Behavioral Solutions for Child Feeding During and After Illness

"Caregivers identify achievable improvements within their means and feel empowered by focusing on what they can do..."

This resource shares a suite of behavioural solutions to address barriers to optimal complementary feeding during and after illness. It is informed by qualitative research conducted in the Democratic Republic of the Congo (DRC) by Breakthrough ACTION and USAID Advancing Nutrition to gather the perspectives, experiences, and challenges experienced by caregivers, health workers, and others seeking to ensure that young children experiencing an illness avoid malnutrition as they recover.

Behavioural design is an approach that leverages insights from behavioural economics, social psychology, human-centred design, and other disciplines to develop and test solutions. In that vein, Breakthrough ACTION and USAID Advancing Nutrition began the process by generated hypotheses about potential drivers of feeding behaviours based on existing evidence. They investigated hypotheses through 58 qualitative interviews and observations of 10 consultations in clinics in Katana and Mubumbano, South Kivu, DRC in 2021. They then translated the 5 key behavioural barriers that emerged (click here for details [PDF]) into concrete objectives for programme design. Through structured individual and group activities, they generated 62 design ideas to address the barriers, eventually building prototype versions of 12 design ideas, which they tested and refined with over 85 caregivers, health workers, and other community members.

The solutions presented in this resource work through multiple channels to support caregivers of 6- to 23-month-old children to continue to breastfeed and feed children during illness and to feed them more for 2 weeks after illness:

• In sick child consultations, a "feeding prescription", counseling aids, and reminder stickers support health providers to counsel consistently and effectively. Through a facilitated discussion, frontline health providers who engage with caregivers during sick child consultations reflect on what sick and recovering children need and how caregivers may understand and respond to their advice. They learn simple, motivational messages that can be integrated into busy consultations.
• In gatherings of caregivers, a peer exchange of coaxing strategies facilitated by a community health worker builds caregivers' skills and confidence to encourage young children to eat when appetite is poor.
• In home visits to families of sick children by a community health worker, families learn together to "celebrate every bite" and plan to overcome challenges to feeding the child during illness and recovery.

The resource is intended to support policymakers and programmers when they consider which of these solutions may help them achieve their health, nutrition, and development programme goals. The brief describes how the solutions work, what questions to ask to determine whether solutions might fit local needs, and how to adapt and integrate them into health services and/or community activities. The solutions can be used separately or together in a package.

Together, these solutions are designed to equip community- and facility-based health workers with resources and approaches to support families to feed children well during illness and recovery. The ultimate aim is to guide and encourage families to take concrete actions to put their intentions to feed their children well into practice.