target="_blank" rel="nofollow" href="#ulink_febdb2a7-0546-50b0-904e-fdc87d190063">33].
Within India, the only CF indicator evaluated in both the 2005–2006 and the 2015–2016 national surveys was the percent of children aged 6–8 months receiving solid or semi-solid food and breastmilk [19, 20]. The percent of children who received solid or semi-solid food and breastmilk decreased by 10%, despite data that showed the breastfeeding indicators substantially increased during this period (Table 1) [19, 20]. While the reasons for this decrease are not clear, CF programs and policies should be strengthened as part of infant and young child nutrition (IYCN) programs.
Accompanying the nutrition transition, multinational beverage companies and their products are more accessible worldwide [34]. Global data on child beverage consumption is extremely limited, especially among children under 2 years old. Most of the literature is specific to the United States and results from the Feeding Infants and Toddlers Study [35]. From the Feeding Infants and Toddlers Study data, Kay et al. [35] found that breastmilk and formula were the top 2 beverages consumed among children younger than 12 months, and as expected, cow’s milk consumption continued to increase as children aged. Children older than 12 months had an average 100% juice consumption of 8 ounces per day, almost twice the recommended amount [35, 36].
Beverage data are limited within India as well. An analysis of the 2005–2006 Indian National Family Health Survey showed that nearly 10% of children (ages 6–59 months) had not consumed any water in the last 24 h [37]. Of those children, over 50% reported not drinking any beverages, while a quarter reported drinking 2 or more beverages such as tea, coffee, or juice. Children over 2 years old were more likely to consume non-milk beverages compared to younger children. The authors found in settings where water is scarce, sugar-sweetened beverages, such as juice or soda, are more widely consumed among younger children [37]. More global data on beverage consumption during early childhood are needed to track sugar-sweetened beverage consumption and its impact on growth throughout early childhood.
Caregiver Feeding Styles
Not only do caregivers play a prominent role in what and when children are fed, they also determine how children are fed. Parental feeding styles play a significant role in establishing healthy behaviors for optimal growth and development [38]. The WHO recommends that parents and caregivers practice RF [14]. According to Black and Aboud RF, includes “(1) ensuring that the feeding context is pleasant with few distractions; (2) encouraging and attending to the child’s signals of hunger and satiety; and (3) responding to the child in a prompt, emotionally supportive, contingent, and developmentally appropriate manner” [15]. Non-RF is defined as “A lack of reciprocity between the parent and child, with the caregiver taking excessive control of the feeding situation (pressuring or restricting food intake), the child completely controlling the feeding situation (indulgent), or the caregiver being uninvolved during meals (laissez faire)” [39]. The importance of the dyadic relationship and the role of infant temperament play a role in how caregiver feeding style may be influenced. For example, caregivers who perceive infants to be “fussy” or “active” may introduce complementary foods more often, as a way to sooth a crying or an active infant [40, 41]. Research on feeding styles and its association with breastfeeding and growth outcomes has been conducted in high-, middle-, and low-income countries [42-44]. Although researchers recognize the importance of RF, there are limited data to assess how RF messages combined with improved CF behaviors contribute to child diet or growth.
An observational study of 100 meal time observations of children aged 12–23 months in rural Ethiopia reported that caregivers of stunted children had poorer IYCF practices, such as being less responsive to the child’s hunger and satiation cues, compared to caregivers of non-stunted children [45]. A randomized controlled behavioral intervention trial in rural Andhra Pradesh, India, conducted a 3-arm study among 600 mother-child pairs within 60 rural villages. The first arm was the control/standard of care, the second arm received an IYCN feeding intervention, and the third arm received the IYCN intervention with additional messages and skills on RF and child development. Although the intervention did not show better growth within the third arm (but did in the second arm), mental development scores in the RF group were significantly higher compared to the control and CF groups [46]. In a cohort study of 217 African-American mother-infant pairs in North Carolina, caregiver feeding style data were collected from 3 to 18 months of infant age using the Infant Feeding Style Questionnaire [47]. Parental feeding styles, including beliefs and practices, had a significant impact on both infant diet and growth, with pressuring and indulgent feeding styles associated with negative IYCF behaviors, such as greater infant energy intake, reduced odds of breastfeeding, and higher levels of age-inappropriate feeding of liquids and solids [48]. In the same study, Slining et al. [49] found that both infant overweight and high subcutaneous fat were associated with delayed infant motor development.
Future Research
In a 2013 Lancet article, several nutrition-specific interventions were assessed across the lifecycle [50]. This included interventions of adolescents, women of reproductive age, pregnant women, infants, and children in multiple countries. The review also assessed the design and implementation process of these nutrition interventions. The results for young children concluded that (1) community breastfeeding promotion had positive impacts on breastfeeding rates, but more data are needed on how this affects growth outcomes later in childhood; (2) previous CF interventions have been insufficient; additional trials, especially trials in food insecure populations, are needed; (3) more interventions need to be targeted toward those with moderate acute malnutrition, specifically infants younger than 6 months of age [50].
As the global nutrition transition continues to affect changes in diet and lifestyle, research and interventions should focus on both under- and overnutrition to inform programs and policy. For infants and young children in every setting, promotion and assessment of breastfeeding and appropriate CF should be a priority. There is a clear gap of data on beverage consumption in early childhood and a need for more research, particularly as access to sugar-sweetened beverages and industry marketing continues to increase [
