A Cross-Sectional Study Regarding Knowledge and

Practices of Complementary Feeding In Mothers of

<2 Year Old Children in Ahmedabad City, India

Abstract: Complementary feeding is a process of gradual introduction of semisolid foods other than
breast milk to an infant to facilitate optimal growth. Complementary feeding practices are often the
most important causes of malnutrition in children from 6-36 months of age. Therefore a cross-
sectional study was carried out in Thakkarbapanagar ward of Ahmedabad to determine the
complementary feeding practices and knowledge among mothers who have <2 year old child. House
to house interviews were carried out using field tested questionnaire.. Exclusive Breast feeding was
given to 61(61%) babies. Colostrum was given to 76(76%) babies. Prelacteal food was given to
39(39%) babies, out of which 29(29%) were given jaggery water and 10(10%) were given glucose
water. Breastfeeding was continued in all the children till 6 months. Around 62(62%) mothers had
the knowledge on initiation of complementary feeding after 6 months of age. A significant
association was observed between timing of complementary feeding and illness during it as well as
bottle feeding. Training programs should be arranged for the mothers in the community to increase
the awareness as well as importance of timely starting complementary feeding.
Keywords: Complementary feeding, mothers of <2 year old children, Breastfeeding, Colostrum

Arohi Chauhan
Ex-Pg student, Community Medicine Department, Smt. NHL
Municipal Medical College, Ahmedabad, India

Aparajita Shukla
Associate Professor, Community Medicine Department, Smt.
NHL Municipal Medical College, Ahmedabad, India

Sandeepkumar Chauhan
Project Manager, MATIND Project, Indian Institute of Public
Health, Gandhinagar, India



I SSN 2319-9725

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1. Introduction:
Complementary feeding is a process of gradual introduction of semisolid foods and liquids
other than breast milk to an infant to facilitate optimal growth. The ideal age of
complementary feeding is six months. The desirable complementary feeding food should be
inexpensive, home available, clean and easily digestible. It should be rich in calories and
protein with adequate amount of trace elements like iron, calcium, vitamins etc. [1]
The link between malnutrition and infant feeding has been well established. Recent scientific
evidence reveals that malnutrition has been responsible, directly or indirectly, for 60% of all
deaths among children under five years annually. Over 2/3 of these deaths are often
associated with inappropriate feeding practices and occur during the first year of life. Only
35% of infants world-wide are exclusively breastfed during the first four months of life and
complementary feeding begins either too early or too late with foods which are often
nutritionally inadequate and unsafe. Poor feeding practices in infancy and early childhood,
resulting in malnutrition, contribute to impaired cognitive and social development, poor
school performance and reduced productivity in later life. Poor feeding practices are,
therefore, a major threat to social and economic development as they are among the most
serious obstacles to attaining and maintaining health of this important age group. [2]
Complementary feeding practices are often the most important causes of malnutrition in
children from six months to three years of age. Habits of child feeding are based on the
quantity and quality of food available; on beliefs about what is and isn't good for young
children; on time available for food preparation; and on custom. The philosophy of
complementary feeding is to let the baby do itlet him nurse until he wants to stop. A
mother should be sensitive to the specific needs of her baby and not follow the rigid
guidelines of any book. Just as some babies get their first tooth at only five months old and
others not until they're well over a year old, some are ready to wean at younger ages then
others.
Therefore, a cross-sectional study was carried out to determine the complementary feeding
practices and knowledge among mothers who have less than 2 year old child.


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2. Objectives:
i. To assess the knowledge and Practice regarding complementary feeding in mothers of
children < 2 years old.
ii. To correlate various socio-demographic factors with this knowledge and practice
regarding complementary feeding.

3. Materials And Method:
A cross-sectional study was carried out among 100 mothers having <2 years old children in
Thakkarbapanagar ward of Ahmedabad municipal corporation during March-October, 2012.

4. Selection Of Subjects:
100 mothers having <2 year old children were selected by simple random sampling using
lottery method at Thakkarbapanagar ward from March-August, 2012. Mothers having < 2
year old child were selected so as to minimize recall bias. Study technique was house to
house interview using pre-tested questionnaire and interviews were conducted by the same
researcher to ensure validity and reliability of the answers. Study tool was a field tested
questionnaire containing both open and closed ended questions. Study variables were age of
the baby, weight of the child, birth order, Colostrum and prelacteal history, breastfeeding
history, complementary feeding history, type of complementary feeding food, illness and
hospitalization during complementary feeding, etc. Answers related to knowledge and
practices were evaluated as correct and incorrect. Appropriate feeding practices were defined
as starting complementary feeding after 6 months along with continue breastfeeding and
feeding the child with bowl and spoon.

5. Ethical Consideration:
Informed verbal consent was taken from all the mothers after explaining the purpose of the
study and ensuring confidentiality.

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6. Statistical Analysis:
Analysis was done in SPSS 20.0 and results were expressed as percentages. To test the
association between two variables, chi-square test was used.

7. Results:
Most of the families had two children and they were aware about family planning practices.
Around 76 (76%) mothers had normal delivery. In the age group 6-12 months, 26 (26%)
children were underweight, in 12-18 months 5(5%) were undernourished while in 0-6 and 18-
24 months, 1(1%) child each were undernourished. Immediately after birth, 5(5%) children
were having jaundice, 2(2%) were having breathing difficulty and 1(1%) were having
pneumonia.
Exclusive Breast feeding was given to 61(61%) babies. Colostrum was given to 76(76%)
babies. Prelacteal food was given to 39(39%) babies, out of which 29(29%) were given
jaggery water and 10(10%) were given glucose water. Breastfeeding was continued in all the
children till 6 months. In 26(26%) children it was stopped at around 12 months after birth.
A total of 62(62%) mothers had the knowledge on initiation of complementary feeding after 6
months of age. Out of which 58(58%) had started complementary feeding appropriately,
while 17(17%) had started early and 25(25%) had started too late. In 93(93%) children,
complementary feeding food constituted of homemade as well as formula based food
(Table.1). About 12(12%) babies were given bottle feeding where as 88(88%) babies were
feed using bowl and spoon. When asked to mothers about the decision regarding meal
quantity, 55(55%) of them couldnt answer the question, while 32(32%) replied that when the
baby felt asleep they consider that the quantity was appropriate while rest answer that if the
baby was calm then the quantity was sufficient. Around 36(36%) mothers were giving food
twice daily and 64(64%) were giving food for 3-4 times a day.
There was a significant association observed between timing of complementary feeding and
illness during complementary feeding. Association between bottle feeding and illness during
complementary feeding was also statistically significant. (Table.2)

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No. Variable Male Female
1 Age
0-<6 months 0 1
6- <12 months 23 19
12- <18 months 14 9
18- 24 months 17 17
2 Weight
5-<8 Kg 18 15
8-<11 Kg 24 22
11-14 Kg 12 9
3 Birth order
1 20 20
2 28 20
3 and above 6 6
4 Type of delivery
Normal 42 34
CS 12 12
5 Colostrum given
Yes 39 37
No 13 9
6 Prelacteal given
Yes 26 13
No 26 33
7 Exclusive Breastfeeding
Yes 26 13
No 26 33
8 Complementary feeding timing
<6 months 37 23
>6 months 15 20
>1 year 2 3
9 Type of complementary feeding food
Homemade 4 0
Formula based 0 1
Both 50 43
10 Illness during complementary feeding
Diarrhea 27 21
Fever 19 12
Cough 4 3
Constipation 1 0
Table 1: Gender wise distribution of various study variables




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Illness Total Chi-square P value
Complementary feeding Yes No
22.793 <0.0001
Appropriate 19 35 54
Inappropriate 38 8 46
Total 57 43 100
Bottle feed
16.513 <0.001
Yes 10 2 12
No 22 66 88
Total 32 68 100
Table 2: Association between illness during complementary feeding and timing of
complementary feeding as well as bottle feeding

8. Discussion:
It is believed that the awareness of mothers regarding feeding practices affect the nutritional
status and health of infants. [3] Complementary feeding is extremely essential from six
months of age while continuing breastfeeding, to meet the growing needs of the growing
baby. Infants grow at a very rapid rate. The rate of growth at this stage is incomparable to that
in later period of life. The purpose of complementary feeding is to complement the breast
milk and make certain that the young child continues to have enough energy, protein and
other nutrients to grow normally.[4]
According to WHO guidelines, children should be exclusively breastfeed for the first 6
months, then complementary feeding should be started along with breastfeeding upto 2 years
or more.[2] In the present study, 62(62%) mothers had the correct knowledge regarding
initiation of complementary feeding i.e. after 6 months of age, whereas Ananda et al observed
in his study that 43.6% mothers had the correct knowledge regarding initiation of
complementary feeding.[1] Chatterjee et al reported that 52.7% mothers had correct
knowledge about complementary feeding.[5]
The single most effective measure for the prevention of malnutrition and protection against
infection in infancy is breastfeeding. [6] In the present study, exclusive breast feeding was
given to 61% babies; colostrum was given to 76% babies and prelacteal feed to 39% babies
respectively. In a study conducted at Kolkota by Chatterjee et al, exclusive breast feeding was
given to 26.9% babies; colostrum was given to 96.3% babies and prelacteal feed to 54.5%
babies respectively. [5] Chaudhary et al observed that colostrum was given to 95% babies in
their study. In the present study, prelacteal feed consist of jaggery water in 29% babies and
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glucose water in 10% babies. Chaudhary et al reported that 10% babies were given glucose
water as prelacteal feed. [7]
Adequate complementary feeding from six months of age while continuing breastfeeding is
extremely important for sustaining growth and development of the infant.[4] Complementary
feeding was started after 6 months in 58% babies in the current study. Chatterjee et al
reported that 70.5% mothers started complementary feeding in their children after 6
months.[5] In present study, 36% babies were given complementary feeding food twice daily
while Ananda et al reported that 45.9% babies were given food twice daily in their study.[1]

9. Conclusion:
The present study highlights the need for health education program regarding exclusive
breastfeeding, timing of complementary feeding, complementary feeding foods, etc. Training
programs should be arranged for the mothers in the community with the locally available
foods to increase the awareness as well as importance of timely complementary feeding.












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References:
1. Ananda Kumar, TS., Rangaswamy, KB., Viswanatha Kumar, HM.(2013)
Complementary feeding practices in rural Tumkur. Curr Pediatr Res, 17(2),115-117.
2. Global Strategy for Infant and Young Child Feeding. WHO (WHO, Geneva,2003).
3. Guiding principles for complementary feeding of the breastfeed child. Pan American
Health Organization and World Health Organization, 2003.
4. National Guidelines on Infant and Young Child Feeding, Ministry of Women and
Child development (Food and Nutrition Board), Government of India, 2006.
5. S, Chatterjee., S, Saha.(2013) A study on knowledge and practice of mothers
regarding Infant Feeding and nutritional status of under-five children attending
Immunization Clinic of a Medical College. Internet Journal of Nutrition and
Wellness. 5(1).
6. I, Pant., K, Chothia.(1990) Maternal Knowledge regarding breast feeding and
complementary feeding practices. Indian Journal of Pediatrics, 57(3),395-400.
7. R, N, Chaudhary., T, Shah., S, Raja.(2011) Knowledge and Practice of mothers
regarding breast feeding : a hospital based study. Health Renaissance, 9(3),194-200.