| What should children eat? |
| Nutrient density, dietary diversity,and provision of ASFs, vegetables,and fruits |
Dilute cereal gruels with low nutrient density are normative for infants in many settings, e.g., Ethiopia, Cambodia, Kenya, Nigeria (30–34), with a shift toward commercial cereals in some urban areas (6) Concerns about young children not being able to chew, liable to choke (30, 35) Norms against feeding meat, fish, or green vegetables to young children transitioning to complementary foods, e.g., Cambodia, Nigeria, Kenya, Ethiopia (30–34) Premasticated meat fed to young children in Laos (36) Nomadic cultures place prestige on ownership of livestock, can limit slaughter of animals and consumption of meat by all family members, e.g., Kenya (37) Eggs make the tongue “heavy,” delay speech development, Kenya (32, 33) Feeding eggs and other ASFs associated with becoming thief, Nigeria (38) Others’ approval influences intention to feed orange-fleshed sweet potato to young children in Kenya (39) Caregivers report basing CF food choices on perceptions of what is viewed as “healthy” in Ghana (40) Positive traditional practices: e.g., including groundnuts in infant diets and using fermentation to reduce contamination in Nigeria (41) Rice and chilies viewed as promoting physical development, Laos (42) Honey not given due to adverse effects on speech development, Ethiopia (43) Young children should be fed foods perceived as “light” rather than “heavy” foods thought to interfere with motor development, Nigeria (34) Cultural norms related to hot and cold humoral typologies, e.g., Pakistan, Nepal, Cambodia (44–46) Religious practices such as fasting impact child feeding via family diets in Ethiopia (43, 47, 48) Cultural or religious dietary restriction limiting fish or meat consumption, e.g., Uganda (49)
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| Avoiding processed, energy-dense, non–nutrient-densefood |
Packaged biscuits and other sweetened snacks perceived as healthy or at least not unhealthy and may be given as a way to show love to children or placate them, e.g., Indonesia, Afghanistan, Egypt, Cambodia, Nepal (6, 30, 44, 50–52).
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| When and how are children fed? |
| Timely introduction |
Norms define age when children need foods in addition to breast milk, e.g., Bangladesh, India, Tanzania, Sierra Leone (35, 51–53) Grandmothers’ determine when to introduce first foods based on their sense of mother's breast milk production and child “readiness” e.g., Mauritania (54) Grandmothers reinforce norm of introducing thin porridges earlier than 6 mo, e.g., Senegal (52)
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| Frequency of feeding |
● Women's workload and sole responsibility for children limits time available for child care and feeding, e.g., Nepal (44) |
| Responsive feeding, interaction, andencouragement |
Lack of norms related to encouraging children to eat, e.g., Tanzania (35) Not forcing children to eat, if lacking appetite, e.g., Tanzania (35) Prioritizing autonomy and choices for child, e.g., Indonesia, Lao PDR (36, 55)
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| Hygienic preparation of foods forchildren |
Perceptions of village and family practices and others’ approval shape food hygiene behaviors, e.g., Malawi (56) Lack of norms for handwashing with soap before meal preparation, e.g., Bangladesh (57)
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| Who is responsible for child feeding? |
| Food preparation and feeding roles,decisions about child feeding,provision of food for household,and food allocation |
Pressure to be a “good mother,” having sole responsibility for child well-being and the stigma of child undernutrition make child feeding stressful for women (30, 45, 58) Strong cultural norms in many contexts make it difficult for mothers to reject the advice of a mother-in-law, e.g., India, Kenya, Sierra Leone, Nigeria, Mauritania (32, 38, 51, 52, 54, 59) In many settings, women are responsible for food preparation and feeding, but men are seen as responsible for provisioning food and making household decisions, e.g., Tanzania, Mauritania, Kenya, Afghanistan, Sierra Leone (6, 32, 52, 54, 59–61). Women expected to provision fruits and vegetables for the household and men typically provide starchy foods and ASFs in Kenya (59) Poor spousal communication and limited joint decision making influence nutrition practices in Ethiopia (31) Social norms and sanctions against male involvement in child feeding occur in many settings, e.g., Mauritania, Ethiopia (31, 54) Males are served first, and served the most valued foods, e.g., Kenya, Ethiopia (33, 43) Community norms influence food access, e.g., interhousehold food sharing during lean season or cultural events and among children who live and play together in Malawi (58)
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