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href="#ulink_400dab96-b645-577a-91db-07d41c6815af">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 [33]. Finally, continued research on the role of caregiver feeding styles and their associations with child growth and development is needed, recognizing the importance of not just what and when children are fed but how they are fed. This research should clearly define RF components, messages, and measures, particularly within intervention studies and evaluations of programs.

      Disclosure Statement

      The authors have no disclosures.

      References

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11World Health Organization, United Nations Children’s Fund: Guideline: Updates on HIV and Infant Feeding: the Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices among Mothers Living with HIV. Geneva, World Health Organization, 2016. https://apps.who.int/iris/bitstream/handle/10665/246260/9789241549707-eng.pdf?sequence=1.

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