Feeding your baby and child responsively

When it comes to getting to grips with feeding your baby or child, there is often lots of information about what to offer but, an equally important consideration is how food is offered and the relationship between a parent or caregiver and child at mealtimes.

Developing long-term positive eating habits and mealtime enjoyment is something every parent wants for their child and it isn’t just about the food you’re putting on the table. So what can you do to help create happy healthy mealtimes? Paediatric Dietitian and Feeding Therapist, Lucy Upton covers key advice and questions below.

What is responsive feeding?

The term ‘responsive feeding’ is well recognised and one which you may have come across already with breast or bottle feeding. It is grounded in the fact that feeding is relational, meaning it involves a shared interaction between a parent or caregiver and the child. Feeding is not something babies or children do alone!   

Feeding interactions start from the moment a baby is born and being responsive is based on parents being able to recognise and respond promptly and appropriately to a baby’s hunger and fullness cues. When parents respond to a baby or child’s feeding cues e.g. by offering a feed or food when hungry and stopping when they are full, this nurtures attunement, attachment and bonding. This approach also recognises that feeding is about more than just nutrition but also involves comfort, love, reassurance, patience and trust.

Responsive feeding during weaning and well beyond is encouraged by the World Health Organisation. As babies transition from just milk feeds to solids, it’s beneficial to consider how you can use a responsive feeding approach, and apply this to eating. It’s also important to mention that regardless of whether you choose a Baby Led Weaning (BLW) approach to weaning or spoon-led, responsive feeding principles can apply to both!

What are the benefits of feeding responsively?

There are huge benefits for both children and parents to adopt a responsive feeding approach. These are wide-ranging and include a child’s health, wellbeing, long-term feeding habits and development. Some key benefits include;

• Promoting a child’s attentiveness and interest in feeding
• Encouraging a child’s attention to their internal hunger and fullness cues
• Successful progression to independent eating 
• Increased likelihood of healthy nutritional status and growth
• Support life-long positive eating and mealtime behaviours
• Improved parental well-being and self-esteem
• Childhood obesity prevention
  

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How do you know when your baby or child is hungry and full?

Before children can communicate with adults directly with words, their behaviour, body language and expressions are their way of communicating. Interpreting these behaviours can be challenging for parents, but getting to grips with them can support a child’s weaning and feeding experiences.

Listed below are some common hunger and fullness cues. Some of these are more likely to be observed when a baby is younger e.g. first few months of weaning, and others develop as a baby gets older and their way of communicating changes.

Hunger cues eg. initiate feeding/mealtimes

• Intentionally opening their mouth and/or leaning toward the food or spoon
• Gazing at food
• Getting excited around food or as food is offered e.g. smiling, vocalising
• Reaches for or points at foods
• Crying
• Fussing
• Exaggerated or expressive facial movements around food
• Wanting to feed themselves
• Eating at a steady pace

> 1 year and into toddlerhood

• Showing or expressing interest or want for a certain food or mealtime
• May seem ‘hangry’ or change in behaviour
• Looks for food e.g. will take caregiver to where food is kept

Fullness cues e.g. stop feeding, end meal

• Crying, fussiness or meltdown
• Closing mouth and/or turning head away from food
• Clamping mouth closed
• Pushing food away (or the spoon, your hand)
• Stress signals e.g. back arching, hand splaying, distress
• Holding food in their mouth 
• Slowed rate of feeding
• Vomiting
• Head shaking e.g. signalling a no
• Turning their whole body away from food or trying to get out of their seat
• Throwing food (can be other reasons for this, so consider how long your child has been at the mealtime)
• Increasingly distracted by surrounding

The division of responsibility

Once your child is having regular meals, and perhaps joining you at the family meal interpreting their hunger and fullness cues, and trusting your child’s appetite links closely with an approach to feeding called ‘The Division of Responsibility (Ellen Satter). This approach aims to empower parents with understanding their role and their child’s role at mealtimes – again focussing on a child’s ability to regulate their own appetite. These roles are outlined simply below:

“Parent provides”

• What food or meal is offered e.g. offering balanced, varied meals
• Where a meal is eaten
• When the meal is offered e.g. providing a regular feeding routine

“Child decides”

• How much they want to eat
• Which foods they want to eat
• What order to eat food in

I’m worried my child doesn’t seem to be eating much or has lost their appetite?

There are often many pressures and worries associated with how much children are eating, appetite changes or behaviours at mealtimes. This can sometimes disrupt a parent’s ability to support responsive feeding and may impact future food parenting approaches. It can be easy to misinterpret developmentally normal child eating or feeding behaviours such as food refusal as a significant cause for concern.  As parents, it’s natural to want to ‘fix’ this if it’s perceived as a problem, however, this can often lead to compensatory parenting strategies which put pressure on the child or mealtimes e.g. using foods as rewards, coercion, offering alternatives, restricting foods to try and encourage others.

If you are worried about your child’s intake or appetite, take a look at these tips and suggestions below;

Child eating behaviours – often unlike adults, it is very common for a child’s appetite to go up and down (often quite dramatically) across days, weeks or months.  This is closely linked to their growth, but also other factors like development, illness and teething. It’s very natural to be concerned if a child skips a meal or only has one mouthful of food, however, at times like this it can be helpful to remind yourself;

• Children are great at listening to and following their own appetite
• Children can often regulate how much they need to eat across days and weeks, rather than resetting every day like a 24-hour clock. This means days where they may eat you out of house and home, and others where it seems like just a few mouthfuls!
• Short-term drops in appetite due to illness are normal – often eating is the first thing to drop and the last to come back
• All children of the same age don’t eat the same amounts! Children can grow healthily across a range of weight centiles, but naturally, children plotting along lower centile lines will need less food in comparison to children tracking higher centiles. It’s hard, but try not to compare.
• Expectation management is key when feeding kids- it is common for children to love one food and seem to loathe it the next, eat less than they did when they were weaning, and develop short-term eating habits which might seem annoying but do pass (feeding you, taking food from your plate, food throwing)

Growth – A child’s growth is a good indicator of whether their intake (from milk and/or food) is sufficient to meet their demands for growth. If you’re worried, take your child to have their growth checked and reviewed by a health professional

Enjoying mealtimes – Helping to keep mealtimes a fun, relaxed and safe place can support positive experiences around food, even with appetite fluctuations. Some positive mealtime behaviours or tips include:

• Focus on your own food, enjoy your meal and remember that your child will be watching and learning from you, your body language, facial expressions and interactions with food
• It is common for children to explore food with their hands, and faces, by chewing and spitting back out again, and more! Allow them to get stuck in and learn about food in the way they know how
• Keep distractions away from mealtimes – avoid having toys, screens or distractions which make it difficult for your child to focus on the task in hand!
• Keep positive (even if this means a game face on sometimes) – children pick up on anxiety, stress and pressure quickly and these are a huge appetite suppressants

Resources – Maureen M. Black, Frances E. Aboud, Responsive Feeding Is Embedded in a Theoretical Framework of Responsive Parenting, The Journal of Nutrition, Volume 141, Issue 3, March 2011, Pages 490–494.

Magarey A, Mauch C, Mallan K, Perry R, Elovaris R, Meedeniya J, et al. Child dietary and eating behavior outcomes up to 3.5 years after an early feeding intervention: the NOURISH RCT. Obesity (Silver Spring). 2016 Jul;24(7):1537–45.

Redsell, SA, Slater, V, Rose, J, Olander, EK, Matvienko-Sikar, K.Barriers and enablers to caregivers’ responsive feeding behaviour: A systematic review to inform childhood obesity prevention. Obesity Reviews. 2021; 22:e13228.