Childhood Feeding Problems 211
3
cation of whether each behavior presents a
problem. The BPFAS has been validated among
typically developing children and used in non-
clinical samples to identify children with feed-
ing problems [16].
Feeding recommendations often focus on
what and when to feed, beginning with breast-
feeding promotion and the timing of comple-
mentary feeding. Traditionally, there has been
limited attention to feeding behavior. A recent re-
view of feeding guidelines found substantial vari-
ability in recommendations with little attention
to how to handle food refusal [17]. Although the
UNICEF and WHO have guidelines that include
responsive feeding, there are few actual recom-
mendations on how to prevent or handle com-
mon feeding problems, such as food refusal, and
limited attention to developmental changes in
children’s feeding behavior, such as self-feeding.
Education on strategies to promote healthy
child feeding behavior is often provided through
information sharing modalities such as leaf lets.
However, ev idence has show n t hat to be ef fective,
education should be provided before feeding
problems occur, should include caregiver social
support, and should provide opportunities to
simulate the recommended practices [18]. Two
recent interventions in Australia were effective in
promoting caregiver-child feeding interactions.
An 8-session, group-based behavioral interven-
tion was effective in reducing feeding problems
among typically developing children, as mea-
sured by parent report and direct observation
[19]. A second intervention to promote respon-
sive feeding among caregivers of infants as a
strategy to prevent childhood obesity found in-
creases in caregiver-reported responsive feeding
and decreases in controlling feeding practices,
with no differences in children’s growth or the
prevalence of overweight/obesity [20].
Interventions have also been conducted in
low-income countries. An intervention in Ban-
gladesh that demonstrated and coached caregiv-
ers to adopt responsive feeding behaviors was
successful in increasing child hand washing, self-
feeding, and maternal verbal responsiveness but
did not change weight gain over the study period
[2]. Hand washing is a particularly relevant inter-
vention because it promotes good hygiene and
prepares the child for self-feeding. An analysis of
maternal responses from the intervention identi-
fied four barriers that interfered with the adop-
tion of self-feeding in this resource-poor setting:
(1) the time required to allow the child to self-
feed, (2) the potential mess as the child spilled the
food, (3) food waste that occurred when the child
played with the food or dropped it, and (4) a per-
ception that the child was unable to self-feed,Fig. 1. Photo of responsive feeding (P.
Caceres, Chile, ‘Mutual Understand-
ing’; http://www.paho.org/hq/index.
php?option=com_content&view=
article&id=8371&Itemid=39899&lang
=en).
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 209–213
DOI: 10.1159/000367875