Practices are "activities that people do on their own in order to continue living, being healthy, healing their diseases and preserving their welfare", behaviors that are deeply rooted in a belief system and cultural traditions, hardly replaced by new knowledge and also unknown to professionals who provide care. In general terms, they can be considered as the way people address and fulfil some needs. The cultural transmission of feeding methods among humans is mainly "by females". It is the mother who learns about categories and child feeding from her mother (the grandmother of the child), and this is how the mother feeds her child according to this cultural background. The World Health Organization and the International Obesity Task Force have established as a priority, the research on the influence of parental styles in healthy eating behaviors and behaviors shown by boys and girls, as obesity can occur as a sequel of malnutrition at an early age. Objective: bibliographic review of articles on maternal feeding and nutritional status of her children, from different models.
Keywords: Maternal feeding, child rearing models, maternal perception.
The child and the family are an interactive process of evolution, dependence and separation; it significantly influences the overall development of children, especially the behavior and attitudes of the mother. It has been considered that relationships; the father’s joint participation; the academic level; the parents’ age; the socioeconomic status; the number of children; the diet; the hygiene; the psychological state of the mother; the rearing expectations; the personality styles; the nutrition; the beliefs about the child care; and the stimulation provided by the parents to their children, are elements involved in child rearing practices.[1]
Child rearing includes historical, social and cultural elements that integrate basic aspects for social reproduction, including customs, languages and parents’ education, which relate to the process of growth and wellbeing of the child. [2]
The cultural transmission of feeding methods among humans is mainly "by females". It is the mother who learns about categories and the concept of child feeding from her mother (the grandmother of the child), and this is how the mother feeds her child according to this cultural background. [3]
Childhood is considered a transcendental stage in the evolutionary process of humans. It is characterized by two phenomena: growth and development, for which a good nutrition is essential. [4] When nutrition is inadequate it wreaks havocs among the general population, its effects result more harmful when having an inadequate nutrition the first years of life. A malnourished childhood generate multiple physical and cognitive disadvantages later in life, as the consequences affect permanently the quality of life.[5]
It has been noted that the best stage to form habits for an adult life is during preschool years. In forming these habits, the mother plays a very important role because she is the main agent for the care and rearing of children.[6]
Practices are "activities that people do on their own in order to continue living, being healthy, healing their diseases and preserving their welfare", behaviors that are deeply rooted in a belief system and cultural traditions, hardly replaced by new knowledge and also unknown to professionals who provide care. In general terms, they can be considered as the way people address and fulfil some needs. [7]
Feeding beliefs consist of a thinking system capable of generating and maintaining a feeding attitude, practice or habit that is hygienic, preventive or healing, healthy or unhealthy. While feeding practices are defined as specific behaviors aimed at a particular goal, through which parents play a monitoring, controlling and coddling role, among others.[8]
It has been emphasized the importance of the role that family plays in health, since, in the early years of childhood, the family is responsible for the care and development of the child; if family members have healthy habits, it is likely that children learn them.[9] Throughout their development, children establish social relationships with multiple members belonging to the environments that surround them. The basic analysis unit to understand their development is established in the mother-child dyad, and the mother-son link influences the cognitive development, the learning motivation and the nutritional status of the child.[10]
Therefore, childcare is a concept that relies on the family and the community, and as a historical-social support of practices inherited from the ancestors.[11]
1.1 Person in charge of the health -disease process.
Women are responsible for the health and nutrition of the whole family, she is characterized for her reproductive functions; this is, maternity defined as a "person for others", also, her role in her home involves decision, provision or acquisition, preparation and distribution of food for the whole family.[7]
Formal schooling achieved by mothers is an indicator associated with the possibility to get and access relevant information for a good nutrition and a family nutrition. Mothers with higher levels of education may have more information to improve their family’s diet, ensure hygienic measures among its members, recognize signs of malnutrition and make the right decisions on what to do in case of diseases.[11]
Perception is a sensory and cognitive process which involves processes and mechanisms to generate judgements about oneself and others.[12] It is a person's own process, influenced by the relationship there is with the perceived subject, experiences, and beliefs associated with a specific phenomenon; besides, this information is affected by the characteristics of the beneficiary, such as age or schooling, which generates responses or judgments about the person stimulus.[13]
The knowledge of mothers comes from various sources. They get information on child nutrition from health facilities, as well as from family, friends and the media, as the State and other actors (non-governmental, churches, etc.) promote the dissemination of this knowledge. Mothers are not only guided by information from external sources, they also make their own perceptions of what is good for the growth and nutritional status of their children, in consequence, it is more likely for them to make decisions based on subjective and biased information. Therefore, the care practices of mothers are conditioned to what they consider appropriate for their children. This way, feeding coming from the mother during and after the breastfeeding period, the importance she gives to health checks, and her hygiene practices, among other factors, are the reflection of her knowledge about nutrition and child care.[14]
Some authors refer that there is a positive relationship between the level of schooling of the mother and the nutritional knowledge of her son/daughter.[14], [15]
The father determines the objectives and goals that are expected to be achieved by the child, and the mother selects the strategies, techniques and procedures to achieve them. That way, the father is the provider, domineering, while the mother is loyal, and protective.[16]
The nutritional status is defined as the result of the balance between intake and the requirement of macro and micronutrients. Knowing the nutritional status of the population is a priority for most countries in order to generate public policies to deal with malnutrition.[17]
3.1 Well-nourished child
The health of a child, or specifically his/her nutritional status, depends on a number of factors, some of them are under the direct control of parents, others are beyond their faculties but can be tackled by other institutions through public policies, like for example the access to health services, or even an exogenous factor like the weather.[14] Of all factors mentioned before, the most relevant in this review is the knowledge about children’s’ nutrition that mothers possess in indigenous and rural areas, as it can have a great impact on the nutritional status of their children. [16]
In Mexico, pediatric preventive care actions are covered by Mexican Official Standard NOM-031-SSA2-1999, where the guidelines for nutritional surveillance, growth and development of children under five years are given.[18] This standard reveals that, in terms of preventive measures, the actions that have proven to be effective and that must be promoted in the community are: provision of dietary guidelines to the mother or the person responsible for the child under five years old, in the areas of food and nutrition, breastfeeding, hygiene and water chlorination.[19]
3.2 Malnourished child
Malnutrition may manifest as undernourishment or overweight/obesity.[20] Malnutrition is caused by a negative balance between energy consumption and expenditure; that is, when there is a deficient food and nutrients intake, which are necessary to fulfil the nutritional requirements of an individual. In children, it has as immediate consequence, the incidence of infectious and parasitic diseases that increase the need of some nutrients, decreasing its absorption, or causing losses of micronutrients.[21]
In 1990, the United Nations Children's Fund (UNICEF) developed a conceptual framework on the causes of child malnutrition; it reveals that the causes of malnutrition are multi-sectoral and cover nutrition, health care, and childcare practices.[22]
The presence of malnutrition in children under five years old has consequences that affect in the short, medium and long term, which can range from a higher presence of infectious diseases[23] to a greater propensity for chronic diseases, disability and death.[24]
Delayed growth is a long-term consequence, accumulated health and nutrition deficiencies. When indicators in children are below two standard deviations of the average of the reference pattern, which is the World Health Organization (WHO), it is considered that there is chronic malnutrition in the height-for-age ratio. This indicator reflects the nutritional status throughout the child's life and reveals the presence of malnutrition that responds to persistent nutritional deficiencies and/or vulnerability to diseases.[25]
Obesity can occur because of malnutrition in early stages of life. This results from malnutrition generated by the restriction of energy intake that promotes the increase of energy reserves even when food consumption is sufficient.[26]
Overweight and obesity have been associated with a higher risk of having comorbid diseases in adulthood, particularly cardiovascular diseases, type 2 diabetes (diabetes mellitus) and hypertension. Also, obesity in children makes them more isolated and with a low self-esteem.[20]
According to WHO, many developing countries, like Mexico, are facing a "double burden" of morbidity. While still struggling with problems of infectious diseases and malnutrition, these countries are experiencing a sharp increase in risk factors of finding non-communicable diseases such as overweight and obesity coexisting in the same country, the same community or even within a same household.[27]
Therefore, the nutritional status in childhood influences the future work capacity and subsequent obtention of incomes in adulthood.[28], [29]
In Mexico, the latest ENSANUT (National Health and Nutrition Survey) 2012 reported that the prevalence of chronic malnutrition in children under five years old was of 13.6 %, which affects 1, 467, 757 children and obesity affects 9.7 %.[30]
Since 1984, child-rearing models have been developed, such as Belsky model that picks up elements like personality of the mother, child characteristics and contextual components with the parent-child interaction, couple relationship, source of stress and support. From these variables, the model "Multiple determinants of parenting" is proposed, which comes from the idea that parenting is a protected system where psychological well-being of parents is the mediating element in the child rearing practice; or like the model developed by Webster-Stratton, in 1990, to know the elements that determine the perception of parents about their children's behavior and family interactions. This model assumes that stressful conditions, such as extra-family events, stressors between parents, and stressors caused by the child, are events in which parents will have to develop strategies to face these situations. In addition, a good relationship of parents and an effective interaction with their children will depend on the psychological well-being of parents and the accessibility to social support. [31]
The correlation model of Vera and Velasco, in 2000, presents some characteristics of the personality of the mother and a subjective evaluation of the participation of the father involved in the development of the child. Evidence shows that maternal variables like self-concept, depression, authoritarianism and some other related to her partner and her job, influence the development of the child. [32]
Vera and Peña, in 2004, performed a correlation model presenting associations between variables that have to do with child rearing and development of children in extreme poverty in a rural population, in families with children aged 1 to 5. In order for the mother to successfully practice motherhood, family and personal conditions are needed, that comply with the role as facilitators of the child’s development. In the case of stimulation and interaction behaviors, there is the parenting stress (stress that the mother perceives during the child rearing practice) and underlying elements (authority style and co-participation perception).[32]
Pérez, González, Peña and Vera, in 2007, made a model consisting of proximate variables (microsystem), as well as the variables involved in the development of the child (child stimulation and mother-father-child interaction). Intermediate variables (mesosystem) are also formed by the characteristics of mothers involved in the child's development (style of mother’s authority, self-concept, stress, perception of co-participation). Underlying variables (exosystem) consist of family functioning and social support for child rearing, for which it is recommend to carry out studies at a regional, municipal or local level, in order to know and understand the ways of child rearing, parenting life styles, family living and support networks; and to identify social and family factors included in the development of cognitive and motor skills of children.[33]
The model of child rearing practices from Norway, in 1996, states that the constituent elements of parenting practices have another source of variation, risk estimates, controllability and susceptibility of the child facing a development, health and nutrition problem. To explain behavior, not intentions, they measured: a) susceptibility as the stimulation of a child's vulnerability to a possible health and development problem; b) the level of control perceived by the mother; c) the risk estimation of inappropriate behaviors. The contribution of these elements to the studied phenomenon depended on the retrospective evaluation of the mother about the development or health of the child, which was different in children at risk or at no risk in their development, reported as healthy, sick, with low and high weight for their height. These variables acted independently or concatenated in determining the specific behavior for children of a population at risk or at no risk in the three child care behaviors.[16]
Useful questionnaire to measure parental behavior, beliefs, attitudes and practices regarding their children feeding. It consists of seven factors (perceived weight of the mother, concern and control of the child’s weight, monitoring, restriction, pressure to eat, perceived responsibility and weight of the child) and two controls (control and manipulation). It has 34 items, it uses a pictographic scale with five response intervals of Likert type, ranging from “a lot” to “nothing”, with a Cronbach's alpha = .82. The way to evaluate it consists of adding the scores of each reagent, giving a value of 1 to the option “nothing” and five to the option “a lot”. For the analysis, the tendencies of the scores are observed; if they are higher than three (theoretical average), it is stated that there is a strong tendency toward the evaluated factor; if they are below three, it is stated less tendency toward the factor. Measured behavioral dimensions, perceived responsibility, self-perception of the weight of parents, perception of the child’s weight, parents’ concern for the child's weight, supervision, cognitive restriction and pressure to eat. Mothers strongly influence the weight of their children and are more conscious about their eating behavior.[9]
Given the premise that behaviors and dietary patterns are formed and learnt, but not inherited, through a process that occurs in the early years of life. The role that parents play in the development of feeding habits in their children, has become more and more important, becoming a topic of global concern, as the World Health Organization and the International Obesity Task Force (International Association for the Study of Obesity) have established as a priority, the research about the influence of parental styles in eating behaviors and healthy behaviors that boys and girls show.[27]
Some authors refer that the influence of parents on their children shows significant differences depending on the gender of the child. Therefore, it is suggested that both fathers and mothers are considered in future studies on feeding practices and infant weight. Beyond the nutritional aspects and the follow up of anthropometric measures, family and school must be considered as institutions in which various factors that promote the development and welfare of children, operate.[34]
There are scarce studies that deal with associations between the feeding practices and the nutritional status of their children, differentiating according to the context of residence: urban and rural areas. Therefore, they represent a big window of opportunity to conduct research in that nature, as well as the parents’ only approach.
[1] Vera Noriega A, Peña Ramos M, Calderón González NG. Prácticas de crianza y educación inicial en la etnia Mayo. Estud. Soc. 2009; 17: 1-9.
[2] Gómez P GJ, Domínguez M C. Crianza y desarrollo infantil en las familias Yoreme-Mayo en el Norte de Sinaloa. In UAIM editor. Sinaloa, México. 2007.
[3] Cabrera Rojas N, Rolón Arámbulo R, Garcete Mañotti L, Sanabria MC, Arredondo M, Pizarro F. Comparison of Maternal Perception and Real Nutritional Status of Preschool Children Seen a General Pediatric Facility. Pediatria (Asunción). 2013; 40: 235-240.
[4] Ortíz-Adrelucchi A, Peña Quintana A, Albino Beñacar A, Mönckerberg Barros F, Serra-Majem L. Desnutrición infantil, salud y pobreza: intervención desde un programa integral. Nutr. Hosp. 2006; 21: 533-541.
[5] Patel K, Langare S, Naik J, Rajderkar S. Gender inequality and bio-social factors in nutritional status among under five children attending anganwadis in an urban slum of a town in Western Maharashtra, India. J Res Med Sci. 2013; 18: 341-345.
[6] Lara Garcia B. Percepción materna del peso del hijo y riesgos a la salud de la obesidad infantil León. In UUAdN editor. Nuevo León. 2010.
[7] Ramos Lafont C. Prácticas culturales de cuidado de gestantes indígenas en el Resguardo Zenú ubicado en la Sabana Córdoba, Bogotá, Colombia. In UNd editor. Bogotá, Colombia. 2011.
[8] Darling N, Steinberg L. Parenting style as context: An integretive model. Psychological Bulletin. 1993; 113: 487-496.
[9] Navarro G. Prácticas parentales de alimentación, locus control y su relación con el índice de masa corporal en niños(as), preescolares y escolares. In UNAM editor. México: Facultad de Psicología. 2006.
[10] De Tejeda M, González de Tineo A, Porras R. Aproximación del perfil conductual de madres con niños desnutridos graves. Archiv. Venezolanos de puericultura y pedriatria. 1996; 59.
[11] Peña Ramos M. Crianza y desarrollo infantil en familias rurales de la región Sur de Estado de Sonora desarrollo CdIeay, editor. Hermsillo, Sonora. 2004.
[12] Lara-Garcia B, Flores-Peña Y, Alatorre-Esquivel MA, Sosa-Briones R, Cerda-Flores RM. Percepción materna de sobrepeso-obesidad infantil y riesgos de salud en Nuevo Laredo, Tamaulipas, México. Salud Pública de México. 2011; 53: 258-263.
[13] Guevara-Cruz M, Serralde-Zuñiga A, Frigolet Vázquez-Vela M, Blancas Galicia L, Islas Ortega L. Association between maternal perceptions and actual nutritional status for children in a study group in Mexico. Nutr Hosp. 2012; 27: 209-212.
[14] Marini A, Alcázar L, Walker I. El rol de las percepciones y los conocimientos de las madres en el estado nutricional de sus niños.In GRADE editor. Lima, Perú. 2011.
[15] Schultz T. Studying the impact of household economic and community variables on child mortality. Population and Development Review. 1984; 10: 215-235.
[16] Vera Noriega Á. Evaluación de un modelo descriptivo sobre Atención Primaria en Salud y Desarrollo Infantil en zonas rurales. In UNAM editor. México, D.F. 1996.
[17] Commitee on Nutrition, American Academy of Pediatrics. Pediatric Nutrition Handbook A.A.P. [Online].; 1998 [cited 2016 Abril 12]. Available from: http://europepmc.org/abstract/med/10545566.
[18] Flores-Peña Y, Ortíz-Félix E, Cárdenas-Villareal VM. Percepciones maternas del cuidado del niño sano. Rev. Latino-Am. Enfermagem. 2012; 20: 1-7.
[19] Secretaría de Salud. NOM-031-SSA2-1999. [Online].; 1999 [cited 2016 marzo 23]. Available from: http://www.salud.gob.mx/unidades/cdi/nom/031ssa29.html.
[20] Rivera Dommarco J, Shamah Levy T, Villalpando Hernández S, González del Cossío T, Hernández Prado B, Sepúlveda J. Encuesta Nacional de Nutrición; Estado nutricio de niños y mujeres en México. [Online].; 1999 [cited 2016 abril 11]. Available from: http://www.salud.gob.mx/unidades/cdi/documentos/nutricion.pdf.
[21] Glewwe P, Durlauf S, Lawrence B. Nutrition an Development. In the new Palgrave Dictionary of economics MacMillan P editor. 2008.
[22] UNICEF, Fondo de la Infancia de las Naciones Unidas. Estado Mundial de la Infancia. [Online].; 1998 [cited 2016 abril 10]. Available from: http://www.unicef.org/spanish/sowc98sp/.
[23] Caulfield E L, De Onis M, Blössner M, Black R. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr. 2004; 80: 193-198.
[24] Black E R, Allen H L, Bhutta A Z, et al. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet. 2008; 371: 243-260.
[25] Moore E, Halsall I, Howarth D, Poskitt M, Prentice M. Glucose, insulin and lipid metabolism in rural Gabians exposed to early malnutrition. Diabetic medicine. 2001; 18: 646-656.
[26] Sawaya L, Roberts S. Stuning and future risk of obesity: principal physiological mechanisms. Cad. Saúde Pública. 2003; 19: S21-S28.
[27] Organización Mundial de la Salud-OMS. Obesidad y sobrepeso. [Online].; 2015 [cited 2016 marzo 28]. Available from: http://www.who.int/mediacentre/factsheets/fs311/es/.
[28] Pollit E, Golub M, Gorman K, et al. A reconceptualization of the effects of undernutrition on Children´s biological, psychosocial, and behavioral Development. Social Policy Report; Society for Research in Child Development. 1996; 5: 2-32.
[29] Engle L P, Black M M, Behrman R J, et al. Strategies to avoid the loss od developmental potential in more than 200 million children in the developing world. The Lancet. 2007; 369: 229-242.
[30] Gutiérrez P, Rivera Dommarco J, Shamah Levy T, et al. Encuesta Nacional de Salud y Nutrición. [Online].; 2012 [cited 2016 marzo 26]. Available from: http://ensanut.insp.mx/.
[31] Belsky J. The determinats of parenting a process model. Child development. 1984: 83-94.
[32] Peña Ramos M. Crianza y Desarrollo infantil en familias rurales de la región Sur del Estado de Sonora. In Centro de Investigación en Alimentación y Desarrollo AC editor. Hermosillo, Sonora; 2004.
[33] Vera Noriega Á, Peña Ramos M, Calderón González G. Prácticas de crianza y educación inicial en la etnia Mayo. Estudios Sociales. 2010;1: 304-324.
[34] Castrillón C, Giraldo R OI. Prácticas de alimentación de los padres y coductas alimentarias en niños ¿Existe información suficiente para el abordaje de los problemas de alimentación?. Revista de Psicología, Universidad de Antioquía. 2014; 6: 57-74.
[a]Corresponding Author:
M.S.P. Raquel Balderrama Díaz
DIGNA - SEDESOL en el Estado de México
Presa Salinillas 370, Naucalpan, Estado de México. Mexico
Tel: (52) 7711275673
E-mail: nutrirachel29@gmail.com
1. DIGNA - SEDESOL, Estado de México. Mexico.
2. Área Académica de Psicología. Instituto de Ciencias de la Salud. Universidad Autónoma del Estado de Hidalgo. Pachuca, Hidalgo. Mexico.