Optimal Infant and Young Child Feeding (IYCF) is crucial for survival across the entire childhood continuum. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended initiation of exclusive breastfeeding from the time of birth up to 6 months of age and continuing up to 24months [1]. Optimal feeding of infants from 0 to 5 months has been associated with significantly lower risk of all-cause and related mortality compared to partial or not breastfeeding at all [1,2]. Estimates suggest that optimal IYCF practices could prevent approximately 12% of mortality in the under 5’s annually. This accounts for about 800,000 lives in Low and Middle-Income Countries (LMICs) [3]. Early initiation of optimal IYCF within the first hour following birth in the form of exclusive breastfeeding up to 6 months followed by continued breastfeeding for up to 2 years and beyond with appropriate complementary foods after completion of 6 months is the gold standard for optimal IYCF [1,4]. Positive parental attitudes towards infant feeding are an important component in child nutritional health. The special supplemental Women, Infants and Children (WIC) Program have lower breastfeeding rates and attitudes that do not contribute towards healthy infant feeding in spite of breastfeeding and nutrition education programs targeting WIC participants [5]. Every time an innocent child suffers the curse of malnutrition; the responsibility goes to the mother, the family and to the community due to their faulty or no knowledge regarding the harmful effects of pre-lacteal feeding, benefits of exclusive breast feeding and initiation of proper complementary foods at the correct time [6]. Therefore, the present study has been carried out to detect feeding practices among infants and children in rural area of Kashmir Valley. An attempt is made to unveil certain important aspects of the feeding practices with respect to effect of breast feeding, complementary and dietary practices. 

Aim and Objectives

To assess the infant feeding practices of the study population.

Study Area

Block Hajin, the field practice area of Department of Community Medicine-SKIMS situated about 30 kilometers from Srinagar city.

Study Design

This study was a cross sectional, community based study.

Study Period: Study was conducted over a period of six months.

Study Population

All the mothers of the under-fives who consented to be the part of the study. 

Sampling Technique

Multistage random sampling technique was used to achieve the required sample size.

Sample size: The sample size for this study was calculated as per formula:

n = Z2 P (1-P)/d2

Sampling Procedure: The study was conducted in Block Hajin which is divided into three health zones namely Hajin, Sumbal and Ajas. The study sample (403) was drawn randomly from these three zones by using multistage sampling technique based on Probability Proportionate to Size (PPS). A written informed consent was taken from the mothers and the necessary information was gathered from them. A pretested questionnaire was used.

Ethical Clearance: 

The study was approved by the institutional ethical committee, SKIMS.

Data Analysis

The data thus collected was subjected to descriptive and analytical statistics using SPSS and appropriate statistical tests were applied wherever needed.

Table 1 depicts that most of the children belonged to age group 25 to 60 months (45.9%) followed by age group 7 to 24 months (36.0 %) and age group ≤6 months (18.1%). There was female preponderance (54.1%) among the study subjects. Most of the study subjects were having birth order first (40.9%) followed by birth order second (32.0%) and 21.6% had third birth order. 3.4% of the children had birth weight of <2.5 Kg and 56.6% had a birth weight of ≥2.5 Kg. The birth weight of the 161 (40%) of the children was not known. The mean of the birth weight was 2.86±0.279 in those whose birth weight was recorded. Maximum respondents were living in nuclear families (40.0%) followed by joint families (32.5%). Most of them were having family size of 6 to 10 (45.9%) followed by family size ≤ 5 members (39.2%) and 14.9% having > 10 family members. Most of the mothers were illiterate (65%). 85.1% mothers were homemakers followed by homemakers and skilled worker (13.9%) only 1% were employed. Most of the respondents belonged to middle class family (96.5%) followed by lower class (3%) and upper class (0.5%).

Table 1: Socio-Demographic Characteristics of the Study Population

Table 2, in the age group of 0 to 6 months 46.6% mothers reported that their infants were fed with pre-lacteal feeds. Commonest pre-lacteal feed given was sugar (82.3%) followed by honey/date in 5.9% and others were given sacred mud. Maximum (95.9%) infants were fed with colostrum. In most (56.2%) of the infants breastfeeding was initiated within 1 to 2 hours, in 32.9% within 1 hour and in 10.9% breastfeeding was initiated after 2 hours. 68.5% infants were exclusively breastfed followed by mixed feeding in 30.1% and 1.4% were receiving artificial feeds. Most (93.2%) infants were taking 8 to 12 feeds per day. Demand feeding was most common type of feeding (83.6%) followed by scheduled feeding in 16.4%. Among artificially fed children 95.7% were fed with formula milk followed by cow’s milk in 4.3%. Complementary feeds were started in 5.5% infants before the age of 6 months.

Table 2: Feeding Practices by Age (0-6 Months, n = 73)

The feeding practices in 7 to 24 month children are depicted in Table 3. In 96.6% breastfeeding was continued beyond 6 months and in 90.3% children complementary feeding was started between 6 to 7 months of age, in 6.2% after 7 months and in 3.5% it was started before 6 months. Most of the children (86.9%) were fed with homemade complementary feeds followed by commercial feeds in 13.1%. Majorities (95.9%) of them were taking appropriate frequency of complementary feeds and 97.2% were taking adequate quantity of complementary feeds.

Table 3: Feeding Practices by Age (7-24 Months, n = 145)

Table 4 shows the dietary assessment in the age group of 25-36 and 37-60 months. The mean calorie intake in the age group of 3 years was 1208.93±276.856 as against a recommended dietary assessment of 1060 calories. For the age group 37-60 months (4-5years), this figure was 1324.49±255.881 against RDA of 1350. The mean protein, fat, iron and calcium intake in the age group 25-36 months was 17.10±1.581 gm, 25.98±1.738 gm, 5.80±2.761 mg and 422.52±222.707 mg against RDA of 16.7gm, 27gm, 9mg and 600mg, respectively. In the age group of 37 to 60 months, the corresponding figures were 20.47±2.105 gm, 26.13±2.123 gm, 7.32±3.916 mg, 488.83±237.727 mg against RDA of 22.1gm, 25gm, 13mg and 600mg for the age group respectively.

Table 4: Distribution of Study Population (25 to 60 months) by Dietary intake (n=185)

The socio demographic characteristics in our study population comprised of 185 (45.9%) males babies and 218 (54.1%) female babies of whom 18.1% were ≤6 months of age, 36% were in age group 7-24 months and 45.9% belonged to age group 25 to 59 months. Almost a similar gender distribution was found in study conducted by Avachat et al., [7] in rural areas of Maharashtra India where 47.36% males and 54.30% females participated in the study. However, in the studies conducted by Yisak et al., [8] in Ethiopia and Makadia et al., [9], in Gujarat India male participants were more than females. Akorede et al., [10], in their study reported age distribution of children as 0-6 months (40.8%), 31-59 months (34.9%), 7-12months (17.2%) and 13-30months as 7.0%. In our study 40.9% under-fives had first birth order followed by second order in 32.0% and third in 21.6%. In contradiction to this the study Brahmam et al., [11] reported 28% each were of first and second birth order while as 43% had birth order ≥3 years. Of those participants whose birth weight was recorded in our study the mean birth weight was 2.86±0.279. Contrarily Mukherjee et al., [12] reported birth weight of <2.5 kg in 48.3%.

In our study 60% (242) belonged to joint/extended families and 40% (161) belonged to nuclear families. 45.9% of our study respondents had a family size 6-10 and 39.2% had a family size of ≤5. Most (65%) of the mothers were illiterate and 85.1% (343) were home makers. The corresponding findings with regard to these socio-demographic variables as reported by Brahmam et al., [11], from MP revealed that 78% of the under-fives belonged to nuclear families while 22% to joint/extended families. 59% of the households had family size of 5-9 followed by ≤ 4 family members in 38%. The mother’s literacy status was 35% and 62.8% of the mothers were housewives by occupation. Akorede et al., [10] from Nigeria reported a family size 1-4 in 59.2% and 40.8% had a family size >5. In a study by Demilew YM et al., [13], from Ethopia 29% of the mothers were illiterate, 64% were housewives. Bagilkar VV et al., [14] in a study from Karnataka reported that 14% of the parents were illiterate, 72% belonged to nuclear families, 92% mothers were unemployed, 66% had only 1 child and 26% had 2 children. Majority (96.5%) of our study population was from middle class and only 3% belonged to lower class. Contrarily Yadav SS et al., [15], from Haryana observed that 65.5% belonged to socioeconomic class IV.

Infant and young child feeding practices in our study revealed that 95.5% were fed colostrum and only 32.9% were breastfed within 1 hour of birth. 68.5% infants received exclusive breast feeding for 6 months, 30.1% received mixed feeding and 1.4% received only artificial feeds. 5.5% infants were started complementary feeds before 6 months of age. Better results were reported in NFHS-4 (J&K) 16 where 46% were breast fed with in 1 hour of birth. Many other studies carried out in India reported that 46% to 75.5% started breast feeding within 1 hour which again is higher than that reported in our study [10,12,17,18]. Exclusive breastfeeding reported in our study was in agreement with NFHS-4 (J&K)16 (65.4%) and that reported by Bentley et al., [17] (62.2%). Exclusive breastfeeding rate reported by Ghosh et al., [18], Ramachandran et al., [19] and Ramji et al., [20] was <50 % which is lower than our study. The studies conducted by Akorede et al., [10] in Ondo state Nigeria and Selvakumar et al., [21], from India showed that 82.3% and 86.7% neonates respectively were administrated colostrum which is slightly lower than that reported in our study (95.5%). In our study 46.6% received pre-lacteal feeds in contrast to the findings of study by Selvakumar et al., [21] from India where only 14% of the newborns received pre-lacteal feeds. The study conducted by Brahmam et al., [11] in district Umaria of M.P state showed that only 2.5% were given pre-lacteal feeds and 5.9% were initiated breast feeding with in 1 hour and almost all participants (97.5%) were fed colostrum and only 1.1% were given complementary feeds before 6 months of age. 

In the age group 7 to 24 months breastfeeding was continued in 96.6% and timely complementary feeding was started in 90.3%. Moreover 96.7% were currently taking complementary foods in our study. The results are encouraging as in a systematic review conducted by Aguayo VM et al., [22] it was reported that timely introduction of complementary feeds, minimum meal frequency, minimum dietary diversity and minimum acceptable diet were estimated at 57.4%, 47.7%, 33.0% and 20.5%, respectively. It further states that in India 87.5% continued breastfeeding and 85.7% were receiving complementary feeds and in South Asia 89.8% had continued breastfeeding and & 84.4% were receiving complementary feeds in the age group of 6-23 months. Majority of the children (86.9%) in our study were receiving homemade complementary foods and 97.2% were taking it in adequate quantity which was in accordance with Aguayo et al., [22].

Assessment of current nutrient intake of 2-5 year old children was done by 24 hour recall method in our study. It was observed that mean daily intake of total calories, proteins, iron and calcium in 4-5 year old children was less than the RDA for these nutrients. 24 hour recall method has its own advantages and disadvantages. Although it is easy to recall but the disadvantage is inability of a single day’s intake to reflect the actual dietary intake besides the success of the recall depending on cooperation and communication ability of the respondent.

From the overall findings of the study it is concluded that healthy practices were prevalent in the study population. These included colostrum feeding, early initiation of breastfeeding and continuation of the same up to 2years of age and timely initiation of complementary feeds.

1. Jones, A.D. et al. “World health organization infant and young child feeding indicators and their associations with child anthropometry: A synthesis of recent findings.” Maternal & Child Nutrition, vol. 10, no. 1, 2014, pp. 1–17.

2. Sankar, M.J. et al. “Optimal breastfeeding practices and infant and child mortality: A systematic review and meta-analysis.” Acta Paediatrica, vol. 104, 2015, pp. 3–13.

3. Black, R.E. et al. “Maternal and child undernutrition and overweight in low-income and middle-income countries.” The Lancet, vol. 382, no. 9890, 2013, pp. 427–451.

4. Tiwari, S. et al. “Infant and young child feeding guidelines, 2016.” Indian Pediatrics, vol. 53, no. 8, 2016, pp. 703–713.

5. Wojcicki, J.M. et al. “Early exclusive breastfeeding and maternal attitudes towards infant feeding in a population of new mothers in san francisco, california.” Breastfeeding Medicine, vol. 5, no. 1, 2010, pp. 9–15.

6. Chatterjee, S. and S. Saha. “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, vol. 5, no. 1, 2008, pp. 1–9.

7. Avachat, S.S. et al. “Epidemiological study of malnutrition (under nutrition) among under five children in a section of rural area.” Pravara Medical Review, vol. 4, no. 2, 2009, pp. 20–22.

8. Yisak, H. et al. “Prevalence and risk factors for undernutrition among children under five at haramaya district, eastern Ethiopia.” BMC Pediatrics, vol. 15, no. 1, 2015, pp. 1–7.

9. Makadia, K. et al. “Maternal factors affecting malnutrition status of children of 1 to 5 years age.” International Journal of Multidisciplinary Research and Development, vol. 3, no. 8, 2016, pp. 71–73.

10. Akorede, Q.J. and O.M. Abiola. “Assessment of nutritional status of under five children in akure south local government, ondo state.” IJRRAS, vol. 14, no. 3, 2013, pp. 671–681.

11. Brahmam, G.N.V. et al. Assessment of Nutritional Status of Under Five Year Rural Children in the Districts of Madhya Pradesh State—Gwalior District. National Institute of Nutrition, Indian Council of Medical Research, 2011.

12. Mukherjee, K. “Malnutrition in under five children in turbhe stores urban slums in Navi Mumbai.” International Journal of Medical Science and Public Health, vol. 3, no. 9, 2014, pp. 1127–1131.

13. Demilew, Y.M. et al. “Infant and young child feeding practice among mothers with 0–24 months old children in slum areas of Bahir Dar city, Ethiopia.” International Breastfeeding Journal, vol. 12, 2017, p. 26.

14. Bagilkar, V.V. and B.B. Savadatti. “A descriptive study on malnutrition.” Asian Journal of Nursing Education and Research, vol. 5, no. 1, 2015, pp. 72–77.

15. Yadav, S.S. et al. “An epidemiological study of malnutrition among under five children of rural and urban haryana.” Journal of Clinical and Diagnostic Research, vol. 10, no. 2, 2016, p. LC07.

16. National Family Health Survey–4 (NFHS-4). State Fact Sheet: Jammu & Kashmir. Ministry of Health and Family Welfare, Government of India, 2015–2016.

17. Bentley, A. et al. “Malnutrition and infant and young child feeding in informal settlements in Mumbai, India: Findings from a Census.” Food Science & Nutrition, vol. 3, no. 3, 2015, pp. 257–271.

18. Ghosh, S. and D. Shah. “Nutritional Problems in urban slum children.” Indian Pediatrics, vol. 41, no. 7, 2004, pp. 682–696.

19. Ramachandran, P. “Poverty nutrition linkages.” Indian Journal of Medical Research, vol. 126, no. 4, 2007, pp. 249–261.

20. Ramji, S. “Impact of infant and young child feeding and caring practices on nutritional status and health.” Indian Journal of Medical Research, vol. 130, no. 5, 2009, pp. 624–626.

21. Selvakumar, B. and B.V. Bhat. “Infant feeding practice and its effect on the growth and development of babies.” Current Pediatric Research, vol. 11, no. 1–2, 2007, pp. 13–16.

22. Aguayo, V.M. “Complementary feeding practices for infants and young children in south Asia: A Review of evidence for action Post-2015.” Maternal & Child Nutrition, vol. 13, suppl. 2, 2017, e12439.