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      Development and Testing of Responsive Feeding Counseling Cards to Strengthen the UNICEF Infant and Young Child Feeding Counseling Package

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          Abstract

          Background

          The UNICEF Community-based Infant and Young Child Feeding Counseling Package (C-IYCFCP) currently has limited responsive feeding (RF) content, thus limiting dissemination of RF messages within infant and young child feeding (IYCF) counseling.

          Objectives

          This project 1) developed counseling cards based on existing evidence-based RF guidelines and 2) tested their feasibility in Ghana.

          Methods

          Five RF counseling cards were developed focusing on eating with family; introducing new foods; hunger/satiety cues; food texture; and calming a child. Four focus group discussions (FGDs) were conducted with adult mothers and fathers of children younger than 3 y of age to assess the cultural appropriateness of the cards and accompanying key messages. The feasibility of including cards as part of IYCF counseling was tested via 1) systematic observation of 8 group education sessions utilizing the cards with the same target audience and 2) in-depth interviews with health care providers involved in IYCF training and/or counseling.

          Results

          FGD findings guided changes to all cards to ensure comprehension and cultural appropriateness. The group education sessions suggested that the counseling cards provided important RF messages that are specific, clear, and feasible to implement. Health care providers strongly endorsed the need for and utility of the RF counseling cards and felt they were feasible and important to integrate into the C-IYCFCP currently being used to deliver IYCF training and counseling in Ghana.

          Conclusions

          The counseling cards have a strong potential to add key RF dimensions to IYCF training and counseling in Ghana.

          Abstract

          We developed and tested responsive feeding counseling cards that can substantially strengthen UNICEF's Community-based Infant and Young Child Feeding Counseling Package in Ghana.

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          Most cited references14

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          Responsive feeding is embedded in a theoretical framework of responsive parenting.

          Children throughout the world are confronted with growth problems ranging from underweight and stunting to overweight and obesity. The development of healthy eating behaviors depends on both healthy food and responsive parenting behaviors. With origins from anthropology, psychology, and nutrition, responsive parenting reflects reciprocity between child and caregiver, conceptualized as a 4-step mutually responsive process: 1) the caregiver creates a routine, structure, expectations, and emotional context that promote interaction; 2) the child responds and signals to the caregiver; 3) the caregiver responds promptly in a manner that is emotionally supportive, contingent, and developmentally appropriate; and 4) the child experiences predictable responses. This paper examines evidence for the practice and developmental benefits of responsive parenting with a view to providing a theoretical basis for responsive feeding. Recommendations are made that future efforts to promote healthy growth and to prevent underweight and overweight among young children incorporate and evaluate responsive feeding.
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            Nutrition disparities and the global burden of malnutrition

            Strategies to tackle stunting, obesity, and micronutrient deficiencies must take into account the inequities in which these diseases are rooted, argue Rafael Perez-Escamilla and colleagues
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              Food insecurity and hunger: A review of the effects on children's health and behaviour.

              Food insecurity and hunger are significant problems in Canada, with millions of Canadians experiencing some level of food insecurity. The purpose of the present article is to review what is currently known about the effects of food insecurity and hunger on children. Longitudinal studies in Canada indicate that hunger is related to poor health outcomes, including a higher risk of depression and suicidal ideation in adolescents, and chronic conditions, particularly asthma. In addition, nutrient deficiencies, such as iron deficiency, are known to impair learning and cause decreased productivity in school-age children, and maternal depressive disorders. School-based nutrition programs and innovations, such as subsidized food (apples, cheese, soy nuts, carrots and broccoli), are an essential immediate need, but long-term solutions lie in adequate incomes for families.
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                Author and article information

                Contributors
                Journal
                Curr Dev Nutr
                Curr Dev Nutr
                cdn
                Current Developments in Nutrition
                Oxford University Press
                2475-2991
                15 July 2020
                September 2020
                15 July 2020
                : 4
                : 9
                : nzaa117
                Affiliations
                Yale School of Public Health , New Haven, CT, USA
                Yale School of Public Health , New Haven, CT, USA
                Yale School of Public Health , New Haven, CT, USA
                Point Hope, Inc. , Kasoa, Ghana
                University of Ghana School of Public Health , Legon, Accra, Ghana
                Yale School of Public Health , New Haven, CT, USA
                Author notes
                Address correspondence to AJH-F (e-mail: amber.hromi-fiedler@ 123456yale.edu )
                Author information
                https://orcid.org/0000-0003-4603-2836
                https://orcid.org/0000-0002-1019-3892
                https://orcid.org/0000-0003-4667-592X
                https://orcid.org/0000-0001-9416-8039
                Article
                nzaa117
                10.1093/cdn/nzaa117
                7447589
                32885131
                48787b04-03a0-4d5c-9d02-24c5cc8d10bd
                Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                : 30 April 2020
                : 25 June 2020
                : 06 July 2020
                Page count
                Pages: 15
                Funding
                Funded by: Hecht-Albert Leadership;
                Funded by: Global Health Leadership Institute, Yale University;
                Categories
                Original Research
                Implementation Science
                AcademicSubjects/MED00060

                infant feeding,counseling,ghana,child,responsive feeding,card,cues
                infant feeding, counseling, ghana, child, responsive feeding, card, cues

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