, 7, 8]and adequate dietary intake and good
nutrition status [9, 10]. However, most of these studies are carried
out in Asian countries and very little research is available that
document responsive feeding practices in the African context.
Rwanda has made progress in decreasing the prevalence of acute
malnutrition. However, the rate of chronic malnutrition (stunting)
remains high (33%) particularly in rural areas [11]. Stunting
reaches the highest point during the complementary feeding period.
Adequate complementary feeding practices remain limited in Rwanda, as
only 19% of children between 6-23 months of age meet the minimum
acceptable diet in 2019 [11]. Efforts to improve complementary
feeding have often focused on nutritional physiological aspects such as
timing, composition, and frequency of feeding [12].Very little
research is available that documents mother-child interactions during
feeding (responsive feeding practices) of Rwandan mothers. Knowledge on
current responsive feeding practices may inform policies and programs
that aim to improve complementary feeding practices beyond nutritional
aspects. The aim of the present study was to investigate mothers’
responsive feeding practices, alongside exploring the common barriers
that made it difficult to implement the recommended practices.