Peer-reviewed article
Caregiver Feeding Behaviours and Child Dietary Diversity and Growth in Rural Bangladesh.
Zaynah T Chowdhury, Kristen M Hurley, Saijuddin Shaikh, Sucheta Mehra, Hasmot Ali et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study of 4,733 children in rural Bangladesh examined how caregivers' feeding behaviours relate to what children eat and how well they grow by age 2. Children whose caregivers used responsive and involved feeding approaches ate more diverse foods and were more likely to meet minimum dietary diversity standards. In contrast, children whose caregivers used forceful feeding tactics ate less diverse diets and had higher rates of being underweight and wasted. The findings suggest that how caregivers feed children matters for their nutrition, though the study could not prove causality.
Key points
- Responsive/involved feeding behaviours were reported by 71% of mothers and were associated with a higher dietary diversity score and 17% higher odds of meeting minimum dietary diversity (MDD)
- Forceful feeding behaviours were reported by 34% of mothers and were associated with lower dietary diversity, 18% lower odds of achieving MDD, 38% higher odds of underweight, and 55% higher odds of wasting
- At 24 months, 55% of children met minimum dietary diversity (eating 4+ food groups), while 40% were stunted, 19% were wasted, and 42% were underweight
- The mean dietary diversity score across the sample was 3.7 out of a possible 7 food groups
- Responsive feeding was associated with dietary diversity but not directly with anthropometric outcomes, while forceful feeding was associated with both lower dietary diversity and undernutrition
Limitations
This is a cross-sectional observational study, so it cannot establish whether feeding behaviours cause differences in dietary diversity and growth, or whether children's characteristics influence caregiver behaviours. The study was also part of an intervention trial, so results may not generalise to other settings.
Abstract
This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to reflect low and high use. Stunting (length-for-age Z-score < -2), wasting (weight-for-length Z-score < -2) and underweight (weight-for-age Z-score < -2) were defined using international growth reference standards. Associations between feeding behaviours, dietary diversity score (DDS, food groups consumed; range 0-7) and anthropometric indicators were examined using multivariable linear or logistic regression models, adjusting for study design, confounders and intervention arm. Mean (SD) age of children in the study was 24.1 (0.3) months. Mean (SD) DDS was 3.7 (1.4), with 55% of children meeting minimum dietary diversity (MDD, DDS ≥ 4). Stunting, wasting and underweight were 40%, 19% and 42%, respectively. Use of high responsive/involved feeding behaviours (reported in 71% of mothers) was associated with higher DDS (0.09, 95% confidence interval [CI]: 0.001, 0.17) and higher odds of achieving MDD (OR: 1.17; 95% CI: 1.02, 1.33) but not with anthropometric outcomes. Use of high forceful feeding behaviours (reported in 34% of mothers) was associated with lower DDS (-0.12, 95% CI: -0.21 to 0.04), lower odds of achieving MDD (OR: 0.82, 95% CI: 0.72, 0.93), and higher odds of underweight (OR: 1.38, 95% CI: 1.22, 1.56) and wasting (OR: 1.55, 95% CI: 1.33, 1.81). In Bangladesh, responsive/involved feeding was associated with higher child dietary diversity whereas forceful feeding was associated with lower dietary diversity and undernutrition. Future research is needed to understand causality and test the effect of responsive feeding interventions on the promotion of child growth.