Nutritional resilience in a hostile environment: positive deviance in child nutrition.

The term "positive deviance" applies to the study of children who demonstrate above-average growth in impoverished environments. Favorable values on known malnutrition correlates and attentive child care characterize positive deviants. Best-growing children do not necessarily mirror the malnourished; for example, best- and worst-nourished infants may both get more breast-milk substitutes than middle growers. Positive deviants receive more high-quality foods, physical interaction, affection and praise, and verbal and environmental stimulation. Factors that influence child growth through care quality also predict cognitive development, health, and social adjustment. They include: the type of society; parental education, mental health, initiative, and work burden; family and community structure; and the value of children to parents. Feeding practices related to growth include: permitting the child to control the length of feeding, encouraging eating while avoiding a power struggle, actively spoon- or hand-feeding, not displacing appetite by giving frequent sweets, and timely introduction of appropriate foods.