Overcoming the Challenges of Complementary Feeding and the Potential Role of Fortified Infant Cereals: A Position Paper from India and Nepal

Abstract

The last National Family Health Survey, 2019–2021, suggests suboptimal infant feeding practices and an increasing burden of micronutrient deficiencies across the country’s states. The research has well established an association of child nutrition with eating habits and health outcomes in later life. The latest National Family Health Survey-5 data state that only about 4 of every 10 infants are introduced solid foods timely i.e., introduced to complementary feeding as per the recommended age. It is equally worrisome to note that only 11.1% of all children in India in the age-group of 6–23 months were fed the minimum acceptable diet with a direct correlation of around 67.1% of children under the age of 5 years suffering from anemia. These findings highlight that incorrect timing of initiation of complementary foods, early or delayed, and inadequate nutrition are a few critical factors behind the prevalence of nutrient deficiencies. In this regard, a group of experts from the field of pediatric nutrition from different parts of India and Nepal gathered and acknowledged that in addition to lack of knowledge on age-appropriate nutrition to infants, cultural beliefs, traditions, myths, and lack of awareness about nutrient enhancers and inhibitors are some of the common challenges in meeting age-appropriate nutrition. The expert group also recognized that supplementation and fortification co-exist in the clinical practice where supplementation is offered on a case-to-case basis to address the therapeutic needs of micronutrient deficiencies. In contrast, fortification should be advised as part of a balanced diet to reduce the risk of micronutrient deficiencies. However, it was unanimously agreed that scientific research and clinical practice have established that fortification or the use of Fortified Infant Cereals (FIC) to have better compliance and suggests this as a strategy to be used as a preventive, long-term sustainable mass approach to partner with homemade feeds for meeting the nutritional needs during the critical period of 6–23 months of age. The present position paper captures the opinion and suggestions of a group of clinicians regarding the pervasive concerns and challenges of complementary feeding in a diverse country like India with varied cultural and eating preferences. Further, the role of FIC is also discussed as a strategy to consider supporting age-appropriate nutrition in the country irrespective of its diversity.