India is facing a grave challenge of having very high rates of under nutrition in childhood and a high infant mortality rate. The study found a statistically significant difference in poor infant and young child feeding practices in the children admitted with severe malnutrition in the 1-6 months age study group as compared to children in the same age group admitted with illness other than severe malnutrition.

We found 78% prevalence of suboptimal infant feeding practices in the study group. Exclusive breastfeeding was practiced only in 22% children in this group. We observed high prelacteal feed (36.08%), colostrum feeding (77.31%), low early initiation of breastfeeding (10.35%), bottle feeding (34%), dilated goat milk (35%) as top feed and water (58%).  In study group the top feeds were initiated earlier (1-3months of age) compared to 4-6 months of age in control group. This lack of exclusive breastfeeding was a major contributory factor to development of malnutrition in this age group.

Most common indication for hospitalization in study group was difficulty in breathing followed by poor weight gain.

Factors other than feeding practices are also contributory in the 1-6 months age group  and the most common co-morbidity associated in our study group were anemia (38), congenital heart disease (17), bronchopneumonia (9) and acute kidney injury (7). Multisystem affective conditions like cerebral palsy (4), Klinefelter syndrome (1), Down syndrome (1), congenital adrenal hyperplasia (1) also presented with severe malnutrition. 16 infants in study group were premature delivered.

Our study has shown that giving prelacteal feed, delayed initiation of breastfeeding at birth, improper duration of each feed and early initiation of top feed contribute a major role in developing under nutrition in infant under 6 months of age. Lack of sustained support and motivation of mothers were major contributors for poor IYCF practices in the study group mothers. These could emanate from the statistically highly significant low KAP scores regarding breastfeeding practices of the primi and multiparous mothers in study and control group (P < 0.0003).

Poor feeding practices were also documented in history of breastfeeding using a structured format wherein most of the multiparous mothers had low breast feeding history scores in the study group (P value 0.0003). In children who were admitted without malnutrition mothers scored better and the difference between breastfeeding history scores was statistically significant (P=0.039).

The same thing was further cemented by direct observation of breastfeeding utilizing a structured breastfeeding observation form. Low scores were documented for maximum number of multiparous mothers in the study group (90.14%) (P=0.0002). Similar was the case with primiparous mothers in study group; who also had statistically significant lower scores on structured breastfeeding observation form (P=0.010).

Use of bottle feeding was very high (34 %) in the 1-6 months old children admitted  with severe malnutrition as compared to only 4 % in the non malnutrition group.

Relactation by SST was successful in 16 mothers and it helped the children to recover from their severe malnutrition.