A biocultural investigation of the weanling's dilemma in Kathmandu, Nepal:Do universal recommendations for weaning practices make sense?

The primary objective of this report is to use data from a study of infant growth and weaning practices in Kathmandu, Nepal, to investigate universal recommendations about exclusive breast-feeding up to 6 months postpartum. A secondary objective is to demonstrate the complexity of the biocultural na ture of infant feeding practices. A sample of 283 children under 5 years of age and their 228 mothers living in a peri-urban district of Kathmandu par ticipated in this study. The children's height/length and weight were measu red three times over 9 months. At each session, a demographic, child health and infant feeding survey was administered; between sessions, in-depth int erviews were conducted with mothers regarding infant feeding practices. Whi le a few of the infants under 2 months were receiving non-breast milk foods , at 3 months of age half of the sample had been introduced to non-breast m ilk foods and by 7 months all infants were eating non-breast milk foods. A comparison of growth indices and velocities between exclusively and partial ly breast-fed infants from birth to 7 months of age shows no evidence for a difference in nutritional status between the two groups. Although there ar e cultural rules about breast-feeding that vary by ethnic group, all mother s followed a feeding method that depended on their assessment of whether th e child was getting enough breast milk. The conclusion is that exclusive br east-feeding up to 6 months may not be appropriate For all infants. In this sample, breast-feeding duration is not shortened by the early introduction of non-breast milk foods, as the median age of breast-feeding cessation is 36 months. One of the main reasons for severance was the onset of another pregnancy. Investigation of infant feeding practices must be contextualized in the local ecology of the population. While cultural beliefs about breas t-feeding are relevant, mothers' individual assessments of their children's nutritional needs and demographic events in parents' lives must also be co nsidered.