What is responsive feeding in babies and children and why does it matter?
What is responsive feeding, and why does it matter? From Christina Hills, a HCPC registered paediatric dietitian and nutritionist with 10+ years experience
Our relationship with food starts the day we are offered solid food, and continues to develop through those early years.
Research into feeding styles in babies is growing and there is a building body of science which shows it is not just the type of food we offer (puree vs finger food, healthy vs unhealthy food), but the way we feed our babies and children that matters. This is where ‘responsive feeding comes in’
Responsive feeding is an approach to feeding babies and children that’s based on recognising and responding to their hunger and fullness cues in a supportive, respectful way.
Whilst offering a wide range of healthy and nutritious foods, appropriate to their developmental staff.
It is about more than just nutrition, it is about the wider parent-child relationship during feeding, based on trust that your baby will eat and drink what they need.
Instead of pressuring and bribing children to eat, responsive feeding encourages self-regulation. It’s rooted in the idea that babies and young children are born with the innate ability to know how much food they need.
Learning to recognise your babies hunger and fullness cues is key to successful feeding and the cues in babies are different to those we see in toddlers and older children.
By telling a baby to just eat a few more spoons’ of a dish- it may feel like we are doing the right thing - but we are actually encouraging our baby to go against those internal signals telling them ‘I am full, I have eaten enough’.
When we look at the research around baby-led weaning, one of the big themes coming out is about how allowing your baby to self-feed actually encourages them to follow those instinctive cues of hunger and fullness.
And that spoon feeding can lead to babies eating more than they would have if they were allowed to self-feed which goes against those internal signals telling baby I am full.
However, I am a big believer that this is not so much about the method of feeding (BLW vs spoon feeding) but the style of feeding: responsive vs non-responsive. And that babies who are spoon fed can also be fed in a responsive way.
In the same way, babies who are breastfeed, actually ’self-feed’ and self-regulate- we have no idea how much they are drinking. Yet formula fed babies can also be fed responsively.
The WHO states responsive feeding as one of the key criteria in how babies should be introduced to solid foods.
What is the evidence?
Studies on baby-led weaning show babies who self feed do get enough nutrients, they grow well and they go on to be less likely to be described as fussy eaters by their parents!
There is also lots of research around responsive feeding in older children. What does responsible feeding look like in older children? It means serving healthy dinners, filling the house with healthy snack options for children to eat if they feel hungry. It means praising positives but trying to not focus to heavily on the negatives
But, when might this go wrong.
In an ideal world we would eat purely for nutrition- we eat when we are hungry- and we stop when we are full. But we are more complex than this and we eat for many reasons other than hunger.
Sometimes, for example, we might worry that our children are not eating enough. This is what happens in the case of picky eaters or restricted eaters. Parents of picky eaters often worry their children are not eating enough. We want them to eat more. How do we do this? Do we need to force them to eat?
Studies have shown that pressurising an older child to eat a food decreases how much they like that food later. In one study - children who were pressurised to eat a whole bowl of soup went on to like the soup less afterwards (which to me - isn’t surprising at all!)
Rewarding a child to eat more of a food also doesn’t work- in one study it increased how much they ate in the moment - but actually decreased how much they liked it later!
Studies have looked at weight gain in children and linked this with maternal pressure to eat. Mothers who have a child who is underweight will want them to eat more. But the studies generally show that maternal pressure to eat actually increases the chance that a child has slower weight gain- so the complete opposite!
Similarly, we know that bribing children with food to reward behaviour or to comfort their emotions were at greater risk of overeating when they weren’t hungry and greater risk of being overweight
Of course this is a complex area and these situations are always multifactorial.
But what the research tells us is that in most situations, pressurising a child to eat when they clearly do not want to is not a good thing!
By forcing children to eat, or rewarding children with food, we are teaching children to eat in ways that does not align with those internal hunger and satiety cues, and instead we are teaching them override them. It also does not encourage liking of foods.
Babies and children eat best when they are exposed to an array of healthy meals and snacks in a low pressure environment where healthy eating is ‘modelled’ - which means eating a healthy diet yourself. For example children with parents who consume lots of fresh fruit and veg are more likely to go on to eat lots of fruit and veg. 5
Key principles of responsive feeding
Offer meals and snacks at regular times, without pressure
Offer a variety of healthy food across the week, a mix of- preferred foods and some new or previously disliked foods
Watch for hunger cues (these are different for babies vs toddlers- see below)
Stop when baby shows signs of fullness (turning away, pushing food away, losing interest- these are different for babies vs toddlers- see below)
Create a positive mealtime environment- calm, no pressure to eat
Trust your child’s appetite- your role is to offer, their role is to decide how much to eat
Hunger + fullness cues in babies (under 12 months)
Hunger cues:
Rooting (turning head toward your chest or a bottle)
Sucking on hands, fingers, clothes
Opening mouth when offered food or breast/bottle
Smacking or licking lips
Becoming more alert or active, restless
Crying (a late hunger cue- try to catch earlier ones!)
Fullness cues:
Turning head away from food or bottle
Pushing spoon, bottle, or breast away
Slowing down sucking or eating
Getting distracted or losing interest
Closing mouth when offered a bottle or food
Relaxed, calm body or falling asleep
Hunger + fullness cues in toddlers (12 months+)
Hunger cues:
Asking for food verbally (e.g. “snack,” “hungry”)
Going to the kitchen or highchair
Pointing to or reaching for food
Increased irritability or restlessness near meal/snack times
Watching others eat with interest
Fullness cues:
Saying “all done” or “finished”
Pushing plate away or trying to leave the table
Playing with or throwing food
Slowing down or stopping eating
Clamping mouth shut or turning head
References / extra reading
Brown, A. (2016). Why starting solids matters. London: Pinter & Martin.
Cooke LJ, Wardle J, Gibson E, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutrition. 2004;7(2):295-302. doi:10.1079/PHN2003527: https://www.cambridge.org/core/journals/public-health-nutrition/article/demographic-familial-and-trait-predictors-of-fruit-and-vegetable-consumption-by-preschool-children/ED216A353C1B99418E8E751BEFB0CBAF
Galloway, A.T., Fiorito, L., Lee, Y., & Birch, L.L. (2005). Parental pressure, dietary patterns and weight status among girls who are picky eaters. Journal of the American Dietetic Association, 105, 541–548: https://pmc.ncbi.nlm.nih.gov/articles/PMC2530930/
Birch, McPheee, Shoba, Steinberg, Krehbiel (2004) Clean up your plate”: Effects of child feeding practices on the conditioning of meal size, Learning and Motivation, Volume 18, Issue 3, Pages 301-317:
https://www.sciencedirect.com/science/article/abs/pii/0023969087900178
Benton, D. (2004). Role of parents in the determination of the food preferences of children and the development of obesity. International Journal of Obesity, 28, 858–869: https://www.nature.com/articles/0802532
Brann, L.S., & Skinner, J.D. (2005). More controlling child-feeding practices are found among parents of boys with an average BMI compared with parents of boys with a high BMI. Journal of the American Dietetic Association, 105, 1411–1416:
https://www.jandonline.org/article/S0002-8223%2805%2901030-8/abstract
Farrow, C.V., & Blissett, J. (2008). Controlling feeding practices: Cause or consequence of early child weight? Pediatrics, 121(1), e164–e169:
Blissett, J., Haycraft, E., & Farrow, C. (2010). Inducing preschool children’s emotional eating: Relations with parental feeding practices. American Journal of Clinical Nutrition, 92(2), 359–365: