The role of care in nutrition programmes: current research and a research agenda

The importance of cultural and behavioural factors in children's nutrition, particularly with regard to feeding, has been recognized only recently. Th e combination of evidence regarding the importance of caregiving behaviour for good nutrition, and improved strategies for measuring behaviour have le d to a renewed interest in care. The UNICEF conceptual framework suggests t hat care, in addition to food security and health care services, are critic al for children's survival, growth and development. The present paper focus es on the care practice of complementary feeding, specifically behavioural factors such as parental interaction patterns, feeding style and adaptation of feeding to the child' s motor abilities (self-feeding or feeding by oth ers). Three kinds of feeding styles (Birch & Fisher, 1995) are identified: controlling; laissez-faire; responsive. Probable effects of each feeding st yle on nutrient intake are described. A number of studies of feeding behavi our have suggested that the laissez-faire style is most frequently observed among families and communities with a higher prevalence of malnourished ch ildren. Nutrition interventions that have been able to show significant eff ects on outcomes, such as the Hearth Model in Vietnam (Sternin et al. 1997) , have usually incorporated behavioural components in their intervention. A t this time, there have been no tests of the efficacy of behavioural interv entions to improve feeding practices. Research is needed to understand beha vioural factors in complementary feeding, and to identify and test interven tion strategies designed to improve nutrient intake of young children. Fina lly, the paper concludes with a discussion of how nutrition programmes migh t change if care were incorporated.