Why complementary feeding is the most critical agenda for child malnutrition?

This September, India celebrated7^thRashtriya Poshan Maah 2024, a month dedicated to nutrition awareness and action, a crucial aspect that demands our collective focus is Complementary Feeding. This practice of transitioning infants from exclusive breastfeeding to a diet that includes solid and semi-solid foods is fundamental to addressing the persistent issue of malnutrition in India. Complementary Feeding is not just about food; it is about ensuring that children receive the right nutrients at the right time, laying the groundwork for a healthy and productive life. Since milk alone cannot meet the nutritional needs of a growing child, the World Health Organization (WHO) recommends introduction of nutritionally adequate and safe complementary foods at 6 months of age together with continued breastfeeding up to 2 years of age or beyond.

Complementary Feeding is crucial for the vital role it plays in brain function, physical growth and immunity development. Scientific evidence on brain development reveals that within two years of birth, brain volume increases by more than 100%, driven primarily by the development of grey matter.

Similarly, during the first year, a baby’s birth weight almost triples. Hence, complementary feeding is not only essential for brain development but also for its role in deterring child undernutrition—a condition that affects nearly one-third of children under five years of age in India. Undernutrition in children encompassing stunting (low height for age), wasting (low weight for height) and underweight (low weight for age), can have significant implications for the physical and mental development of the growing child. For example, research shows that stunted children are more likely to have lower test scores, poor cognitive outcomes, and even reduced economic productivity later in life.

Moreover, complementary feeding is essential in building a strong immune system. It helps reduce the incidence of infectionssuch as diarrhoea, respiratory illnessesand food allergies, which are common in young children. Evidently, the first two years of a child’s life, is a critical window of opportunity where adequate nutrition can significantly enhance physical growth, cognition and immunity of our future generations. It is a critical period where a balanced diet full of vitamin-rich fruits and vegetables, whole grains, legumes, eggs and dairy products can have long-lasting effects on a child’s health.

Despite its significance, prevalence of complementary feeding in India remains alarmingly low. Data from the National Family Health Surveysshows a significant gap in complementary feeding for young children, which requires urgent attention to effectively combat malnutrition. It is in this context that prioritization of Complementary Feeding by the Ministry of Women and Child Development (MoWCD) in the Rashtriya Poshan Maah (National Nutrition Month) 2024, highlighted an important milestone in India’s Nutrition Agenda.

This leads us to the key question: What steps can be undertaken to increase the adoption of Complementary Feeding among young children in India?

First and most essential for successful complementary feeding is the inclusion of healthy and nutritious food in the diet, especially during the window betweensix months and two years. India’s rich culinary heritage offers a variety of nutrient-dense options that are ideal for young children. Traditional recipes like khichdi and daliya, are not only easy to prepare, but also packed with essential nutrients. For example, Ragi banana porridge is an excellent source of iron and calcium, while Bajra Khichdi provides a good mix of vitamins and minerals. Most importantly,MoWCD’s guidelines for Mission Poshan 2.0 put a big emphasis on promoting “dietary diversity” and consumption of fresh fruits, vegetables, millets and whole foods which are locally available,nutritious and suited to the regional context. Building on these guidelines, reviving traditional weaning foods made from locally available and affordable ingredients can help ensure that children receive a balanced diet that supports their growth and development.

Second, the use of cultural platforms for scientific messaging can be a key strategy in promoting largescale social and behavioural change. Interestingly,WHO’s recommended timing for initiating complementary feeding after six months of birth, matches perfectly well with the age-old practice of ‘Annaprashan’, an important milestone in the Indian cultural context. Recognizing the importance of complementary feeding, MoWCD promotes the celebration of Annaprashan Divas as a community-based event organized by Anganwadi Workers across the country to counsel mothers and local communities about the importance of introducing diverse and nutrient-rich foods to children’s diet. Utilizing traditional wisdom and socio-cultural practices for scientific messaging thus emerges as a best practice for promoting the acceptance and uptake of evidence-based infant and young child feeding practices.

Third, to ensure that all young children, regardless of socio-economic background, have access to nutritious food, it is crucial to leverage existing government programs. MoWCD’s Supplementary Nutrition Program (SNP), which provides Take-Home Rations (THR) and Hot Cooked Meals (HCM) to children aged six months to six years, acts as a lifeline for families, particularly in low-income communities where access to nutrient-dense food is often limited.

Fourth, while promoting healthy foods, it is equally important to protect children from the dangers of “junk” and ultra-processed foods, particularly those high in fat, sugar, and salt. Junk foods such as cookies, chips, namkeens, instant noodles, soft drinks, and bakery products have unfortunately become staples on the “Kids Menu”. Additionally, heavily marketed "baby foods" from leading multi-national brands have recently come under the scanner by institutions like the National Commission for Protection of Child Rights for containing “high sugar” content, particularly for sale in India.

It thus comes as no surprise that junk food consumption among young children in India is rising exponentially every year. Alarmingly, recent scientific evidence indicates that early exposure to these unhealthy foods can lead to early onset of obesity and diabetes, culminating in chronic health conditions in adulthood.Therefore, it is crucial to raise awareness about the harmful effects of processed foods and encourage parents to opt for healthier alternatives. This can be achieved through community education, media campaigns, and the active involvement of healthcare providers and community health workers in counselling parents on appropriate feeding practices.

Conclusively, Complementary feeding wasa critical component of 7^thPoshan Maah 2024, addressing one of the most overlooked aspects of maternal and child nutrition. By promoting evidence-based practices, leveraging cultural traditions like Annaprashan, disseminating affordable and locally available food recipes and protecting children from unhealthy foods, India can make significant strides in addressing its priority agenda for eliminating malnutrition. The Government’s efforts, combined with “Jan Andolan” or mass mobilization, can ensure that all children receive the nutrition they need to thrive, setting the foundation for a healthier future for the nation.

Author: Dr. Ananya Awasthi is a public health researcher and the director for Anuvaad Solutions- an accelerator designed to translate scientific evidence into policy action.