Analysis of the Concept of Responsive Feeding Based on Culture
DOI:
https://doi.org/10.37287/picnhs.v7i1.2236Keywords:
responsive feeding, cultural adaptation, child nutrition, stunting prevention, nursing practiceAbstract
Background: Responsive feeding is an essential component of child nutrition and responsive caregiving; however, the concept remains inconsistently defined across disciplines and cultural contexts, limiting its application in nursing practice and stunting prevention. Objective: This concept analysis aimed to clarify the meaning, defining attributes, antecedents, consequences, and empirical referents of culturally based responsive feeding among children aged 6–24 months. Method: Walker and Avant’s concept analysis approach was used through the identification of concept use, defining attributes, model cases, antecedents, consequences, and empirical referents. Literature from WHO/UNICEF guidelines, empirical studies, and cross-cultural research related to responsive feeding was comprehensively reviewed. Results: Six defining attributes were identified: caregiver sensitivity to child cues, warm reciprocal interaction, non-coercive and supportive feeding approaches, support for child autonomy and self-regulation, family cultural sensitivity, and orientation towards the feeding process and eating experience. Antecedents included caregiver knowledge of child development, psychological readiness, safe caregiver–child relationships, family support, socioeconomic conditions, family cultural values, access to nutrition education, culturally sensitive healthcare services, and WHO/UNICEF guidelines. Consequences included positive eating experiences, improved diet quality and child self-regulation, more harmonious family relationships, reduced feeding difficulties and caregiver stress, and contributions to stunting prevention. Conclusions: Culturally based responsive feeding is a multidimensional concept integrating nutritional, emotional, relational, and cultural aspects as a foundation for culturally sensitive nursing practice in stunting prevention.
References
Aboud, F. E., Moore, A. C., & Akhter, S. (2008). Effectiveness of a community-based responsive feeding programmed in rural Bangladesh: A cluster randomized field trial. Maternal & Child Nutrition. Doi: 10.1111/j.1740-8709.2008.00146.x
Athavale, P., Hoeft, K., Dalal, R. M., Bondre, A., Mukherjee, P., & Sokal-Gutierrez, K. (2020). A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India. Journal of Health, Population and Nutrition, 39, Article 24. https://doi.org/10.1186/s41043-020-00215-
Affleck, W., & Pelto, G. (2012). Caregivers’ responses to an intervention to improve young child feeding behaviors in rural Bangladesh: A mixed method study of the facilitators and barriers to change. Social Science & Medicine, 75(4), 651–658. https://doi.org/10.1016/j.socscimed.2012.03.030
Behbehani, F., et al. (2025). Parent-reported feeding practices associated with children’s observed willingness to try new foods: Implications for responsive feeding assessment. Maternal & Child Nutrition. Advance online publication. https://doi.org/10.1111/mcn.13760
Black, M. M., & Aboud, F. E. (2011). Responsive feeding is embedded in a theoretical framework of responsive parenting. The Journal of Nutrition, 141(3), 490–494. https://doi.org/10.3945/jn.110.129973
Black, M. M., Tofail, F., Hodges, E. A., Bann, C. M., Hamadani, J. D., Aktar, S., & Lutter, C. K. (2022). Rethinking responsive feeding: Insights from Bangladesh. Nutrients, 14(15), 3156. https://doi.org/10.3390/nu14153156
Bentley, M. E., Wasser, H. M., & Creed-Kanashiro, H. M. (2011). Responsive feeding and child undernutrition in low- and middle-income countries. Journal of Nutrition, 141(3), 502–507. https://doi.org/10.3945/jn.110.130005
Cheney, A. M., Ramirez, A., Vázquez, E., Tovar, A., Mujuru, P., Ortiz, G., Zimmer, A., & Carrillo, D. (2025). Adapting an evidence-based infant feeding and nutrition program to promote healthy growth and development in Latinx families of low income. Journal of Nutrition Education and Behavior, 57(7), 572–587. https://doi.org/10.1016/j.jneb.2025.02.00
Disantis, K. I., Hodges, E. A., Johnson, S. L., & Fisher, J. O. (2011). The role of responsive feeding in overweight during infancy and toddlerhood: A systematic review. Journal of Nutrition, 141(3), 508–516. https://doi.org/10.3945/jn.110.130047
Flax, V. L., Bentley, M. E., Chasela, C. S., Kayira, D., Hudgens, M. G., Knight, R. J., & Jamieson, D. J. (2013). Responsive feeding and child interest in food vary when rural Malawian children are fed lipid-based nutrient supplements. Maternal & Child Nutrition, 9(3), 344–357. https://doi.org/10.1111/mcn.12003
Julianti, E., Elni, E., Azmy, R. A., & Zamziri, Z. (2025). Mothers’ experiences in implementing responsive feeding for stunted toddlers: A qualitative phenomenological study. Journal of Applied Nursing and Health, 7(3), 418–431. https://doi.org/10.55018/janh.v7i3.387
Jawad, M., Renzaho, A. M. N., & Gallegos, D. (2024). Responsive feeding practices among Arabic- and Mongolian-speaking migrant mothers in Australia: A qualitative study. Maternal & Child Nutrition, 20(1), e13663. https://doi.org/10.1111/mcn.13663
Killion, K. E., et al. (2024). Responsive feeding practices to promote healthy diets in early childhood: Limitations of caregiver self-report. Nutrients, 16(4), 550. https://doi.org/10.3390/nu16040550
Liu, Y., Yu, G., Li, Z., Kong, Y., Yang, R., Yin, C., & Sun, X. (2023). A responsive feeding questionnaire based on self-determination theory for caregivers of Chinese toddlers. Journal of Nutrition Education and Behavior, 55(8), 722–731. https://doi.org/10.1016/j.jneb.2023.02.011
Marshall, S., et al. (2021). Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia. Woman and bird, 34 (4), e346-e356. https://pubmed.ncbi.nlm.nih.gov/36853761/
Meiyenti, S., Effendi, N., Djafri, D., & Devianto, D. (2025). Cultural barriers in stunting prevention policy implementation: An ethnographic study in West Sumatra, Indonesia. Cogent Social Sciences. https://doi.org/10.1080/23311886.2025.2586379
Nurturing Care for Early Childhood Development. (2023). Nurturing young children through responsive feeding (Thematic Brief). Nurturing Care for Early Childhood Development. https://nurturing-care.org/wp-content/uploads/2023/05/NRF.pdf
Perez-Escamilla, R., Jimenez, E. Y., & Dewey, K. G. (2021). Responsive feeding recommendations: Harmonizing integration into dietary guidelines for infants and young children. Current Developments in Nutrition, 5(6), nzab076. https://doi.org/10.1093/cdn/nzab076
Pelto, G. H., Levitt, E., & Thairu, L. (2016). Improving feeding practices: Current patterns, common constraints, and the design of interventions. Food and Nutrition Bulletin, 37(3_suppl), S27–S58. https://doi.org/10.1177/0379572116655321
Prabowo, B., Wardani, R., Dian, A., & Suwarto, S. (2025). Determinants of family empowerment and complementary feeding quality: Evidence from a transcultural care framework. Healthcare, 13(17), 2237. https://doi.org/10.3390/healthcare13172237
Pook, J., Blake, C. E., Bentley, M. E., & Flax, V. L. (2023). Feeding frontlines: A descriptive qualitative study exploring the experiences and perceptions of caregivers feeding typically developing children. Maternal & Child Nutrition, 19(3), e13529. https://doi.org/10.1111/mcn.13529
Robert, R. C., et al. (2021). Responsive feeding is associated with minimum dietary diversity in rural areas of Peru, Nicaragua, and Indonesia. Current Developments in Nutrition, 5(Supplement_2), 430–431. https://doi.org/10.1093/cdn/nzab029_062
Rodgers, B. L. (1989). Concept analysis: An evolutionary view. Research in Nursing & Health. https://pubmed.ncbi.nlm.nih.gov/2661622/
Schwendler, T. R., Rowel, D., Abdulloeva, S., Jayawickrama, H., de Silva, C., Romano, O., Senarath, U., & Kodish, S. R. (2023). A comparison of observed feeding practices of infants and young children aged 6–23 months to national responsive feeding recommendations in Sri Lanka. Maternal & Child Nutrition, 19(3), e13522. https://doi.org/10.1111/mcn.13522
Suminar, R., Fatimah, S., & Karim, F. (2024). The culture of complementary feeding practice among stunting in toddlers aged under 24 months. Interdisciplinary International Journal of Conservation and Culture, 2(1), 21–30. https://doi.org/10.25157/iijcc.v2i1.3875
UNICEF (2020) – Improving Young Children’s Diets during the Complementary Feeding Period (Complementary Feeding Guidance / Programming Guidance) https://www.unicef.org/media/93981/file/Complementary-Feeding-Guidance-2020.pdf
Vazir, S., Engle, P., Balakrishna, N., Griffiths, P. L., Johnson, S. L., Creed-Kanashiro, H., Fernandez Rao, S., Shroff, M. R., & Bentley, M. E. (2012). Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth, and development among infants and young children in rural India. Maternal & Child Nutrition, 8(1), 99–117. https://doi.org/10.1111/j.1740-8709.2011.00348
Young, S. L., Miller, J. D., Frongillo, E. A., & Ruel, M. T. (2021). Responsive feeding practices are associated with dietary diversity among children in low- and middle-income countries. Maternal & Child Nutrition, 17(2), e13112. https://doi.org/10.1111/mcn.13112
World Health Organization, & United Nations Children’s Fund (UNICEF). (2021). Infant and young child feeding counselling: An integrated course (2nd ed.). World Health Organization. https://www.who.int/publications/i/item/9789240032828
Walker, L. O., & Avant, K. C. (2014). Strategies for theory construction in nursing (5th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall
(2019). Strategies for Theory Construction in Nursing.
World Health Organization. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
Whitfield, K. C., Ventura, A. K., & Birch, L. L. (2019). Exploration of responsive feeding during breastfeeding versus bottle feeding of human milk: A within-subject pilot study. Journal of Human Lactation, 35(2), 347–356. https://doi.org/10.1177/0890334419830992
Wiastuti, S. M., & Susanto, T. (2025). Framework for specific and sensitive of cultural interventions for management stunting children: A viewpoint. Journal of Research & Health, 15(6), 533–536. https://doi.org/10.32598/JRH.15.6.2647.1
