Complementary Feeding Practices and Their Association with Nutritional Status of Children Attending a Hospital-Based Pediatric Outpatient Department

Open Access

Abstract

Background: Appropriate complementary feeding is essential for meeting the nutritional requirements of children during the critical period of 6-24 months. However, inadequate dietary diversity, meal frequency, and overall diet quality remain important contributors to childhood undernutrition, particularly in low-resource settings. Aim of the study: To assess complementary feeding practices and determine their association with the nutritional status of children attending a hospital-based pediatric outpatient department. Methods & Materials: A hospital-based cross-sectional observational study was conducted among 314 children aged 6-24 months attending a pediatric outpatient department in Bangladesh. Sociodemographic characteristics, breastfeeding history, complementary feeding practices, and dietary diversity were collected through caregiver interviews. Minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were assessed according to WHO/UNICEF indicators. Anthropometric measurements were obtained using standardized procedures, and associations were assessed using chi-square tests and multivariable logistic regression. Results: The mean age of the children was 15.7±5.1 months, and 59.9% were male. Complementary foods were introduced at 6 months in 65.0% of children, while adequate MMF, MDD, and MAD were achieved by 65.0%, 32.5%, and 29.9%, respectively. Stunting, wasting, and underweight affected 32.8%, 16.2%, and 29.6% of children, respectively, while 43.6% were undernourished. Undernutrition was significantly associated with delayed or early complementary feeding, inadequate MMF, MDD and MAD, and absence of animal-source food consumption (all p≤0.028). In multivariable analysis, inadequate MAD showed the strongest association with undernutrition (aOR 2.47, 95% CI 1.47-4.16; p<0.001), followed by inadequate MDD (aOR 2.08, 95% CI 1.29-3.36; p=0.003). Conclusion: Suboptimal complementary feeding, particularly inadequate dietary diversity and minimum acceptable diet, was common and strongly associated with undernutrition. Strengthening caregiver counselling on dietary diversity, meal frequency, and animal-source foods should be integrated into routine pediatric services.