Responsive Mealtime Matters: Feeding Autonomy and Varied Settings Were Associated With Problem-Solving Skills of Ethiopian Children Aged 6-23 Months.

Although Ethiopia has established an early childhood development (ECD) policy framework and implemented various nutrition and health interventions, substantial risks for poor ECD outcomes persist. This study aimed to determine the association between responsive feeding (RF) practices and problem-solving skills of children aged 6-23 months. A community-based cross-sectional study was conducted from March to June 2024 among 401 randomly selected mother-child dyads in Hawassa Zuria woreda/district and Hawassa City Administration, Sidama Region. Data were collected using pre-tested questionnaires with Kobo Toolbox. RF practices were assessed using the locally translated and adapted 15-item RF Practices Assessment Tool (RFPAT), while child problem-solving skills were evaluated using the Ages & Stages Questionnaires, Third Edition (ASQ-3). Data analysis was performed in SPSS version 20, employing bivariate analysis and logistic regression, with statistical significance set at p < 0.05. The median (IQR) problem-solving skill development score was 30 (IQR: 20-60). Approximately two out of five children were at risk for problem-solving development skills. The problem-solving skills domain demonstrated a significant positive correlation with both language (r = 0.69, p < 0.001) and composite motor skills (r = 0.81, p < 0.001). Children living in a household with a larger family had 1.2 times higher odds of being on track in problem-solving skills compared to those who were part of smaller families (AOR = 1.2, p < 0.05). Mothers or caregivers who rarely fed their child in a place designated only for feeding had 2.6 times higher odds of the child being on track in problem-solving skill development compared to those who always fed their child in a designated feeding place (AOR = 2.6, p < 0.05). Mothers who rarely allowed their child to practice self-feeding or did not encourage feeding autonomy had 70% lower odds (AOR = 0.3, p < 0.05) of their child being on track in problem-solving skills compared to those who strongly encouraged feeding autonomy. Promoting feeding autonomy, household interaction and feeding a child in varied and stimulating environments may offer a strategic opportunity to promote problem-solving skills of young children in Ethiopia. Longitudinal intervention studies are required to clarify cause and effect relationship between RF practices and ECD domains.