What Can Meal Observations Tell Us about Eating Behavior in Malnourished Children?

Responsive feeding is an important aspect of child care, yet little is known about child eating and caregiver feeding behavior in Kenya. This study aimed to develop a mealtime observation methodology and assess child eating and caregiver feeding behavior in healthy and undernourished children in Nairobi. Healthy (n = 6) and undernourished (n = 13) children aged 6-24 months were observed during a meal, with standardized rating of child interest in food, mood, distraction and caregiver responsiveness. Eating and feeding behavior varied with the stage of the meal. Child interest in food decreased and child and caregiver distraction increased as the meal progressed. Healthy children were happy and interested in food during meals, but undernourished children often had low interest in food (7/13). The 7 undernourished children eating home food were distracted (3) and unhappy (5) but children eating ready-to-use therapeutic foods (6) were all happy and undistracted. Caregivers of healthy children offered encouragement more often during meals than caregivers of undernourished children (5/6 healthy, 3/13 undernourished). Meal observations were resource intensive and could give only a snapshot of the child feeding experience. More efficient research methods that can capture a general assessment of infant eating behavior are needed.