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Community and International Nutrition

A Responsive Feeding Intervention Increases Children's Self-Feeding and Maternal Responsiveness but Not Weight Gain^1,2

³ Department of Psychology, McGill University, Montreal H3A 1B1, Canada; ⁴ International Centre for Diarrhoeal Diseases Research, Dhaka 1212, Bangladesh; and ⁵ Plan International, Dhaka 1212, Bangladesh

Responsive complementary feeding, whereby the mother feeds her child in response to child cues and psychomotor abilities, is low in some countries and likely contributes to malnutrition. Interventions are needed to evaluate whether promoting responsive feeding would add any benefit. Using a cluster-randomized field trial, we evaluated a 6-session educational program that emphasized the practice of child self-feeding and maternal responsiveness. A total of 108 mothers and their 8- to 20-mo-old children in 19 clusters were randomly assigned to the intervention group and 95 in 18 clusters were assigned to the informational control group. Outcomes were assessed at pretest, postintervention, and follow-up. Research assistants, who were unaware of group assignment, observed and coded mother and child midday meal behaviors. At follow-up, the percent of self-fed mouthfuls was 47.8 ± 42.4 (mean ± SD) in the responsive feeding group children compared with 32.2 ± 41.0 in the controls (P = 0.01); likewise, the number of responsive verbalizations was 6.55 ± 5.9 in the responsive feeding mothers and 4.62 ± 4.5 in controls (P = 0.01). Intervention mothers recalled more messages. Mouthfuls of food eaten by children and weight were equivalent in the 2 groups. Lack of change in foods eaten and small quantities may explain the similarly low levels of weight gain. These results provide evidence that self-feeding and maternal verbal responsiveness, two developmentally important behaviors, can be increased by targeting specific behaviors with appropriate behavior change strategies of modeling and coached practice. Weight gain may require more nutritional input, especially in areas of high food insecurity.

^* To whom correspondence should be addressed. E-mail: frances.aboud{at}mcgill.ca.

Manuscript received 22 January 2009. Initial review completed 16 March 2009. Revision accepted 16 June 2009.

Published online 8 July 2009.