The recent article on the subject brings out very interesting findings(1) which should be considered while formulating appropriate child survival strategy. It is shown that 51.3% infants were started on supplementary feeds (SF) within 6 weeks of age. Contrary to common belief the situation is even worse in rural area(2). The commonest reasons for starting SF was 'not enough milk' as 'perceived' by mother. The picture is similar in our neighboring country Bangladesh(3) and elsewhere. All of us agree that this type of lactation failure is more 'conceptual' (psychological) than real. So far as feeding methods are concerned the bottle was used by 73.3% in this study, whereas in rural area the percentage is :much lower. Kapil et al.(4) found it to be only 9%. Thus though not bottle fed, a large number of infants consume SF with the help of Katori/Spoon or some other vehicle.

The article brings out another very important fact regarding the type of milk used for SF. It is shown that 'animal milk' was consumed by 97.3% and 'formula feeds' by 2.7% only. Kapil et al. in their study also, found only 2% below one year of age receiving formula feeds(4). Thus a vast majority of infants both urban and rural consume 'fresh animal milk' with usual life threatening consequences. There is hardly any awareness and restrain regarding use of 'fresh animal milk' as breast milk substitute(2,S). Apart from 'non-human milk' (fresh or processed) other ingredients commonly used as SF in the rural area' are arrowroot, powdered rice, suji, barley and many other cereal based substances.

The tragedy of supplementary feeding is that even when it is started due to some unavoidable reason it is most often continued beyond six months of age and the infant is deprived of appropriate energydense semi solid home made food, during the critical period of 6 month to 2 years- 'the period of perpetual hunger'. 'This obsession with liquids must cease(6). Therefore, what is needed is an appropriate and comprehensive strategy, its proper implementation through effective communication involving the community who must understand their responsibility and co-operate to become real partner for sustainable behavioral change in feeding and caring infants. Mere awareness is not enough; sharing responsibility is a must. This calls for a firm 'political will'.

N.C. De,
CINI-Child in Need Institute,
Vill. Daulatpur, PO. Pailan,
Via-Joka, 24-Parganas (S),
Pin 743 512 West Bengal, India.
 

1. Agarwal A, Arora S, Patwari AK. Breast feeding among urban women of low socioeconomic status: Factors influencing introduction of supplemental feeds before four months of age. Indian Pediatr 1998; 35: 269-273.

2. De NC. Top feeding: Whom to blame. Academy Today 1994; pp 17-19.

3. Ahmed S. Lactation management: Practical aspects. The Newborn 1996; 2: 6-7.

4. Kapil V, Verma D. Narula: S. et al. Breast feeding practices in schedule caste communities in Haryana State Indian Pediatr. 1994,31: 1227-1232.

5. De NC. Expand the scope of the Act. Indian Pediatr 1995; 32:1199-1200.

6. Ghosh S. Preventing malnutrition: The critical period is 6 months to 2 years. Indian Pediatr 1995; 32: 1057-1059.