Aboud Frances E, Shafique Sohana, Akhter Sadika
Department of Psychology, McGill University, Montreal H3A 1B1, Canada. frances.aboud@mcgill
J Nutr. 2009 Sep;139(9):1738-43. doi: 10.3945/jn.109.104885. Epub 2009 Jul 8.
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.
响应式辅食喂养是指母亲根据孩子的提示和心理运动能力来喂养孩子，但在一些国家这种喂养方式的比例较低，这可能会导致营养不良。需要进行干预措施来评估推广响应式喂养是否会带来任何益处。我们通过一项整群随机现场试验，评估了一个为期6节的教育项目，该项目强调了儿童自主进食和母亲响应性的实践。19个群组中的108位母亲及其8至20个月大的孩子被随机分配到干预组，18个群组中的95位母亲及其孩子被分配到信息对照组。在干预前、干预后和随访时对结果进行评估。不了解分组情况的研究助理观察并记录了母亲和孩子午餐时的行为。在随访时，响应式喂养组孩子自主进食的口数百分比为47.8±42.4（均值±标准差），而对照组为32.2±41.0（P = 0.01）；同样，响应式喂养组母亲的响应性言语数量为6.55±5.9，对照组为4.62±4.5（P = 0.01）。干预组的母亲回忆起更多信息。两组孩子吃的食物口数和体重相当。食物摄入量没有变化且量少可能解释了体重增加水平同样较低的原因。这些结果表明，通过采用示范和指导练习等适当的行为改变策略来针对特定行为，可以增加自主进食和母亲的言语响应性这两种对发育很重要的行为。体重增加可能需要更多的营养投入，尤其是在粮食不安全程度高的地区。
