Infant feeding toolkit supports family caregivers by highlighting importance of mental health, social support and adequate time

February 1, 2024

Many child health, nutrition and development interventions center on parents and other family caregivers — the people responsible for caring for infants and young children at home. However, these efforts often miss a key factor in sustainable success: Caregivers need more than tangible resources like food and money.

To improve child nutrition, family caregivers also need intangible resources that support their own physical and psychological well-being.

Dr. Stephanie Martin

In a new article published in the journal Public Health Nutrition, senior author Stephanie Martin, PhD, assistant professor of nutrition at the UNC-Chapel Hill Gillings School of Global Pubic Health, calls attention to the importance of measuring these intangible caregiver resources. Co-authors on the piece include Mia Haller, a recent graduate of the Gillings School’s Master of Public Health program who now works at JSI Research and Training Institute, and UNC alum Stephanie Cooper, along with collaborators from Cornell University and USAID Advancing Nutrition.

Together, the researchers conducted a systematic scoping review of more than 9,000 research abstracts related to how the intangible resources families need to practice optimal infant feeding have been measured to date in low and lower-middle income country settings.

Based on their review, they created a toolkit of measures with USAID Advancing Nutrition, which was the flagship nutrition project of the United States Agency for International Development.

The toolkit is intended to help program and research teams understand whether their interventions successfully influence intangible resources such as healthy stress levels and adequate time.

“Caregivers can’t pour from an empty cup,” Martin says. “Even when families have financial resources and access to food, if parents — mothers in particular — experience violence or a lack of social support, their children tend to have poorer nutrition outcomes. We need programs that are designed to enhance caregiver resources, and we need to measure them to know if they are successful.”

The toolkit covers eight caregiver resources related to nutrition outcomes in young children, which are: mental health; healthy stress levels; perceived physical health; safety and security; equitable gender attitudes; self-efficacy; social support; and sufficient time.

By providing easy-to-use guidance on relevant measurement tools, the co-authors hope to promote broader incorporation of caregiver resources into child feeding interventions.

For example, they write in the toolkit: “Imagine a new program that prioritizes feeding children 6-23 months a diverse diet. […] Initial research reveals that caregivers often feel isolated, are overburdened by multiple responsibilities and experience physical abuse in their households. Using this information, the program team identifies three caregiver resources that their program can address to improve child feeding: social support, time sufficiency, and safety and security. The team then intentionally incorporates these intangible resources into the program impact pathway.”

“The toolkit also can help program and research teams select outcomes related to caregiver resources. By incorporating these outcomes into evaluations and measuring them, they will better understand whether their programs successfully influenced these intangible resources,” Martin says. “That’s vital. When families have these resources, they can more easily provide care that leads to positive child health, nutrition and development outcomes — and they can experience better quality of life for themselves.”

Martin also is senior author of another recent article on infant feeding, which she co-wrote with colleagues from Kilimanjaro Christian Medical University College in Moshi, Tanzania; Gillings School Department of Nutrition alumni Scott Ickes (PhD, 2010), Samantha Grounds (BSPH, 2021), and Emily Seiger (PhD 2024); and UNC Health Sciences Library staff member Jamie Conklin.

“We conducted a systematic scoping review to understand how paid work influences infant feeding practices during the first six months of life in Africa,” she said. “Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding. We wanted to learn exactly what supports are needed to overcome these barriers.”

The pre-print of this article is available at Science Direct.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.