Knowledge and Perception About Breastfeeding and Complementary Feeding Practices Among Mothers of Infants: A Cross-Sectional Study

Abstract

Background: How a baby is breastfed and consumes complementary foods in the first two years of life are key determinants of infant growth, immunity and long-term health. Despite this, suboptimal feeding is common in Pakistan due to poor knowledge, cultural practices and limited counseling. Objective: To assess the knowledge and perception of mothers of infants aged 0–24 months regarding breastfeeding and complementary feeding practices and to describe current feeding practices in Lahore, Pakistan. Methods: A cross-sectional questionnaire-based survey was conducted among 206 mothers of infants aged 0–24 months during July 2022 to December 2022 in Day-care center, Lahore College for Women University and the outpatient pediatric department, Mayo Hospital, Lahore. Convenient sampling was used to select the participants. Demographic characteristics, breastfeeding initiation and frequency, complementary feeding practices and maternal knowledge and attitudes were collected using a structured 29-item questionnaire. Data were analyzed descriptively using SPSS version 25.0 and results reported as percentages. Result: The first food introduced to infants was breast milk 72.3%, followed by formula milk 18.9% and cow’s milk 8.8%. But only 13.6% of mothers initiated breastfeeding within one hour of delivery, and 59.2% had heard of exclusive breastfeeding. Complementary feeding was commonly delayed, with 40.3% of mothers introducing complementary foods only at 7–8 months against the WHO-recommended six months. Among the infants, Cerelac was the most commonly selected food for weaning 36%, followed by fruit puree 22%, mashed potato 21%, and khichri 19%. Awareness gaps were evident: only 38.8% of mothers knew appropriate portion sizes and 51.2% didn’t know the portion size of food. While 78% mothers were concerned about their child's weight and 21% were not concerned about their child's weight and 58% mothers pressurized their infants to eat all the food on their plate and 41 % didn’t pressurize their child. Conclusion: Although breast milk remains the preferred first feed, delayed initiation of breastfeeding, delayed and inappropriate complementary feeding, and limited maternal knowledge of portion control point to substantial gaps in infant feeding practice. Specific maternal education, hospital-based breastfeeding counseling and community awareness programs are required to implement a practice in accordance with WHO and UNICEF recommendations.