Feeding practices that fall short of recommendations of the World Health Organization (WHO), in particular breastfeeding, were associated with stunting in children — thereby necessitating nutrition education interventions targeted at mothers in rural population, suggests a study.

“The WHO recommends exclusive breastfeeding (EBF) up to 6 months of age followed by the introduction of safe and appropriate foods for this age, maintaining breastfeeding for 2 years or beyond,” according to the researchers. [http://www.who.int/topics/breastfeeding/en/]

“Childhood food practices directly impact a child’s nutritional status and health. If they are inadequate ... it will hinder growth and the consequences will extend into adult life,” they added.

The cross-sectional study sampled 189 mother-child dyads to understand the feeding practices and their association with stunting in children aged 1–24 months (mean age 10.5 months, 59 percent girls) in rural communities of Mexico. Data collected were based on 24-hour recall of mothers. [Nutr Hosp 2018;35:271-278]    

In general, among children aged 1–6 months old, 37 percent were exclusively breastfed, while 16 percent were partially breastfed and 6 percent received infant formula.

When analysed by specific months, a trend of declining breastfeeding was revealed after the first month, despite WHO recommendation to maintain breastfeeding for at least 2 years. Among infants one month of age, 73 percent received EBF, but the rate dropped to only 30 percent in infants aged 2 months.

The reduction in EBF starting from the second month of life was accompanied by early introduction of complementary feeding close to the third month (57 percent).

The researchers also found that 10.1 percent of the children in the total sample had stunted growth. Of note, the proportion of non-breastfed children with stunting was double that of breastfed children (27.5 percent vs 12.0 percent; p<0.03).                   

Furthermore, mean Z-scores for length-for-age indicated a trend towards increasing stunting with age, with a score of -0.463 for younger infants aged 1–6 months, -0.669 for infants aged 7–12 months, and -0.985 for infants aged 13–24 months (p<0.05).

“This study was able to identify that stunting becomes evident in the fourth month of age, a problem that in our study corresponded graphically to the month of decline of EBF and the early introduction of complementary feeding in the third month of age,” observed the researchers.

“It is important to point out that the problem with introducing food at an early age (under 4 months) is that it favours a reduction in maternal milk consumption. With food, a child becomes satiated more quickly, which impedes reaching nutritional goals,” they explained.  

“The evident decline of breastfeeding makes it necessary to propose and perfect strategies that aim at increasing its prevalence among women, both in rural and urban environments,” urged the researchers.