Moore Anna C, Akhter Sadika, Aboud Frances E
ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh.
Soc Sci Med. 2006 Apr;62(8):1917-30. doi: 10.1016/j.socscimed.2005.08.058. Epub 2005 Oct 11.
It is now widely recognized that malnutrition can partly be attributed to caregiver-child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother-child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding.
现在人们普遍认识到，营养不良部分可归因于喂养期间照顾者与儿童之间的互动。当前的概念框架强调反应性（包括主动和社交行为）、儿童自我喂养的心理运动能力以及无干扰的喂养环境的重要性。本观察性研究有三个主要目标：（1）从操作上定义诸如反应性喂养和主动喂养等关键术语，并观察它们在孟加拉国农村样本中的出现频率；（2）研究母亲和儿童的自我喂养、反应性和主动行为是否随儿童年龄和进食量而变化；（3）确定母亲和儿童行为之间的关联。在一次喂养期间观察了54对母婴，并对行为进行了5类编码，即自我喂养、反应性、主动性、社交性和干扰性行为。儿童年龄在8至24个月之间。结果表明，这五种行为可以被观察到并可靠地编码。三分之二的母亲采用主动喂养方式，但只有三分之一具有反应性；这两种方式并不重叠。对于年龄较大的儿童，母亲鼓励更多进食和更多自我喂养，但儿童并没有更多地自己进食；相反，年龄较大的儿童反应更消极（拒绝提供的食物）。积极反应的母亲往往有活跃的孩子，这些孩子会明确表示他们对食物或水的需求，并且吃的口数更多。积极主动的母亲采用不同策略鼓励进食，如口头指导孩子进食、集中注意力和暂时转移注意力。这些母亲往往有反应消极并拒绝食物（的孩子）。儿童平均接受5.31口食物，拒绝2.13口。使用侵入性主动策略（如强迫喂养）的母亲往往有既积极又消极反应的孩子，从而部分强化了她的强迫行为。因此，反应性喂养框架一旦实施，就有可能识别出在辅食喂养期间支持或阻碍母婴互动的特定行为。
