Correlation Between Mothers’s Knowledge, Attitude, and Practice

Basic Feeding Rules vs. Eating Behavior in Preschool Age Children

Fina Intan Puspita

, Lailatul Muniroh

1,2

and Tsamara Alifia Ramadhani

Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

Research Group Center for Health & Nutrition Education, Counselling and Empowerment, Indonesia

Keywords: Basic Feeding Rules, Eating Behavior, Preschool Age Children.

Abstract: The stunting rate in Surabaya is 27,4%. The implementation of basic feeding rules aims to reduce

inappropriate feeding practices and improve children’s nutrition and health. This study aimed to analysed the

correlation between a mother’s knowledge, attitude, and practice of basic feeding rules with eating behavior

in preschool-age children. A sample size of 41 respondents was selected by simple random sampling for this

cross-sectional study. Mothers’ knowledge, attitude, and practice of basic feeding rules were assessed based

on Bonnin’s theory in 2005. Children’s eating behavior was assessed using the Behavioral Pediatric Feeding

Assessment Scale (BPFAS) and categorized based on the Total Frequency Score (TFS) and Total Problem

Score (TPS). The study results showed that 39% of children experienced eating problems, while most mothers

had good knowledge, attitude, and practice of basic feeding rules. The test results showed no correlation

between mothers’ knowledge (p= 0,788 based on TFS; p=0,794 based on TPS) and attitude (p= 0,587 based

on TFS; p=0,903 based on TPS) with children’s eating behavior problem. However, there was a significant

correlation between mothers’ practice of basic feeding rules with children’s eating behavior based on TFS

(p=0,033), but no correlation based on TPS (p= 0,091).

1 INTRODUCTION

Toddlerhood is an important phase in a child’s growth

because the development that occurs during this

period lays the foundation for their future growth and

can significantly influence their maturation. As

children transition into the preschool age, they start to

express their preferences (Ministry of Health, RI.,

2016). Within the initial five years of life, the body

undergoes rapid changes and growth. The

establishment of eating habits, which may serve as the

groundwork for future eating patterns, takes place

during these first five years (Taylor and Emmet,

2019). During this stage, children may encounter

eating behavior problems, such as being small eaters

and displaying food preferences (selective eating and

picky eating), which can potentially lead to various

health risks later in life (IDAI, 2015). Additionally,

these problems can give rise to nutritional issues, such

as stunting and wasting (Prasetyo dan Hagono, 2020).

According to the 2021 Indonesian Nutrition Status

Survey, the stunting rate in Indonesia is 27,67%. The

stunting rate in Surabaya is 27,4%. Based on research

conducted by the UKK Nutrition and Metabolic

Diseases IDAI in 2014, inappropriate feeding

practices significantly contribute to the emergence of

eating problems in children. Children often consume

the food provided at home, those the meals served at

home heavily influence their dietary choices.

Consequently, families particularly parents, play a

crucial role in shaping and educating children

regarding their eating behavior (Ogden, 2014).

However, the primary responsibility for child-feeding

practices lies with the mother (Muriyanti, et al.,

2022).

The basic feeding rule was created to address

numerous mistakes that parents make when feeding

their children. Basic feeding rules consist of

structured guidelines encompassing three key aspects,

such as feeding schedules, environment, and

procedures (Ghinanda, et al., 2022). Therefore,

mother's Knowledge, Attitude, and Practice (KAP)

are also highly important to promote children's health.

Exposure of mothers and children to dietary

guidelines is very important to encourage healthy

eating habits and good nutritional status (Prasetya dan

Khomsan, 2022).

Puspita, F. I., Muniroh, L. and Ramadhani, T. A.

Correlation Between Mothers’s Knowledge, Attitude, and Practice Basic Feeding Rules with Eating Behavior in Preschool Age Children.

DOI: 10.5220/0012919700004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 213-217

ISBN: 978-989-758-727-6; ISSN: 2975-8297

213

Research conducted by Setiarsih and Habibi,

(2020) revealed a correlation between the feeding

style practiced by parents and the occurrence of eating

difficulties among children aged 3-5 years at TK

Nurul Hikmah Pamekasan. Eating problems were also

identified at TK Pengawas II Surabaya, as evidenced

by a survey involving 60 parents. as Among the

respondents 88% reported observing at least one of

the signs of feeding behavior problems in their

children. This study aimed to analyze the correlation

between a mother’s knowledge, attitude, and practice

of basic feeding rules with eating behavior in

preschool-age children.

2 SUBJECTS AND METHODS

This study used an analytic observational method

with a cross-sectional design. The data were gathered

through interviews using a questionnaire. The

research was conducted at TK Pengawas II Surabaya

from May to November 2022 involving a population

of preschool children. The study’s participants

included mothers and children from TK Pengawas II

Surabaya. The sample consisted of children aged 36-

60 months, selected using a simple random sampling

technique. The minimum sample size in the study was

41 children, determined using the Lemeshow (1997)

formula.

Children's eating behavior data was

collected using the Behavioral Pediatric Feeding

Assessment Scale (BPFAS) instrument with the total

score classification categorized into two groups:

normal (TFS≤84 and TPS≤9) and non-normal

(TFS>84 and/or TPS>9). Mother’s Knowledge,

Attitude, and Practice of Basic Feeding Rules were

assessed through the Knowledge, Attitude, and

Practice Basic Feeding Rules questionnaire based on

Bonnin's theory, (2005) with a scoring system. This

questionnaire comprised 30 questions in total, with 10

questions dedicated to each aspect: knowledge,

attitude, and practice of basic feeding rules.

Data analysis of the study was carried out using SPSS

v.20.0 software. The analysis performed was

univariate analysis, with data presentation in tabular

form in the form of frequency distribution,

percentage, mean, and standard deviation of each

variable. Bivariate analysis using the Pearson

Correlation Test, which was carried out with the aim

to analyze the relationship between knowledge,

attitude, and practice of basic feeding rules of mothers

with eating behavior of preschool-age children.

3 RESULTS

Characteristics of the child including age and gender.

This data was collected with a questionnaire. The

outcomes derived from the gathered data are

presented in the subsequent table.

Table 1: Characteristics of children.

Characteristics of

children

n %

Age

36-48 months 10 24,3

49-60 months 31 75,6

Gende

Boys 19 46,3

Girls 22 53,7

Total 41 100

The results showed that there were 24,3% of

children aged 36-48 months and 75,6% of children

aged 49-60 months. In addition, the results regarding

the gender characteristics of children, it was found

that there were more girls than boys, which amounted

to 53,7%.

Table 2: Characteristics of respondents.

Characteristics of children’s

guardians

n %

Age

20-35 years ol

26 63,4

36-45 years ol

15 36,5

Children’s guardian

Mothers

33 80,5

Others

8 19,5

Education

Elementar

School

0 0

Junior high school

3 7,3

Senior high school

22 53,7

College

16 39,0

Work status

Worke

18 43,9

Non-workers 23 56,1

Total 41 100

The total number of respondents was 41 people.

Data were obtained through the completion of

structured questionnaires containing questions about

age, children’s guardian, education, and work status

given to respondents. Based on Table 2, the age

distribution of children’s guardians was in the range

of 20 to 45 years with most subjects being cared for

by mothers, as many as 80.5% and 19.5% were cared

for by others such as grandmothers. The distribution

of education level was mostly high school graduates,

as many as 53.7%, and the highest education was

ICSDH 2023 - The International Conference on Social Determinants of Health

214

college, which amounted to 39%. Work status is

mostly not working, with a percentage of 56.1%.

3.1 Mother’s Knowledge, Attitude, and

Practice Basic Feeding Rules

Mother’s Knowledge, Attitude, and Practice of Basic

Feeding Rules were assessed through the Knowledge,

Attitude, and Practice Basic Feeding Rules

questionnaire. The results can be seen in the following

table.

Table 3: Knowledge, Attitude, and Practice Basic Feeding

Rules of Respondents in TK Pengawas II Surabaya 2022.

KAP Basic

eedin

Rules

Poor Good Total

Knowledge

n 3 38 41

7,3 92,7 100,0

Attitude

n 2 39 41

% 4,9 95,1 100,0

Practice

n 3 38 41

% 7,3 92,7 100,0

Based on Table 3, the frequency distribution of

the results of Basic Feeding Rules Knowledge’s

respondents is mostly classified as good, with a

percentage of 92.7%. The result of attitude Basic

Feeding Rules has the highest value, which is 95.1%.

The results of the practice of Basic Feeding Rules

were also classified as good with a value of 92.7%.

3.2 Children’s Eating Behaviour

The results of the children’s eating behavior scores

are presented in the form of average, minimum, and

maximum values in the following table.

Table 4: Eating Behavior Scores of Subjects in TK

Pengawas II Surabaya 2022.

Eating Behavior

Scores

Average Minimum Maximum

Total

Frequency

Score

(

TFS

)

73,54 ±

13,6333

47 101

Total

Problem

Score (TPS)

7,12 ±

6,038

0 21

Based on Table 4 shows that the average Total

Frequency Score (TFS) and Total Problem Score

(TPS) are classified as normal. Total Frequency

Score (TFS) shows an average of 73.54 ± 13.6333,

while the average Total Problem Score (TPS) is 7.12

± 6.038.

Table 5: Eating Behavior of Subject in TK Pengawas II

Surabaya 2022.

Eating Behavior n %

ormal 25 61,0

Not-Normal 16 39,0

Total 41 100,0

Children's eating behavior data was obtained by

filling out the Behavioral Pediatric Feeding

Assessment Scale (BPFAS) questionnaire given to

respondents. Based on the results in Table 5, most

subjects had normal eating behavior, as many as

61%. The abnormal eating behavior was found in

subjects with the results of 39%.

3.3 Relationship between Mother’s

Knowledge of Basic Feeding Rules

with Children’s Eating Behavior

The results of the analysis on the relationship between

Mother’s Knowledge of Basic Feeding Rules with

eating behavior in preschool children using the

Pearson correlation test obtained a significance value

between the knowledge score and TFS is 0.788, while

the knowledge score with TPS is 0.794. This shows

that there is no significant relationship between

knowledge score and eating behavior in this study.

A non-significant relationship was also found

between mother’s attitude toward basic feeding rules

and children's eating behavior. This is because the

significance values based on TFS and TPS are 0,587

and 0,903. These results show that the significance

value is >0,05.

However, a significant value was found in the

relationship between the mother’s practice of basic

feeding rules in preschool children's eating behavior

with a significance value based on the TFS score of

0,033. Based on the TPS score, the p-value was 0,091

which indicates that there is no significant

relationship.

Correlation Between Mothers’s Knowledge, Attitude, and Practice Basic Feeding Rules with Eating Behavior in Preschool Age Children

215

Table 6: Cross Tabulation of Knowledge, Attitude, and Practice of Basic Feeding Rules of Mothers with Children's Feeding

Behavior in TK Pengawas II Surabaya 2022.

Classification of Eating Behavior

Total % p-value

Normal % Not-Normal %

Classification of Knowledge

Basic Feeding

Rules

Poor 2 4,9 1 2,4 3 7,3 TFS (0,788)

TPS

(0,794)

Good 23 56,1 15 36,6 38 92,7

Classification of Attitude

Basic Feeding Rules

Poor 2 4,9 0 0,0 2 4,9 TFS (0,587)

TPS (0,903)

Good 23 56,1 16 39 39 95,1

Classification of Practice

Basic Feeding

Rules

Poor 0 0,0 3 7,3 3 7,3 TFS (0,033)

TPS

(0,091)

Good 25 61,0 13 31,7 38 92,7

Total 35 61 16 39,0 41 100

4 DISCUSSIONS

Eating problems in children are picky eating, selective

eating and small eating. However, when children

show eating problems, parents tend to give

supplements or multivitamins to children, while the

cause of the appearance of eating problems in children

can occur due to inappropriate feeding practices.

Therefore, there are basic feeding rules that are

expected to help children with feeding problems. It is

important for parents, especially mothers, to know the

basic feeding rules for children to support the

nutritional status and health of children. (IDAI,2015)

Based on the research, both the knowledge,

attitude, and practice of mothers towards basic

feeding rules are classified as good but the

significance value between the knowledge score and

TFS was 0.788, while the knowledge score and TPS

was 0.794. This shows that there is no significant

relationship between knowledge score and eating

behavior in this study. The significance values of

attitude scores with TFS and TPS were 0.587 and

0.903. These results also indicate that there is no

significant relationship between attitude score and

eating behavior in this study.

The absence of a relationship is due to the high

and low scores of knowledge and attitude in this study

did not affect the score of eating behavior, both TFS

and TPS scores. The results of the study are not in line

with the research of Rahayu, et al., (2021) that as the

mother's knowledge of feeding rules increases, eating

problems in children decrease. Meanwhile, a

significant relationship was found between the

practice basic feeding rules score and eating behavior

based on the TFS assessment, while there was no

significant relationship between the practice basic

feeding rules score and eating behavior based on the

TPS assessment. This is due to mothers who do not

consider their children's eating behavior as a problem,

so there is no relationship between practicing basic

feeding rules and TPS.

In this study, it was found that the lower the

practice score, the higher the TFS, which indicates

that there is a non-normal eating behavior or eating

problems in children. The results related to the

relationship between the practice of basic feeding

rules and children's eating behavior in this study are

supported by Saidah and Dewi's research, (2020)

which shows that the lack of practice of Basic Feeding

Rules significantly increases eating difficulties in

children.

Lack of knowledge and feeding practices that are

not in accordance with basic feeding rules can cause

feeding problems in the form of primary inappropriate

feeding practices. Inappropriate feeding practices by

mothers or caregivers are non-organic etiologies of

feeding problems in children. However, there are

organic etiologies that can also lead to feeding

problems in children, such as structural or functional

abnormalities that affect the physiology of the body

Kivilcim et al. (2019).

5 CONCLUSIONS

The results showed that there was no significant

relationship between the knowledge and attitude of

basic feeding rules of mothers with children's eating

behavior. The mother's practice of basic feeding rules

showed a significant relationship with eating

behavior based on TFS. Mothers who play an

important role in child feeding are expected to always

apply the practice of basic feeding rules, especially on

the child's meal schedule. The recommended meal

schedule is three main meals and 2 - 3 snacks. Main

meals consist of staple foods, animal/vegetable side

dishes, vegetables, and fruit. Interludes can include

ICSDH 2023 - The International Conference on Social Determinants of Health

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fruit, milk, pudding, and biscuits. Children are also

encouraged to consume water.

ACKNOWLEDGEMENTS

Our gratitude is sent to TK Pengawas II for

generously providing the essential resources and

conducive environment that facilitated the successful

realization of our research.

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