Open access peer-reviewed chapter
Abstract
Inappropriate feeding during the early childhood period plays a detrimental role in the child’s growth, development, and overall health. Some of these are suboptimal feeding practices, which have a negative impact on a child’s nutritional status and well-being. Suboptimal child feeding is a common problem in developing countries, despite the efforts that have been made to address it. This book chapter explores the determinants of suboptimal child feeding and identifies the various factors that contribute to it among caregivers. By reviewing existing literature and the author’s prior work, the chapter provides comprehensive insights into suboptimal feeding during childhood and its contributing factors. The book chapter reviews recent research on suboptimal child feeding practices and contributing factors. It also presents the findings and interprets the researcher’s own work on the topic. The chapter highlights the importance of the research findings in enriching the existing body of knowledge and informing future research in the field. It also concludes that a multidimensional approach is needed to address the socioeconomic, maternal, family, and environmental factors that contribute to suboptimal child-feeding practices. This approach will help to ensure better health outcomes for children.
Keywords
- suboptimal child feeding
- child feeding practices
- determinants
- breastfeeding
- complementary feeding
1. Introduction
In this book chapter, the author summarizes their own research findings, as well as the findings of other studies, on the topic of suboptimal child feeding practices and their determinants. A detailed explanation of suboptimal child feeding practices and their contributing factors is provided.
Suboptimal child feeding practices are becoming increasingly important because they can significantly impact a child’s health and well-being. In the early years of life, children’s brains and bodies are rapidly developing, and they need the right nutrients to support this growth and development. Suboptimal feeding practices can lead to nutrient deficiencies, which can have long-lasting consequences for a child’s health [1, 2].
Suboptimal child feeding is a serious problem that can have several negative consequences for children’s health and development. The determinants of suboptimal child feeding can be categorized into three main groups: maternal factors, socioeconomic factors, and environmental factors [3]. Suboptimal child feeding can lead to several health problems, including undernutrition, overweight and obesity, iron deficiency anemia, and vitamin A deficiency [2]. The topic of suboptimal child feeding is relevant, important, and timely because it has a significant impact on children’s health and development.
In this book chapter, suboptimal child feeding is defined as any deviation from the World Health Organization’s (WHO) optimal feeding recommendations, which include early initiation of breastfeeding within one hour of birth, appropriate complementary feeding at 6 months of age, and continuation of breastfeeding for up to 2 years or beyond. However, many infants and children do not receive optimal feeding. For example, only about 44% of infants aged 0–6 months worldwide were exclusively breastfed over the period of 2015–2020 [4].
The main issues and challenges related to suboptimal child feeding include lack of awareness, limited access to healthy foods, and cultural beliefs. There are several approaches that can be considered to address the issue of suboptimal child feeding, including educating parents about the importance of good nutrition, providing families with access to healthy foods, and challenging cultural beliefs about breastfeeding and complementary feeding [2].
The purpose of this chapter is to provide an overview of suboptimal child feeding practices and their determinants by exploring the author’s own work as well as the work of others on the topic. This will help to depict the scope of the problem, the attempts that have been made to resolve it, and the future direction of research and interventions to improve child feeding and well-being.
The chapter begins by defining suboptimal child feeding and discussing the different factors that can contribute to it. The chapter then discusses the significance of suboptimal child feeding, highlighting the fact that it can lead to several health problems, including undernutrition, overweight and obesity, iron deficiency anemia, and vitamin A deficiency. The chapter then discusses the key challenges associated with improving child-feeding practices. The chapter then discusses some interventions that can be used to improve child-feeding practices.
The chapter concludes by noting that suboptimal child feeding is a complex problem with no easy solutions. However, by understanding the determinants of the problem and the key challenges associated with it, we can develop effective interventions to improve child-feeding practices and improve the health and development of children.
The chapter does not attempt to cover all aspects of the topic of suboptimal child feeding thoroughly. However, it provides a comprehensive overview of the topic and offers insights that can be used to improve child-feeding practices.
2. Definition of optimal breastfeeding
WHO and UNICEF recommend that optimal breastfeeding includes:
Early initiation of breastfeeding within 1 hour of birth.
Exclusive breastfeeding for the first 6 months of life, meaning no other foods or liquids are provided, including water.
Introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond [4].
Below are listed some of the benefits of optimal breastfeeding.
Protects babies from infections.
Provides babies with all the nutrients they need for their first 6 months of life.
Helps babies develop a healthy gut microbiome.
Reduces the risk of obesity and chronic diseases later in life.
Promotes bonding between mothers and babies.
Not all mothers can exclusively breastfeed for 6 months. However, they can still provide their babies with many of the benefits of breastfeeding by breastfeeding as often as possible and for as long as they are able.
2.1 Definition of suboptimal child feeding
Suboptimal child feeding refers to any feeding practices that deviate from the World Health Organization’s (WHO) recommendations for children aged 0–2 years. These practices include delaying the initiation of breastfeeding, introducing formula or other liquids before 6 months of age, stopping breastfeeding before 2 years of age, and inadequate feeding. Suboptimal child feeding is considered when these practices occur [4].
Suboptimal breastfeeding is when infants do not receive the recommended amount of breast milk. There are two main risk factors for suboptimal breastfeeding: not breastfeeding exclusively for the first 6 months of life, and stopping breastfeeding before the age of two [5].
2.2 Types of suboptimal child feeding
Based on how the feeding approach deviates from the World Health Organization’s (WHO) recommendations for optimal child feeding, suboptimal child feeding can be classified into the following:
Delayed initiation of breastfeeding is a condition in which a baby is not put to the breast within the first hour of birth. This is contrary to the World Health Organization’s (WHO) recommendation, which states that all babies should be breastfed within the first hour of life. Delayed initiation of breastfeeding is critical because it can deprive the baby of the essential colostrum, which is the first milk produced by the mother. Colostrum is high in antibodies and nutrients, and it provides the baby with important protection against infection. Delayed initiation of breastfeeding can also make it more difficult for the mother and baby to establish a good breastfeeding pattern [6, 7].
Non-exclusive breastfeeding before 6 months refers to the introduction of any foods or fluids before the age of 6 months. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of a child’s life, meaning that the infant receives only breast milk without any additional food or liquids (except for oral rehydration salts, drops, or syrups of vitamins, minerals, or medicines as needed).
Early cessation of breastfeeding is the discontinuation of breastfeeding before the child reaches the age of 2 years. The World Health Organization (WHO) recommends that mothers continue to breastfeed their children until at least 2 years of age or beyond, along with the introduction of nutritionally adequate and safe complementary foods.
There are many benefits to breastfeeding for both the mother and the child. Breastfeeding helps to protect the child from infection, allergies, and obesity. It also helps to promote the development of the child’s brain and immune system. For mothers, breastfeeding can help to reduce the risk of postpartum depression and cancer.
Inadequate breastfeeding is a condition in which a child does not receive enough breast milk. This can happen for a variety of reasons, including poor latch, insufficient milk supply, incorrect breastfeeding techniques, or maternal issues. Inadequate breastfeeding can lead to poor infant nutrition and growth. Inadequate breastfeeding can lead to poor infant nutrition and growth. A child who is not getting enough breast milk may be more likely to experience weight loss, growth delays, and other health problems. Our study supports this finding, showing that poor latch can lead to inadequate feeding of the child. This is because a poor latch can make it difficult for the baby to suck effectively, which can lead to them not getting enough milk [8].
Inappropriate breastfeeding practices: These include feeding infants with bottles, teats, or pacifiers, which can interfere with proper breastfeeding techniques and reduce milk supply. Study have also suggested that exposure of infants to artificial nipples (bottle feeding) has been strongly associated with breastfeeding problems [9]. This is because artificial nipples are easier for infants to suck on than the breast. As a result, infants may prefer the bottle and may not be as motivated to breastfeed.
Our work on the introduction of Prelacteal feeding, a form of suboptimal feeding, has shown that a significant number of mothers (16.8%) introduced Prelacteal feeds within the first 3 days after birth [10]. This means that one in every six newborns receives some form of Prelacteal food or fluid. This can lead to improper establishment of breastfeeding and a decreased likelihood of achieving effective suckling, which can result in poor disease protection and frequent infection.
Another study on breastfeeding practices that assessed the positioning and attachment of mothers during breastfeeding found that poor attachment and positioning were observed among a notable proportion of mother [8]. This is the single most important cause of inadequate breastfeeding. This has a significant impact on the health of the child, and it raises the need to reconsider the approach to enhancing maternal counseling during the postnatal period to improve effective feeding and prevent the child from illness.
A study by the authors found that even among caregivers of sick children, inappropriate feeding practices were observed. This is even though there are well-established recommendations to increase feeding during and after common childhood illnesses [11]. This finding suggests how deeply rooted the problem of suboptimal feeding practices is. The study’s findings highlight the importance of interventions that address the underlying determinants of feeding practices during illness to ultimately improve children’s well-being.
3. Determinants of suboptimal child feeding
Determinants of suboptimal breastfeeding can vary across different populations and contexts. Several factors have been identified through research and evidence that contribute to suboptimal breastfeeding rates.
Our study on Prelacteal feeding found that mothers’ knowledge of breastfeeding, exposure to counseling on optimal breastfeeding during antenatal care (ANC) follow-up, and receipt of immediate postnatal care were predictors of suboptimal feeding in the form of Prelacteal feeding. These findings emphasize the importance of considering a wide range of participants, including mothers with poor knowledge about breastfeeding, who have no exposure to counseling on breastfeeding, and those without immediate postnatal care [10].
Studies have shown that mothers who lack accurate information about breastfeeding may face difficulties in establishing and maintaining breastfeeding. This is because they may not know how to deal with challenges such as not knowing the benefits of breastfeeding, not knowing how to properly latch their babies, and not knowing how to manage common breastfeeding challenges. This lack of knowledge can lead to mothers giving up on breastfeeding early. Therefore, it is important for mothers to have access to accurate information about breastfeeding. This information can help them to overcome challenges and breastfeeding successfully [12, 13].
Accurate information and support are essential for mothers to make informed decisions about breastfeeding and breastfeed successfully. Societal and cultural norms, beliefs, and practices can influence breastfeeding rates, and negative attitudes and practices can hinder optimal breastfeeding practices. In short, mothers need the right information and support to breastfeed successfully, and society should foster a supportive environment for breastfeeding [14].
The support and practices within the healthcare system can significantly impact breastfeeding outcomes. Factors such as limited access to skilled lactation support, inconsistent advice from healthcare professionals, and inadequate postpartum care can contribute to suboptimal breastfeeding [15].
Maternal employment status also affects breastfeeding. Returning to work shortly after childbirth without supportive policies, such as paid maternity leave, flexible work arrangements, and dedicated breastfeeding spaces, can create challenges for mothers who wish to continue breastfeeding [16].
Marketing and availability of formula milk: Aggressive marketing of infant formula and the easy availability of formula milk products can influence maternal decisions and undermine exclusive breastfeeding.
Studies have shown that social support is a critical factor that affects breastfeeding. Lack of support from family members, partners, and the broader community can make breastfeeding more challenging for mothers. Lack of understanding, unsupportive attitudes, and limited assistance with household chores and childcare can worsen breastfeeding rates [17, 18].
Maternal physical and mental health are important factors that can interfere with successful child feeding practices. Issues such as difficulties with breastfeeding due to pain or insufficient milk supply, postpartum depression, or stress can negatively affect the initiation and maintenance of breastfeeding [19, 20].
Inappropriate use of complementary foods is the most common determinant of suboptimal breastfeeding. For example, introducing complementary foods too early, before the recommended age of 6 months, can reduce breastfeeding duration as well as exclusivity.
4. The impact of suboptimal child feeding
The global prevalence of suboptimal child feeding is high. According to the World Health Organization (WHO), about 44% of infants under 6 months are exclusively breastfed. Additionally, many children are fed unhealthy diets that are high in processed foods and low in nutrient-rich foods. Few children receive nutritionally adequate and safe complementary foods; in many countries less than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age [4].
In Africa, about 37% of infants under 6 months of age were exclusively breastfed in 2017 [21]. In Ethiopia, only 59% of infants under 6 months are exclusively breastfed. Contrary to the WHO recommendation that children under age 6 months should be exclusively breastfed, 14% of infants 0–5 months also consume plain water, 1% of them consume non-milk liquids, 8% consume other milk, and 13% consume complementary foods in addition to breast milk (Figure 1). Notably, 6% of infants under age 6 months are not breastfed at all [22].
Figure 1.
Proportion of infants under 6 months who are exclusively breastfed.
Suboptimal breastfeeding can have various negative impacts on child health. Breast milk is the optimal source of nutrition for infants and provides a wide range of essential nutrients and antibodies that support their growth and development. When breastfeeding is suboptimal or not practiced at all, it can lead to the following consequences for child health.
In 2019, suboptimal breastfeeding was associated with 2.8% (95% uncertainty interval (UI) 2.1–3.5) of disability-adjusted life years (DALYs) among children under 5 years of age. This means that suboptimal breastfeeding was responsible for 2.8% of the total burden of disease in children under 5 years of age.
Suboptimal breastfeeding was also associated with 146,000 under-5 deaths (95% UI 104,000–197,000) in 2019. This means that suboptimal breastfeeding was responsible for 146,000 deaths of children under 5 years of age in 2019.
The burden of suboptimal breastfeeding is significant, and it is important to take steps to improve breastfeeding practices in order to reduce the number of deaths and DALYs associated with this problem [5].
Evidence shows that suboptimal breastfeeding increases the risk of infections in infants [23, 24, 25]. This is because breast milk contains high levels of antibodies and immune-boosting substances that help protect infants against various infections, including respiratory and gastrointestinal infections. Suboptimal breastfeeding, on the other hand, impedes these protective substances, leaving infants more susceptible to illnesses and with a higher risk of developing infections.
Suboptimal breastfeeding unquestionably leads to nutritional deficiencies among infants. Breast milk is the main and initial source of nutrients for infants, and it is uniquely tailored to meet their nutritional needs. It provides an ideal balance of proteins, fats, carbohydrates, vitamins, and minerals. When infants are not fed optimally, they may not acquire all the necessary nutrients for their growth and development, leading to nutritional deficiencies and associated health problems [1, 26].
Increased risk of chronic diseases: Studies have shown that suboptimal breastfeeding is associated with a higher risk of developing chronic diseases later in life. These include conditions such as obesity, type 2 diabetes, asthma, allergies, and certain types of cancers. Breastfeeding provides long-term health benefits that can help reduce the incidence of these diseases [27].
Impaired cognitive development: Breast milk contains essential fatty acids, such as docosahexaenoic acid (DHA), which are critical for brain development. Infants who are not breastfed or receive suboptimal breastfeeding may have a higher risk of impaired cognitive development, including lower intelligence quotient (IQ) scores and decreased academic performance.
Increased risk of obesity: Breastfeeding has been shown to play a role in preventing childhood obesity. Suboptimal breastfeeding, particularly when combined with early introduction of solid foods or the use of formula, may increase the risk of obesity in childhood and later in life [28, 29].
Emotional and psychological impacts: Breastfeeding promotes a strong emotional bond between mother and child. It provides comfort, security, and a sense of closeness, which contributes to the child’s emotional well-being. Lack of breastfeeding or suboptimal breastfeeding practices may affect the mother-child bonding and emotional development of the child [30].
It is important to note that while breastfeeding is highly beneficial, some mothers may face challenges or circumstances that prevent them from breastfeeding exclusively. In such cases, alternative feeding methods should be adopted to ensure the infant receives adequate nutrition. Consulting with healthcare professionals and lactation specialists can provide guidance and support to address any breastfeeding difficulties and ensure the best possible outcomes for the child health.
Protecting, promoting, and supporting breastfeeding will save more lives of babies and children than any other single preventive intervention. Globally, exclusive and continued breastfeeding could help prevent 13% of deaths among children under 5 years old. Breastfed children have fewer childhood infections, fewer chronic diseases, 3–5 extra points of IQ , higher earning potential, more opportunities to prioritize education, and healthier mothers. Breastfeeding reduces burdens on society in terms of health spending, hospitalizations, and absenteeism. It also saves families money because it obviates the need for commercial substitutes [31].
5. Interventions and strategies
Suboptimal child feeding practices can have long-term consequences on a child’s health and development. To address these issues, various interventions and strategies can be implemented. Here are some approaches that can help reduce suboptimal child-feeding practices:
Nutrition education: Providing parents, caregivers, and communities with accurate and practical information on infant and child nutrition is crucial. This education can focus on topics such as breastfeeding, introducing complementary foods, nutrient requirements, portion sizes, and the importance of a balanced diet [32].
Breastfeeding support: Promote and support exclusive breastfeeding for the first 6 months of a child’s life, as recommended by the World Health Organization (WHO). This can involve training healthcare providers and establishing lactation support programs to assist mothers with breastfeeding challenges [4].
Complementary feeding guidance: Educate caregivers on the appropriate timing and methods for introducing complementary foods to infants around 6 months of age. Emphasize the importance of nutrient-rich and diverse foods, proper food preparation, and responsive feeding practices.
Peer support and counseling: Establish support groups, mother-to-mother networks, or community health workers to provide guidance, encouragement, and practical advice on optimal child feeding practices. Peer support can be particularly effective in promoting behavior change [15].
Food affordability and accessibility: Addressing economic barriers to accessing nutritious foods is essential. Implement strategies such as social protection programs, agricultural development initiatives, and market interventions to improve affordability and availability of nutrient-rich foods for families [33, 34].
Parenting programs: Incorporate child feeding and nutrition education into existing parenting programs. These programs can provide comprehensive support on various aspects of childcare, including feeding practices, responsive feeding, meal planning, and portion control [35].
Quality healthcare services: Strengthen healthcare systems to provide quality services related to child nutrition and feeding practices. Ensure that healthcare providers are trained in evidence-based guidelines, and that they offer consistent and accurate counseling to parents and caregivers [36].
Policy and advocacy: Advocate for policy changes that support optimal child feeding practices. This can include regulations on marketing of unhealthy foods, mandatory labeling of nutritional information, and workplace policies that support breastfeeding and parental leave [37].
Monitoring and evaluation: Establish mechanisms to monitor and evaluate the effectiveness of interventions and strategies aimed at reducing suboptimal child feeding practices. Regular assessments and data collection can help identify gaps and refine approaches for better outcomes [38].
6. Gaps in knowledge and future directions
Despite progress, there are still gaps in knowledge and areas that require further attention in addressing suboptimal child feeding practices. These gaps include:
Cultural influences: A deeper understanding of cultural influences on feeding behaviors is needed to develop culturally appropriate interventions.
Behavior change strategies: Effective behavior change strategies that can be implemented at the individual, family, and community levels need to be identified.
Critical periods and long-term effects: Critical periods during early childhood when specific feeding practices have the greatest impact on long-term health outcomes need to be investigated. Longitudinal studies are needed to understand the long-term effects of suboptimal feeding practices.
Socioeconomic determinants: Complex relationships between socioeconomic status, food security, and feeding behaviors need to be understood to inform targeted interventions.
Technology-based interventions: The potential of technology in delivering child-feeding interventions needs to be explored.
Male involvement: Fathers and male caregivers need to be engaged to promote their active involvement in child feeding decisions and practices.
Policy interventions and environmental factors: The impact of policy interventions needs to be assessed, and environmental factors such as the availability of healthy foods need to be explored to inform strategies to create supportive environments for optimal child feeding.
International partnerships: Collaboration among researchers, practitioners, policymakers, and communities worldwide needs to be promoted to facilitate knowledge sharing, exchange of best practices, and scaling up effective interventions.
7. Conclusion
Suboptimal child feeding is a widespread problem with serious consequences for children’s health and development. However, there are effective interventions that can help parents and caregivers provide their children with nutritious and balanced diets. These interventions include nutrition education, breastfeeding support, complementary feeding guidance, peer support, and parenting programs. Comprehensive interventions must address food affordability and accessibility, healthcare services, and supportive policies. It is also important to recognize the cultural context of different communities, conduct further research, and address gaps in knowledge to tailor interventions to the specific needs and challenges of each community.
Future efforts should focus on understanding the cultural influences on child feeding practices, identifying effective ways to change feeding behaviors, investigating the long-term effects of different feeding practices, addressing socioeconomic factors that affect feeding practices, exploring the use of technology to improve feeding practices, promoting male involvement in feeding practices, and implementing policy and environmental changes to improve feeding practices. Collaboration, knowledge sharing, and international partnerships will be essential for developing evidence-based interventions and scaling them up globally.
Acknowledgments
I am grateful to Intech Open, an open-access publisher of books and journals, for inviting me to contribute to this chapter. I would also like to thank Mr. Kristian Josic, the publishing process manager, for his unwavering support and guidance throughout the development of this chapter.
Accronyms and abbrevaition
World health organization | |
intelligence quotient | |
disability-adjusted life years |
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