Infant feeding toolkit supports family carers by emphasizing the importance of mental health, social support and adequate time

Infant feeding toolkit supports family carers by emphasizing the importance of mental health, social support and adequate time

February 1, 2024

Many child health, nutrition, and developmental interventions focus on parents and other family caregivers (those responsible for caring for infants and young children at home). However, these efforts often overlook a key factor for sustainable success: caregivers need more than just tangible resources like food and money.

To improve child nutrition, family caregivers also need intangible resources to support their own physical and mental health.

Dr. Stephanie Martin

Dr. Stephanie Martin

In a new article published in the magazine public health nutrition, Senior author Stephanie Martin, PhD, assistant professor of nutrition at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, calls attention to the importance of measuring these invisible resources of care. Co-authors of the article include Mia Haller, a recent graduate of the Gillings School’s Master of Public Health program and now at the JSI Research and Training Institute, and UNC alumna Stephanie Cooper ), and collaborators at Cornell University and the USAID Center for Nutrition Advancement.

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

Based on their review, they created a toolkit of measures with USAID Advancing Nutrition, USAID’s flagship nutrition program.

The toolkit is designed to help projects and research teams understand whether their interventions are successfully affecting intangible resources, such as healthy stress levels and adequate time.

“Nursing staff can’t pour water from an empty cup,” Martin said. “Even if families have economic resources and access to food, if parents, especially mothers, experience violence or lack social support, their children tend to have poorer nutritional outcomes. We need programs designed to strengthen caregiver resources, and we They need to be measured to know whether they are successful.”

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

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

For example, they write in the toolkit: “Imagine a new program that prioritizes providing a diverse diet to children aged 6-23 months. […] Preliminary research shows that caregivers often feel isolated, have multiple responsibilities, and experience physical abuse in the home. Using this information, the project team identified three caregiver resources that their project could use to improve child feeding: social support, time adequacy, and safety and security. The team then intentionally incorporates these intangible resources into the project’s impact path. “

“The toolkit can also help program and research teams select outcomes related to caregiver resources. By incorporating these outcomes into their assessments and measuring them, they will better understand whether their programs are successfully impacting these intangible resources,” Martin explain. “This is important. When families have these resources, they can more easily provide care that leads to positive child health, nutrition and developmental outcomes, and they themselves can experience a better quality of life.”


Martin is also the senior author of another recent article on infant feeding, which she co-authored with colleagues at Kilimanjaro Christian Medical University College in Moshi, Tanzania. Gillings School Nutrition Department 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 system-wide review to understand how paid work affects how babies in Africa are fed during their first six months of life,” she said. “Across the world, paid work without appropriate structural support is a major barrier to optimal breastfeeding. We wanted to understand exactly what support is needed to overcome these barriers.”

A preprint of this article is available at scientific guidance.


Contact the UNC Gillings School of Global Public Health communications team: [email protected].

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