Abstract
BACKGROUND: Responsive feeding is an integral component of nurturing care under the umbrella of early childhood development and has been recommended as an optimal feeding practice globally. OBJECTIVE: This study was conducted to explore responsive and nonresponsive feeding practices among caregivers of children aged 6-35 months in China. Factors influencing responsive/nonresponsive feeding practices were further explored. METHODS: This study used a combination of survey and video observation approaches and was conducted in Hebei Province from August to October 2020. A cross-sectional survey (n=409) was conducted to measure caregivers' responsive/nonresponsive feeding practices using a prevalidated scale (5-point Likert scale). The overall and individual dimension scores were calculated. Multiple linear regression was performed to explore the demographic factors associated with responsive/nonresponsive feeding practices. Video observation was conducted among 42 caregiver-child pairs to record the dining episodes of main meals for a day at participants' homes. Videos taken were coded, and the feeding practices were extracted. The occurrence of each feeding practice was calculated. The results from the 2 methods were confirmatory and complementary to each other. RESULTS: Caregivers adopted responsive feeding more frequently than nonresponsive feeding, with a median overall responsive feeding score of 3.52 (IQR 3.36-3.76) in the survey and a higher occurrence in video observation (responsive vs nonresponsive feeding: 75.6%-97.6% vs 0%-46.3%). No significant differences in feeding practices were found across breakfast, lunch, and dinner (all P>.05). Nonparental caregivers (β=0.13, 95% CI 0.05-0.21) and those with a household monthly income of >5000 RMB (>US $721; β=0.07, 95% CI 0.01-0.14) had a higher score for overall responsive feeding, while unemployed caregivers (β=-0.07, 95% CI -0.13 to -0.01) had a lower score. CONCLUSIONS: Caregivers appear to be more likely to use responsive feeding practices than nonresponsive feeding practices. Interventions to promote responsive feeding should target parental, unemployed, and low-income caregivers. The findings of this study might serve as a reference for the comprehensive assessment of responsive feeding practices.