Health providers give feedback on potential interventions to improve the feeding of young children during and after an illness.

For young children experiencing an illness, adequate nutrition is critical for recovery. However, children often don’t receive the recommended amounts of food during and after an illness. In the Democratic Republic of the Congo (DRC), 70% of children under five receive less food than usual or no food during episodes of diarrhea. Similar gaps exist across many low- and middle-income countries like Pakistan (63%), Ethiopia (65%), and Peru (72%). In settings like these where childhood illness is common, too little food during and after illness contributes to high rates of child malnutrition, as children are unable to recoup lost weight. Malnutrition, in turn, can lead to stunted growth and development and higher child mortality.

Why aren’t young children fed enough during and after illness? As part of our behavioral approach to understanding this problem, we conducted qualitative research with families and health providers in the DRC. Working through the USAID-funded Breakthrough ACTION project and in collaboration with the USAID Advancing Nutrition Project and local partners, we learned that while caregivers want to feed their child well during an illness, they understandably feel discouraged and at times powerless in the face of the myriad constraints they encounter. These significant constraints, discussed below, obscure steps that caregivers could take with the resources available to them.

Sud Kivu is the region in the DRC where research was conducted to better understand the barriers to feeding young children during and after an illness.

Mental models of “worthwhile” foods limit the choice set

First, caregivers described a need for the child to recoup strength lost during illness with specific, “high quality” foods they associate with strength, like meat, dairy, and eggs. Health providers, leveraging their nutrition training, reinforce this perception by counseling on the importance of feeding children animal-source foods. However, most families can rarely afford or access these products. This rigid mental model of worthwhile foods leads caregivers to underestimate more locally available, affordable options such as small fish, fruits, and vegetables. Redirecting attention to these foods can expand a family’s choice set of which foods are worthwhile and may increase feeding during recuperation. 

Strengthening coaxing skills can help overcome a child’s limited appetite 

Second, caregivers expressed frustration with their child’s limited appetite during illness, which they saw as outside their control and a reason not to offer more food. Coaxing is critical for encouraging a sick child to eat, yet caregivers do not have broad repertoires of coaxing tactics. The tactic caregivers most frequently mentioned was offering their child’s favorite foods, but these foods are often unaffordable. Strengthening caregivers’ coaxing skills through counseling programs, workshops, or peer-to-peer sharing networks could empower caregivers to feel that they can win over their child’s appetite and allow them to feed more when the child is sick. 

The consultation room at a health center in Sud Kivu, DRC. Providers and caregivers alike focus intensely on medical treatment during a sick child consultation and do not currently discuss lost nourishment. Optimal feeding during and after illness is a critical behavior not widely practiced.

These insights and others identified through our formative research provide a roadmap for program design that supports caregivers to feed their children well with the resources they have, building skills and habits that are critically important during periods of illness and recovery but that remain relevant in times of good health. 

We, along with our partners in Breakthrough ACTION and at USAID Advancing Nutrition, are currently developing a suite of solutions with caregivers and health workers. In one solution, for example, community health workers use a set of cards during home visits to families with sick children to identify affordable foods and make a feeding plan. Another intervention uses the time mothers spend waiting for child vaccinations to facilitate peer-to-peer sharing of coaxing strategies. These solutions, and others, work across multiple health system touchpoints to help families better feed their children to promote recovery from illness, fight off future illness, and ensure infants grow into healthy children and adults. 

Stay tuned for our full suite of solutions and more insights from our work supporting caregivers to feed their children well. We’ll be sharing an in-depth look at our intervention designs in an upcoming post. Questions? Reach out to the Global Health team at gh@ideas42.org.

This content is also available on the Breakthrough ACTION blog.