Factors associated with appropriate complementary feeding: A scoping review

Determinants of minimum dietary diversity attainment among infants aged 6-11 months in rural China: a COM-B model-based Bayesian network analysis

Achieving minimum dietary diversity (MDD), a crucial indicator of infant and young child diet quality, remains a challenge in rural China, especially for infants aged 6-11 months. This study examined the rate of MDD attainment in rural China, identified its determinants using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Bayesian network analysis, and estimated the potential impact of improving each modifiable determinant. A multi-stage sampling design selected 1,328 caregivers of infants aged 6-11 months across 77 rural townships in China. Data were collected through a cross-sectional survey via in-person household interviews. Bayesian network analysis identified key factors influencing MDD attainment and their interrelationships, while Bayesian inference estimated MDD attainment probabilities. Results showed that only 22.2% of the sample infants attained MDD. Bayesian network analysis revealed that caregiver knowledge (a proxy of capability), self-efficacy and habits (proxies of motivation), and infant age directly influenced MDD attainment. Social support (a proxy of opportunity) indirectly promoted MDD attainment by boosting self-efficacy and habit. Notably, simultaneous improvements in knowledge, self-efficacy, and habit could increase MDD attainment by 17.6%, underscoring the potential effectiveness of interventions focused on enhancing caregiver capability and motivation. The critically low MDD attainment rate among rural Chinese infants highlights the urgent need for targeted interventions. Strategies should prioritize enhancing caregiver feeding knowledge, self-efficacy, and habit formation to improve infant dietary diversity. Addressing these key factors could substantially boost MDD attainment in rural China.

Biocultural Determinants of Mothers' Complementary Feeding Decisions in the Urban Brazilian Amazon

OBJECTIVE

Complementary feeding (CF) occurs during a critical period of infant growth and development with life-long health implications. Despite international efforts, there remains significant variation in the adequacy of complementary diets across settings. In Brazil, there is marked variation in adherence to CF guidelines and infant growth outcomes, with the north (Amazon) lagging other regions of the country. This study aimed to characterize the complementary diet and develop a model to explain feeding decisions in the Amazonian city of Belém.

METHODS

With a sample of n = 30 mothers, we combined 24-h dietary recalls, a pile-sorting activity, and in-depth interviews to address study aims. Using descriptive statistics, we analyzed the pile-sort data to characterize the evolving complementary diet. Then, using thematic analysis of interview transcripts, we identified the most salient factors shaping mothers' feeding decisions.

RESULTS

While there was variation in opinion regarding the timing of introduction of liquids other than breastmilk and ultra-processed convenience foods, we found high consensus regarding the ideal complementary diet which, beginning at 6 months, met WHO dietary diversity guidelines and evolved with infant age. Three themes-integrating and applying trusted sources of advice, infant readiness and future health, and challenges to feeding ideals-illustrate how socioeconomic, cultural, and infant bio-behavioral cues interact to shape CF.

CONCLUSION

Efforts to improve infant feeding must move beyond identifying individual factors and toward biocultural models that consider how political-economic and local contexts interact to influence the ethnomedical systems, household sociocultural dynamics, including income, gender, and age-based responsibilities, and power relations that shape feeding behaviors.

Factors affecting behaviors during complementary feeding in infants and children aged 6-24 months

The process that begins around the 6th month of life and continues until the 24th month is called the complementary feeding period. During this period, infants and children start receiving foods that complement breast milk or formula for the first time. The psychosocial factors the infants and children encounter during this period may affect their growth and health in later life. This cross-sectional and descriptive study aimed to examine the factors influencing behaviors of infants and children during complementary feeding. The study sample included 345 mothers with infants and children aged 6-24 months. The research data were collected using two forms and one scale. The first form contained questions about the mothers' sociodemographic characteristics, sources of support in childcare, and information sources related to complementary feeding. The second form contained questions about the sociodemographic characteristics of infants and children, the presence of allergies, breastfeeding, and feeding status. The scale used was the validated Behaviors of Transition to Complementary Feeding Scale. The effect of independent variables on behavior of infants and children during complementary feeding was examined using multiple linear regression analysis. Infants/children older than 12 months exhibited more negative behaviors during complementary feeding compared with those aged 6-12 months. The study also found that being the first infant/child in the family had a negative impact on behaviors during complementary feeding. Infants and children currently receiving only complementary feeding displayed more positive behaviors during the complementary feeding process. Paternal support in childcare positively influenced behaviors during this period. In conclusion, complementary feeding is a multifaceted process influenced by various factors, including the infant's and child's age, family dynamics, and parental support. Strategies to support mothers, involve fathers, and provide reliable information can facilitate a smoother process of complementary feeding and promote healthier feeding behaviors in infants and children. Descriptive, interventional, qualitative, and mixed-methods studies are required to analyze these factors in detail and improve the complementary feeding process.

"She deserves the best. So how can I feed her the best?" Complementary food introduction practices among young mothers with a history of child maltreatment

PURPOSE

To explore the practices, experiences, and needs of young mothers with a history of maltreatment who are introducing their children to complementary foods.

DESIGN AND METHODS

In-depth interviews (n = 9) were conducted with young mothers (19-23 yrs) who had childhood histories of abuse and neglect (maltreatment). Interviews were transcribed verbatim and analyzed using a five-step thematic analysis approach.

RESULTS

Thematic analysis resulted in three themes: (1) Practices and sources of information, (2) Providing the best, and (3) Feeding challenges. Participants' primary sources of nutrition information were family or foster parents and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) educators. Participants expressed wanting to give their children healthy food and to change the cycle by not repeating some of their own childhood food experiences. Finally, participants sometimes struggled with food affordability.

CONCLUSIONS

The study highlights the need for additional support for young maltreated mothers, including access to healthy foods and education about infant feeding.

PRACTICE IMPLICATIONS

Young maltreated mothers are in need of trauma-informed and strengths-based complementary feeding information and support with basic needs. Universal trauma-informed care has the potential to prevent re-traumatization and improve patient care and nutrition education.

Complementary feeding challenges: Insights from Swiss parents' perspectives

Parents play a crucial role in deciding what foods to introduce to their infants during the transition from milk to solids. This study examined the challenges they face, including adherence to official complementary feeding recommendations and the struggles and concerns across different stages of feeding. Specifically, this study focused on the initial stage (transition from breastmilk/formula to mashed foods), middle stage (consumption of mashed foods and some fingerfoods, transitioning towards family foods) and late stage (complete transition to family diet). Findings from 22 semi-structured interviews with Swiss parents reveal that, despite being well-informed, practical obstacles such as returning to work, limited time for preparing homemade foods, managing multiple children, and food preferences often hinder adherence. Safety concerns like allergies and choking were prominent early on but decreased as infants grew older and parents gained confidence. In the middle phase, concerns shifted towards pesticides, indicating a growing awareness of food quality. Maintaining a healthy diet was a constant concern, with early reassurance from breastfeeding or formula feeding giving way to worries about balanced nutrition as solids became more prominent. Time constraints were particularly significant in the first two stages, due to the effort of preparing small amounts of mash and later cooking separate meals. Tailored support and clear communication can help parents navigate these challenges and promote healthier feeding practices.

Mother's perception of early introduction of complementary feeding affecting stunting in Ghana: A qualitative research

OBJECTIVES

The study aimed to explore mothers' perceptions for timely introduction of complementary feeding through interviews with 2-12-month-old infants' mothers in Ghana.

METHODS

Qualitative descriptive research with 16 semi-structured interviews with mothers attending the Child Welfare Clinic at Ejisu Hospital was conducted from June 2022 to May 2023. The study was guided by the Declaration of Helsinki, and all participants were instructed about informed consent for the study. Interviews and analysis were guided by Theory of Planned Behavior. NVivo 1.5 was used throughout the coding procedure. This study was conducted after the approval from St. Luke's International University.

RESULTS

Four themes were revealed: (1) attitude toward the behavior based on the mothers' experience raising children, (2) attitude toward the behavior influenced by subjective norm (grandmothers' recommendation), (3) attitude toward the behavior influenced by perceived behavioral control (difficulty in continuing breastfeeding), and (4) mothers who are worried about underweight despite timely introduction of complementary feeding. Attitudes toward the behavior were influenced by mothers' experiences raising children and grandmothers' recommendations. Surroundings disruptive of breastfeeding also influenced attitudes toward intentions and behavior. Moreover, some mothers suffered from underweight even if they introduce complementary feeding at an optimal time.

CONCLUSION

Supporting to continue breastfeeding and conducting re-education for grandmothers is a key recommendation for midwives and pediatric nurses. Moreover, pediatric nurses are required to further enhance not only health education regarding the timing of initiating complementary feeding but also support after the introduction.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey

Introduction

Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data.

Methods

Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant.

Results

The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use.

Conclusion

Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Cross-cultural adaptation and validation of the medical outcome study social support survey among mothers of children aged 6-23 months in Indonesia

BACKGROUND

Social support significantly influences a mother's adherence to complementary feeding guidelines, with family support fostering a positive attitude towards this practice. The Medical Outcome Study Social Support Survey (MOS-SSS) is a multidimensional scale designed to evaluate functional aspects of social support, but no instrument has been validated for Indonesia.

PURPOSE

The study aims to validate the MOS-SSS instrument for measuring mothers' social support in providing complementary food to infants and young children aged 6-23 months in Indonesia.

METHODS

A cross-sectional survey was conducted on 196 mothers with children aged 6-23 months in West Sumatera, Indonesia. The MOS-SSS's internal consistency was assessed using Cronbach alpha, composite reliability, and split-half analysis, while its construct validity was evaluated using convergent and discriminant validity.

RESULTS

The Indonesian version of the MOS-SSS among mothers with children aged 6-23 months has been found to be satisfactory in content validity through translation and expert review. The questionnaire exhibits strong convergent and discriminant validity, reliable construct reliability, and internal consistency.

CONCLUSIONS AND IMPLICATIONS

The MOS-SSS questionnaire was found to be reliable and valid in measuring the social support mothers perceive in providing complementary feeding to their infants and young children. Future research should explore the psychometric properties of the Indonesian version of the MOS-SSS in various populations, including pregnant women, lactating mothers, and women with special conditions.

Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Malnutrition is a public health problem in sub-Saharan Africa with an increased morbidity and mortality rate than in other parts of the world. Poor complementary feeding practices are one of the major causes of malnutrition during the first two years of life. Therefore, this study aimed to determine the prevalence and associated factors of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries.

METHODS

A multilevel mixed-effect analysis was carried out using recent demographic health survey data from 19 sub-Saharan African countries, which were conducted between 2015 and 2020. A total weighted sample of 60,266 mothers of children aged 6 to 23 months were included in the study. The demographic health survey employs a stratified two-stage sampling technique. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with complementary feeding practice. Variables with a p-value less than 0.05 and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported as statistically significant variables associated with appropriate complementary feeding practices.

RESULTS

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries was 13.02% (95% CI: 12.75-13.29%). Maternal educational level [AOR = 0.69, 95% CI (0.64, 0.74)] and [AOR = 0.52, 95% CI (0.47, 0.57)], marital status of the mother [AOR = 0.85, 95% CI (0.74, 0.96)], sex of household head [AOR = 1.78, 95% CI (1.09, 1.27)], total children ever born [AOR = 1.52, 95% CI (1.18, 1.96)], [AOR = 1.43, 95% CI (1.14, 1.81)], and [AOR = 1.31, 95% CI (1.04, 1.64)], media exposure [AOR = 0.74, 95% CI (0.69, 0.79)], ANC visits attended during pregnancy [AOR = 0.73, 95% CI (0.63, 0.80)] and [AOR = 0.67, 95% CI (0.62, 0.74)], place of delivery [AOR = 0.92, 95% CI (0.85, 0.98)], currently breastfeeding [AOR = 1.12, 95% CI (1.01, 1.23)], PNC checkup [AOR = 0.75, 95% CI (0.70, 0.80)], the current age of the child [AOR = 0.26, 95% CI (0.24, 0.28)] and [AOR = 0.14, 95% CI (0.13, 0.16)], birth order [AOR = 1.31, 95% CI (1.09, 1.58)], number of under 5 children in the household [AOR = 0.76, 95% CI (0.59, 0.97)], community illiteracy [AOR = 1.09, 95% CI (1.02, 1.18)], and country category [AOR = 1.62, 95% CI (1.18, 2.22)] were significantly associated with appropriate complementary feeding practices.

CONCLUSION

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan Africa was relatively low. Higher maternal educational level, female household head, having media exposure, attending more ANC visits, health facility delivery, currently breastfeeding, having PNC follow-up, low community illiteracy, and living in the West Africa region increase the odds of appropriate complementary feeding practices. Women empowerment, increasing maternal health services accessibility, promoting breastfeeding behavior, increasing media exposure of the household, and improving the proportion of health facility delivery are strongly recommended.