Association of caregiver and child behaviors during feeding with child acceptance of food in Malawi

We investigated the association of specific caregiver and child behaviors with acceptance of food in 170 underweight 6–17 month old Malawian children. Caregivers' and children's physical and verbal actions and the number of bites of food offered and accepted were recorded by trained observers during one 11‐h home visit. Logistic regression was used to estimate the odds of accepting some versus all of the bites offered. Models controlled for age and sex of the children and were adjusted for repeated meals per participant. The odds of accepting all offered bites decreased when mothers pressured children to eat (OR=0.01, p<0.01) or tried to distract children as a way of encouraging them to eat (OR 0.5, p<0.01). Children who fed themselves (OR=4.8, p<0.001) and who played during meals (OR=1.7, p<0.05) had an increased odds of accepting all of the bites. Our results showing an association between caregiver pressure to eat and decreased acceptance of food are similar to findings from other settings, and could have implications for interventions promoting responsive feeding.