Forced feeding is pressuring a child to eat even when they say they are not hungry or forcing them to eat [1–3]. Pressure by verbal encouragement (eat a little bit more, have some peas, or eat three more mouthfuls) or physical encouragement to get a child to eat, usually by offering food to the child. This includes placing food on the spoon or fork and offering it to the child, or putting food on the cutlery ready for the child to pick up and eat [4]. Forcing the spoon into the mouth of the baby, distracting, nose pinching, and flogging were the common methods employed by respondents when force-feeding children [5].
Mothers view the refusal to eat as a sign of poor appetite and pressure their child to eat. Several factors undermine appropriate child feeding. The factors include inadequate maternal knowledge, ignorance, socio-cultural factors, burdens, and responsibilities related to cultural beliefs and food taboos; restrictions; and beliefs associated with certain foods that have a strong influence on infant feeding and have an impact on optimal infant feeding practices and other health-related consequences [6].
Forced feeding is used with the best of intentions for the benefit of the child. But it has a negative impact on child development and health, and degrading treatment could lead to unhealthy food habits. Mothers think their child is thinner and apply forced feeding, but forced feeding is negatively associated with child weight or BMI [3, 7, 8].
appropriate child feeding practices and the behaviors of parents have a positive effect on the growth of children [9]. Many mothers or caregivers in both high- and low-income countries use forced feeding practices, especially among lower-income populations where food availability is unstable and children live in a less stimulating environment. Forced feeding practice could disrupt a child's eating behavior, causing frustration and stress, and several cases of child death following forced feeding have also been reported [10].
Globally, forced feeding is the most common practice. almost 70% were force-fed during childhood [9]. Globally, 49% of respondents reported they cried, 55% experienced nausea, and 20% vomited during the forced-feeding episodes, in addition to negative feelings of anger, fear, disgust, and confusion, which are usually felt during the feeding process [9]. Especially in developing countries, forced feeding is the most common practice [10]. The improper feeding practice is a major cause,
along with other factors, for why 149 million (22%) and 49 million (7.3%) children under 5 around the world are stunted and wasted, respectively. Africa is the only region where the number of malnourished children has increased.
Ethiopia is one of the countries where infant and under-5 mortality rates are the highest in the world (48 per 1,000 live births and 67 per 1,000 live births, respectively) (8).
About 50% of child deaths are related to malnutrition, which can be prevented through appropriate feeding practices [10]. Forced feeding practices have been widely documented in Ethiopia, despite the government and other stakeholders implementing many strategies aimed at improving IYCF practices [11]. Despite all these factors, the prevalence of forced feeding is high. The study shows that 66.9 percent of children under five in Ethiopia are forced to eat [12].
The problem of force-feeding and the associated factors is a significant global health concern, resulting in both immediate and long-term negative consequences. Force feeding is most common among children due to parents who feel pressured to overfeed them or enforce specific diets; this has led to widespread problems related to malnutrition, obesity, eating disorders, and other physical and mental health issues. Additionally, the public health sector and policymakers struggle with limited resources when facing an issue that often takes place within family environments. For meaningful progress towards healthcare solutions, there must be a thorough examination of how social norms can influence dietary habits as well as how institutions such as schools and healthcare settings can play a role in promoting healthy eating habits for children [3, 8, 13].
To improve feeding practice through this essential time of growth and development of the child, assessment of feeding practices and their factors are vital [14].
The Ethiopian government has made efforts to improve child feeding, but the current rate of progress is not fast enough to reach the global target by 2025. Studies done in Addis Ababa and Derashe showed variations in the prevalence of forced feeding practices [15, 12]. Forced feeding practices could disrupt a child's eating behavior, causing frustration and stress, and several cases of child death following forced feeding have also been reported globally [8, 13]. Evidence shows a huge burden of inappropriate feeding practices, from the global to the national level [15]. Although early childhood malnutrition can
be attributable to poverty and a lack of resources, characteristics of mothers and caregivers, such as education and household management skills or the mother's coping skills, can determine normal growth and development. Feeding practices can contribute to malnutrition to a greater degree than a lack of food [16]. In Ethiopia, according to a study conducted in Addis Ababa, 71% of caregivers forced a child to eat [14]. To improve child feeding practices and the nutritional status of children, the government of Ethiopia has implemented different activities. Accordingly, the country adopted the WHO recommendations for child feeding practices and developed the national guideline of the IYCF to improve children's nutrition and health status [17].
It is essential to include specific feeding practices components, together with responsive feeding, in national nutritional programs to improve the nutritional status of children aged 6–59 months [14]. Anon-responsive feeding practices have been widely documented in Ethiopia despite the government and other stakeholders implementing a number of strategies aimed at improving infant and young child feeding (IYCF) practices practice [11].
Hence, most studies carried out in Ethiopia have focused mainly on identifying factors associated with undernutrition and there have been few studies about forced feeding. Factors contributing to forced feeding were not determined to the best of our knowledge. This study is aimed at filling a gap in the evidence about childhood forced feeding and associated factors.