The document discusses a study that assessed the nutritional status and feeding practices of toddlers aged 12-24 months in Mumbai, India. 90 mothers participated in interviews about their child's feeding patterns, diet, and anthropometric measurements. Key findings included that working mothers were less likely to breastfeed, families with higher incomes preferred readymade foods, and toddlers' weight and height increased with age appropriately. The type of food fed did not significantly impact the toddlers' current nutritional status.

1. B Y
M S . P R A N O T I M A N E
M . S C . C L I N I C A L N U T R I T I O N A N D D I E T E T I C S
2 0 1 2 - 2 0 1 3
G U I D E D B Y M R S . A N U R A D H A S H E K H A R
H . O . D . F O O D S C I E N C E A N D N U T R I T I O N
P O S T G R A D U AT E D E PA RT M E N T O F C L I N I C A L N U T R I T I O N A N D D I E T E T I C S
D R . B . M . N . C O L L E G E O F H O M E S C I E N C E
3 3 8 , R A F I A H M E D K I D WA I R O A D , M AT U N G A ,
M U M B A I - 4 0 0 0 1 9 .
A F F I L I AT E D T O S N D T W O M E N ’ S U N I V E R S I T Y
ASSESSMENT OF NUTRITIONAL STATUS AND FEEDING
PRACTICES OF TODDLERS IN MUMBAI CITY

2. Aim
 To study the nutritional status and feeding patterns in infants belonging to age group of 12 to 24 months and
understand the nutritive effect of different infant formulas, homemade formula and both on baby’s growth and
development
Objectives
 To study the feeding practices among of toddlers aged 12 to 24 months
 To assess the nutritional status of infants using anthropometric data.
 To assess the nutritional status of infants using diet recall
 To compare between commercial and homemade formulas.

3. Research Methodology
 Proper feeding practices during infancy and toddlerhood are essential for attaining and maintaining proper
nutrition, health, and development of infants and young children. Results of studies on infant and child feeding
across different developing countries have indicated that inappropriate feeding practices have profound
consequences for the growth, development, and survival of infants and children, particularly in developing
countries. (Edward A Frongillo, 2008)
 So, a research was carried out in Mumbai city to study the feeding practices among toddlers aged 12 to 24
months & assess their nutritional status using anthropometric data. Since the toddlers cannot be interviewed for
the study their mothers was targeted.90 mothers having kids belonging to 12-24 months and fulfilling the
required criteria was considered. The questionnaire covered the following areas:
 General information
 Anthropometric data
 Dietary recall
 Feeding practices among toddlers aged 12 to 24 months(Type of food fed to their babies and the
reasons for using the same.

4. Contd..
NULL HYPOTHESIS
 There was no significant change in feeding practices and nutritional status of the toddlers.
RESEARCH DESIGN
 A structured questionnaire was designed to obtain required information. Samples of working &non working
mothers were identified and explained the purpose of the study. Face to face interviews were conducted with
those women who met the desired criteria & showed willingness to participate in the survey. In some cases
interviews were conducted later, at time & date convenient to the respondents.
 In Household interviews- Interviews was conducted at different locations selected randomly in an area in
buildings at Sion.
 In Hospital interviews – some interviews were conducted with mothers sitting in the reception area.
 The study included questions on details of feeding pattern and also anthropometric measurements of baby like
height, weight, and head circumference. Each interview took approximately 20 to 25 minutes.
 The survey took approximately 3 months. After the survey was completed, the responses obtained in the survey
was coded and punched in the system wise for all respondents. The output was then analyzed.

5. Sampling
Quantitative research methodology was adopted for the study.
 The target group of the study was mothers of age group 20 to 40 years & having kids belonging to age group of
12 to 24months.
 The study was conducted in Pratiksha Nagar &Sion Circle areas of Sion.
 Permission from the housing society and maternity & nursing hospital was obtained prior to starting the actual
survey. A brief explanation of the topic, its importance and its benefits was also given to the concerned
authorities.
The criteria for the selection of the subjects were as follows:
 Age: Mothers of kid belonging to the age group of 12-24 months years old were selected for the study.
 Inclusion criteria: Healthy kids were selected for the purpose.
 Exclusion criteria: Subjects with any disease condition like diseases of the kidney, liver, cancer, etc.or other
disease condition were not selected.
 Young women (working and non-working) were interviewed about the nutritional status (anthropometry, dietary
recall) and feeding practices of their child. In addition babies’ height and weight at birth and current height and
weight were taken and registered. A total of 90 young women were included. They were enrolled in the study
purely based on their willingness to participate. The participants were first met and briefed upon the topic and
they were informed about the study design.
 Their role as a participant was explained to them. They were also assured of the confidentiality of personal
information.

6. STATISTICALANALYSIS
The data were analyzed using the SPSS/PC+ statistical package. Analysis of variance (ANOVA) was performed to
evaluate differences between age groups with respect to the different variables measured. Simple linear
correlation was performed on variables in the total sample and within age groups. Unless otherwise stated, the
results are expressed as the mean ± standard deviation

7. Findings
Findings of the study

8. Occupation status of the mother vs. breastfeeding
0
10
20
30
40
50
60
70
80
No
breastfeeding
One time aday Two times a
day
Three times
aday
Any other
73.3
15.6
6.7
2.2 2.2
66.7
20
8.9 2.2
2.2
Percent
Number of times breastfed
Working
Nonworking
 N= 33(73%) of working mothers & N= 30 (66.7%) non working mothers do not breast their kids.
 Out of the working mothers who breast feed their kid, n=7 (15.6%) give feed one time a day. Also n=9(20%) of non
working mothers feed their babies one time a day
Base: All (90)

9. Feeding pattern
 Food pattern seen in toddlers (N = 90)
Homemade
24%
Readymade
33%
Both
42%
Type of food
Base: All (90)
 From the Fig it can be observed that out of 90 subjects, 24% (N=22) of them were fed with homemade food, 33%
(N=30) with readymade food and 42% (N=38) toddlers were fed with both homemade & readymade food.

10. Type of food in comparison with occupation of mothers
Working Non working
49
67
33
51
Type of food by household income
Homemade Readymade Both
o 67 % of the working mothers feed their babies ready made food
o 49% of non working mothers feed their babies with home made food.
oBoth home made & ready made food is preferred by non working mothers (51%)

11. Type of food in comparison with household Income
30 - 35 k 45 - 55k 55k & more
40
25
17
30
39
39
30
36
44
Type of food by household income
Homemade Readymade Both
o 40% of the subjects having household income in range of 30 to 35ooo eat home made food.
oReady made food is preferred most by families having high income of more than 35ooo.
oAlso both ready made & home made food is preferred by high income families

12. Birth weight of toddlers – By occupation of mother
Occupation
Weight
Non working Working Total
2 - 3 kg % 20.0% 2.2% 11.1%
3 – 3.5kg % 62.2% 55.6% 58.9%
3.5 – 4 kg % 17.8% 42.2% 30.0%
Total Count 45 45 90
o 62.2% of non working mothers reported their babies weight to be in the range of 3 to 3.5 Kg. n= 8 (17.8%) said that their babies weight
lied in the range 3.5 to 4 kg at birth. So we can say that n = 36 (80%) non working mothers reported their babies weight at birth to
be greater than 3 Kg
55.6% working mothers gave birth to babies in the weight of 3 to 3.5 Kg, while n =19(42.2%) said that their babies weight at birth was
in the range of 3.5 to 4 Kg. Therefore in case of working mothers, n= 44 (98%) toddlers weighed more than 3 Kg at birth
Also p value for chi square test between the 2 variables is less than 0.05 , so association between birth weight & mother’s occupation is seen.

13. Birth height of toddlers – By occupation of mother
Occupation
Weight
Non working Working Total
30-39cm % 26.67% 17.78% 11.11%
40-49cm % 57.78% 60.00% 58.89%
More than 49cm % 15.56% 11.11% 30.00%
Total Count 45 45 90
26.67%) mothers reported their babies height to be in the range of 30 to 39 cm. Highest numbers n=26 (57.78%) mothers had babies heigh
in range of 40 to 49 cm at birth, while n=7 (15.56%) said that their babies height was more than 49 cm at birth.
So we can say that n = 33 (73.33%) non working mothers reported their babies height at birth to be greater than 49 cm
N=27 (60%) of N=45 working mothers gave birth to babies having height of 40 to 49 cm, while n =15 (33.33%)
said that their babies height at birth was more than 49 cm. Therefore in case of working mothers, n= 32 (71.11%)
toddlers height more than 49 cm at birth. p value is less than 0.05 for height of baby at births Vs occupation of mothers.
So association between height at birth & occupation is observed.

14. Correlation of mothers education & type of food fed
Education Type of food Total
Homemade Readymade Both
Not attended college Count 12 4 4 24
% 55% 13% 11% 22%
Graduate Count 10 17 20 63
% 45% 57% 53% 52%
Post graduate Count 0 9 14 3
% 0% 30% 37% 26%
Total Count 22 30 38 90
o 55% (N=12) mothers, who have not attended college feed their babies with homemade food, while 13% (N=4) use
readymade food and 11% (N=4) use both type of food.
o Of the N=63 graduate mothers, highest 57% (N=17) feed their babies with readymade food followed by 53% (N=20)
both homemade & readymade and then 45% (N=10) use homemade food to feed their babies
o 37% (N=14) mothers of N=3 who have completed their post graduation feed their babies with both homemade &
readymade food and the rest 30% (N=9) uses readymade food.

15. Anthropometric parameters of the toddlers in comparison with type of food fed
Parameters Type of food fed N Mean Std. Deviation
Current Height
Home made 22 70.9 .379
Readymade 30 67.55 .183
Both home & readymade 38 69.47 .802
Current Weight
Home made 22 11.27 .000
Readymade 30 11.06 .183
Both home & readymade 38 11.27 .504
Current Head
Circumference
Home made 22 43 .000
Readymade 30 43 .000
Both home & readymade 38 43 .000
o From table 5, it can be observed that not much difference in the average figures of the different types of food eater is
observed

16. Current weight of toddlers – By their age, occupation of mother & type of food
Age of baby Occupation Type of food
Weight 12 -16
months
17- 20
months
21- 24
months
Non
working
Working
Home
made
Ready
made
Both Total
8-10 kg % 83.3% .0% .0% 28.9% 26.7% 27.3% 23.3% 31.6% 27.8%
11-13kg % 16.7% 96.7% 53.3% 57.8% 54.3% 54.5% 44.7% 70% 55.6%
14-15kg % .0% 3.3% 26.7% 13.3% 6.7% 18.2% 3.3% 10.5% 10.0%
More than 15 % .0% .0% 20.0% 4.4% 8.9% .0% 3.3% 13.2% 6.7%
Total Count 30 30 30 45 45 22 30 38 90
o Highest number of toddlers having current weight of 14 to 15 kg, n=8 (26.7%) belong to 21 to 24 months of age, while only n=1 (3.3%)
belongs to age group of 17 to 20 months. So we can say that weight of toddlers increase with age.
oAlso p value for chi square test between the 2 variables in less than 0.05 , so association between current weight & age of toddlers is seen.
oNot much difference in current weight of toddlers is found in case of working & non working mothers.
oSame is true for different types of food fed.
oAlso the p value for chi square test between the above 2 groups of variables in more than 0.05 , so no association is observed between them

17. Current height of toddlers – By their age, occupation of mother & type of food
Age of baby Occupation of mothers Type of food
Height
12 -16
mnths
17- 20
mnths
21- 24
mnths
Non
working
Working
Home
made
Ready
made
Both Total
Less than 55 cm % 3.3% .0% .0% 2.2% .0% 4.5% .0% .0% 1.1%
55 – 65 cm % 96.7% .0% 3.3% 31.1% 35.6% 27.3% 33.3% 36.8% 33.3%
66 – 90cm % .0% 100.0% 96.7% 66.7% 64.4% 68.2% 66.7% 63.2% 65.6%
Total Count 30 30 30 45 45 22 30 38 90
o Highest number of toddlers n= 59 (96.7%) out of N=30 belonging to 12 to 16 months of age have current height in the range of
55 to 65 cm, while all n=30 (100%) toddlers in 17 to 20 months age group have heights in the range of 66 to 80 cm.
o n=29 (96.7%) of toddlers belonging to 21 to 24 months age group have current height in range of 66 to 90 cm.
o Also p value for chi square test between the current height & age is less than 0.05 , so association between the variables is seen.
o Not much difference in current height of toddlers is found in case of working & non working mothers.
oSame is true for different types of food fed.
oAlso the p value for chi square test between the above 2 groups of variables in more than 0.05 , so no association is observed between them

18. Current Head Circumference of toddlers – By their age, occupation of mother &
type of food
Age of baby Occupation of mothers Type of food
Head
Circumfere
nce
12 -16
mnths
17- 20
mnths
21- 24
mnths
Non
working
Non
working
Home
made
Ready
made
Both Total
35 – 40 cm % 100.0% .0% .0% 37.8% 33.3% 31.8% 30.0% 36.8% 33.3%
40- 50 cm % .0% 100.0% 100.0% 62.2% 66.7% 68.2% 70.0% 63.2% 66.7%
Total Count 30 30 30 45 45 22 30 38 90
o Head circumference of toddlers show same trend as current weight & height.
oP value of chi square test between current head circumference & age is less than 0.05 showing association between the 2, whereas
p value for chi square test between head circumference & occupation & type of food is more than 0.05.
oSo no association between them is observed

19. Different types of home made food fed
12 -16 mnths 17- 20 mnths 21- 24 mnths Total
Khichadi + rice porridge 30.00% 20.00% 16.60% 22.30%
Chapatti +dal + scrambled egg 10.00% 6.70% 16.70% 11.10%
Idli+ smashed fruit+ khichdi 6.60% 0.00% 13.40% 6.60%
Khichdi+chickensoup+ dalrice 3.30% 6.70% 6.70% 5.60%
Boiled & smashed veg+curdrice+breastmilk 3.30% 3.30% 3.30% 3.30%
Plain khichdi+veg+banana 0.00% 3.30% 6.70% 3.30%
Mashed fruit+idli+mashed fruit 3.30% 0.00% 3.30% 2.20%
khichadi +v.soup +rice porridge 0.00% 3.30% 0.00% 1.10%
Chapatti veg+ khichdi+breastmilk 0.00% 3.30% 0.00% 1.10%
khichdi+breastmilk+fruitjuice 0.00% 3.30% 0.00% 1.10%
Mix veg khicdi+chapathiveg+curd 0.00% 3.30% 0.00% 1.10%
Ragi porridge+khichdi+scrambled egg 3.30% 0.00% 0.00% 1.10%
Ragi+riceporridge+chickensoup+khichdi 0.00% 0.00% 3.30% 1.10%
Vegsoup+ragiporride 0.00% 3.30% 3.30% 1.10%
Dal khichdi+riceandragi porridge 3.30% 0.00% 0.00% 1.10%
Khichdi+curd+scrambled egg 0.00% 3.30% 0.00% 1.10%

20. Different types of ready made food fed
12 -16 mnths 17- 20 mnths 21- 24 mnths Total
No readymade 23.30% 26.70% 23.30% 24.40%
Ceralac,Milk biscuit,chocolate 46.70% 60.00% 46.70% 51.10%
Ceralac and lactogen, 13.30% 3.30% 10.00% 8.90%
Milk biscuit,chocolate,Nanpro 6.70% 6.70% 10.00% 7.80%
Powdered milk and ceralac,chocolate 3.30% 0.00% 3.30% 2.20%
Lactogen and milk biscuit 0.00% 3.30% 3.30% 2.20%
Ceralac and fruit juice 3.30% 0.00% 0.00% 1.10%
Nanpro,idli and ceralac 3.30% 0.00% 0.00% 1.10%
Chocolate and milk biscuit 0.00% 0.00% 3.30% 1.10%
Total 30 30 30 90

21. Nutrient intake
o Mean calorie intake of toddlers across all the three age groups were near
the standard values.
oThose belonging in the age group of 12 – 16 months have calorie intake
(904 ±100).
o Toddlers in age group of 17 to 20 months have highest calorie intake of
950 ± 112.
o Those in the age group of 21 to 24 months recorded the lowest energy
intake with high standard deviation.
o So the energy requirements of toddlers in this age group may or may
not be fulfilled with the current dietary habit.
o Carbohydrate intake in the toddlers under study was below
the standards.
oThe above figure also depicts that the mean carbohydrate intake
of 17 to 20 months toddlers (97 ± 22 ) is slightly high than those
of 21 to 24 months (95 ± 22)
o Toddlers in the age group of 12 to 16 months have (92 ± 19) mean
carbohydrate intake.
12-16 Months 17-20 Months 21-24 Months
904 950 890980 1000
1150
Energy Intake
Actual mean Std
12-16 Months 17-20 Months 21-24 Months
92 97 9598 120 130
Carbohydrate Intake
Actual mean Std

22. Nutrient intake
o Mean calorie intake of toddlers across all the three age groups were near
the standard values.
oThose belonging in the age group of 12 – 16 months have calorie intake
(904 ±100).
o Toddlers in age group of 17 to 20 months have highest calorie intake of
950 ± 112.
o Those in the age group of 21 to 24 months recorded the lowest energy
intake with high standard deviation.
o So the energy requirements of toddlers in this age group may or may
not be fulfilled with the current dietary habit.
12-16 Months 17-20
Months
21-24
Months
13 13 13
18 18 19
Protein Intake
Actual mean Std
12-16 Months 17-20 Months 21-24 Months
33 33 3237 40 44
Fat IntakeActual mean Std
The analysis of the data (figure) highlighted the similar
trend in the consumption of fat in the diet of the selected
participants of all the three age groups

23. Nutrient intake
12-16 Months 17-20 Months 21-24 Months
402 353 363
550
450 450
Calcium Intake
Actual mean Std
The above table states that calcium intake in toddlers
belonging to 12 to 16 months of age is 252 ± 54 , which is
significantly lower than the standard value range of 400 -
500.
Calcium intake across the other two age groups is also
significantly low than standard
12-16
Months
17-20
Months
21-24
Months
5
7
4
7 7 7
Iron Intake
Actual mean Std
The mean iron intake of toddlers across the three age groups
was lower than the standard. However in 12 to 16 months
age group toddlers the mean iron intake is 5 ± 1, which is
close to the standard. In case of toddlers belonging to 17 to
20 months age, the mean iron intake is 7 ± 12, which is also
close to standard.

24. Correlation between Nutrient Intake & anthropometric measurements
Correlation
Energy Fat Protein CHO Calcium Iron
Current
Weight
of baby
Pearson
Correlation
.047 .096 -.013 -.008 .193 .005
Sig. (2-tailed) .658 .366 .903 .939 .069 .960
N 90 90 90 90 90 90
Current
Height
of baby
Pearson
Correlation
.170 .095 -.017 -.001 .031 .066
Sig. (2-tailed) .108 .374 .870 .991 .768 .534
N 90 90 90 90 90 90
Head
Circum
current
Pearson
Correlation
.046 .087 -.030 -.026 .044 .061
Sig. (2-tailed) .666 .416 .776 .807 .683 .569
N 90 90 90 90 90 90

25. Contd…
 No significant association was seen between intake of energy, carbohydrate, fat, calcium, iron and the three
anthropometric indices of the subjects - current weight, height & head circumference.
 This is contradicts with the earlier studies conducted on nutritional requirements in toddlers.
 Negative correlation exists between current weight and proteins (- 0.13), current height and protein (-0.17) current head
circumference & proteins (-0.30), current weight & height and carbohydrate (-0.08) & (-0.01) respectively.
 But a positive significant correlation is seen between current weight and iron (0.05)

26. Reasons for using homemade food
The top 4 reasons for using homemade food are:
 It is healthy & nutritious for baby
 Recommended by elders
 Less expensive
 Easy to use

27. Reasons for using readymade food
Key reasons for using readymade food are found to be:
 Convenient to use
 easy to prepare
 baby eats it well
 doctor's recommendations
 publicity through advertisements

28. Reasons for using both homemade & readymade food
Key reasons for using both homemade & readymade food are:
 To fulfill nutritional requirements
 Recommended by doctors/ elders
 Baby eats well both type of food.

29. Conclusion
 The present study showed that homemade food is generally a preferred choice of food for non working
mothers as they believe it to be healthy & nutritious. On the other hand non working mothers’ uses
readymade food more often as for them it is convenient & easy to use. Also a combination of
homemade& ready made food is used by 38(42%) out of 90 subjects.
 It was found that most of the toddlers were fed about 4 to 5 or even more than 5 times in a day, but their
nutrient intake were not meeting the standard requirements.
 This is not found related to food type, family size, household income or education or occupation of
mothers. The mothers are not aware of the nutrition requirements & the type of food required fulfilling
their baby’s nutritional requirements.
 It is difficult to meet all of the micronutrient needs of toddlers through home-based foods only. A review
of 23 complementary food combinations used in developing countries, including some animal products,
revealed that although most of the homemade feed could supply enough energy and protein, none had
enough iron and few had enough zinc. Animal products supply more of these nutrients but only few, such
as liver, have high enough densities to meet requirements.
 Thus, the study suggests that complementary feeding is important for toddlers. At the same time
educating mothers about right feeding practice & food supplying right nutrition is also important.

30. Limitations
 A larger sample size could not be obtained due to time constraints and participant inconvenience.
 Mothers from different locations in Mumbai city could be recruited due to feasibility issues, time
constraint.
 Biochemical parameters could not be conducted due to monetary constraints.
 24- Hour dietary recall could not be recorded for the entire population due to feasibility issues
 There are variables apart from food fed that affects child’s growth, which were not considered in
the survey like mother’s health.

31. Recommendations
 Study could be carried out in different areas and with more number of people.
 Few in-depth interviews with couples & doctors could be conducted to gauge their opinion on toddler’s
nutrition.
 There could be comparative study for baby girl & baby boy.
 A food record diary could have been used to record food intake of the subjects.
 Body composition analysis could be done.
 Appropriate nutrition in toddlers (12-24 months of age) requires interventions across the life span; from
pregnancy into the first 2 year of life. They include support for maternal nutritional, early initiation of
breastfeeding, exclusive breastfeeding for 6 months, and the introduction of adequate complementary foods at or
after 6 months.
 Influencing appropriate feeding practices is as critical as influencing availability and use of adequate foods.
 Quality counseling of mothers, and appropriate decision makers on type of food chosen for child are essential
for improving infant/ toddler and young child feeding practices. They should be at the centre of any strategy to
improve infant and young child nutrition. Identifying approaches to reduce the prevalence of malnutrition
particularly in the vulnerable first 2 y of life is a priority in developing countries.
 Similarly, strategies should maximize the utilization of locally produced foods in any given setting, and consider
the promotion of additional products only if they can fill a critical gap in nutrients in an acceptable, feasible,
affordable, sustainable and safe way.

32. References
 Source: www.thousanddays.org
 http://articles.timesofindia.indiatimes.com/2012-07-02/india/32508089_1_maternal-
mortality-mortality-rate-mdg.