Association of Feeding Practices with Growth in Infants: A Longitudinal Observational Study in a Rural District of Pakistan

Background Exclusive breastfeeding (EBF) is recommended for the first six months of an infant’s life, but barriers to EBF persist due to socio-cultural, economic and health-related factors. Promoting optimal feeding practices, particularly EBF, in resource-constrained settings is essential for child growth and development. This study examines the association between feeding practices and malnutrition in a birth cohort in a rural district of Pakistan. Methods Data were collected from a cohort of over 2600 infants, up to six months of age, through routine household visits by community health workers. The study analyzed demographic characteristics, feeding practices, anthropometric, and health information of infants and their mothers. Results Breastfeeding practices varied, with exclusive breastfeeding being more common in the first month, while predominant breastfeeding (breastmilk with non-milk liquids) was most prevalent from 1 to 6 months. A total of 98.3% of infants had been breastfed at some point between birth and 6 months of age, with a significant proportion experiencing wasting (14.7%), stunting (36.7%), and being underweight (38.5%) at baseline. Early initiation of complementary feeding before four months was significantly associated with increased odds of wasting by six months of age (AOR = 4.14, 95% CI: 1.95–8.77; p < 0.001). The early initiation of breastmilk alternatives/lower rates of EBF were identified as correlating factors with wasting and underweight status in infants. Conclusion Parents may have to resort to suboptimal complementary feeding practices before 6 months of age, when they observe their child’s failure to thrive on exclusive breastfeeding. Our findings indicate that a comprehensive, multi-faceted health and policy approach is required to promote optimal feeding practices and improved infant nutrition and growth in resource-constrained settings. Additionally, context-specific guidelines (beyond lactation counselling) and alternative feeding options are required to support mothers who are unable to exclusively breastfeed.