212 Black^leading to the possibility of hunger and associat-
ed irritability [9]. When asked about allowing
children to determine how much they wanted to
eat and responding to food refusal by terminat-
ing the meal, many caregivers expressed grave
concerns about the child’s ability to determine
satiety and the health consequences that could
result in ‘sickness or death’ without adequate
food. Caregivers often reported that they had no
choice other than to force-feed their children.
These findings emphasize the central role that
maternal beliefs, the social conditions, and local
customs play in feeding behavior.
Conclusions- Childhood feeding problems are common
among infants and young children throughout
the world. They can increase family stress and
lead to long-term negative nutritional and be-
havioral problems - Strategies to promote healthy feeding behav-
iors and avoid childhood feeding problems ex-
tend from cultural recognition and support of
infant developmental needs and young child
feeding skills (including self-feeding) to care-
giver practices such as ensuring that children
Ta b l e 1. Strategies to promote healthy child feeding and avoid feeding problems- Cultural beliefs: recognition that children’s feeding skills increase over the first
2 years of life and that self-feeding (with fingers) can start during the first year - Family support and labor-saving strategies to help caregivers devote the time necessary
for responsive feeding and to promote self-feeding [9] - Access: families need access to a variety of healthy food [9]
- Hygiene: promotion of hygienic practices such as hand washing by making soap and
water accessible [2] - Positioning: children who are seated in a comfortable position where they can reach the
food are more likely to eat during the meal - Modeling: children learn by imitation and are more likely to exhibit healthy
feeding behaviors when they observe others eating - Exposure: children may require multiple exposures to a new food (10 – 20) prior to tasting
[21] - Self-feeding: children strive for independence and will retain their focus in eating when
they can self-feed, first using fingers, then using utensils; provide food that children can
self-feed - Recognition of satiety signals: when parents pressure children to eat after they have
signaled that they have reached satiety, the meal should end - Freedom from distractions: distractions such as television may interfere with self-
regulation of hunger and satiety, leading to refusal to eat or overeating - Routine, habits, and mealtime rules: establishing feeding habits related to healthy food
can improve children’s food intake [22] - Food as nutrition, not as a reward: using food as a reward overvalues the ‘reward’ and
increases the likelihood of overeating [13] - Ensure hunger at meals: meal consumption is increased when children are
hungry and not filling up on snacks and sugary beverages - Covert restriction of high-fat, high-sugar foods: covert restriction means limiting access for
all family members rather than only for the child and does not result in the restricted food
becoming overvalued [23] - Pleasant and stress-free interactions: children are more likely to eat and enjoy the meal
when interactions are pleasant than when they are characterized by conflict or arguments
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