WHO and UNICEF define complementary feeding as the process of starting solid, semi-solid or other food to the child along with breastfeeding when breast milk alone is no longer sufficient to meet the nutritional requirements of infants [1]. Nutrition is important before, during and after pregnancy and is the most influential non-genetic factor in fetal development. Women with preconception healthy Body Mass Index (BMI) tend to gain an appropriate amount of weight during pregnancy and women with BMI below 19.1 have fivefold increased in delivering low birth weight baby. Maternal undernutrition is a risk factor for fetal growth restriction and adverse prenatal outcomes [2,3].

Any non-breast milk, foods or nutritive liquids that are fed to young children after six months of age are defined as complementary foods. It is the transition of baby food from exclusive breastfeeding to family foods, with gradually increasing the amount of food from 6 to 24 months [4]. In the past, such foods were often called ‘weaning foods’ however, the term ‘complementary food is preferred because weaning implies the cessation of breastfeeding, whereas complementary meaning to complement the breast milk along with the continuation of breast milk [5]. A proper complementary feeding consists of foods that are rich in energy and in micronutrients (especially iron, zinc, calcium, vitamin A, vitamin C and folates), free from contamination (pathogens, toxins or harmful chemicals), without much of salt or spices, easy to eat and easily accepted by the infant, in an appropriate amount, easy to prepare from family foods, and at a cost that is acceptable by most families [6]. Complementary feeding is extremely essential and typically covers the period from 6 to 18-24 months of age. WHO recommends introducing complementary feeding only from the seventh month onwards [7] because, at this age, breast milk alone is no longer sufficient to maintain the child’s recommended daily allowances of nutritional requirements to enhance growth. Children are fed small quantities of solid and semi-solid foods while continuing to breastfeed up to age 2 or beyond. The amount of food is increased gradually from 6 to 23 months, which is the period of transition to eating the regular family diet. This period is characterized by an increase in the prevalence of malnutrition because of poor feeding practices and infections [8]. Feeding practices not meeting the need and requirements of children increases the risk of becoming undernourished and other health consequences even leading to death [3,9,10].

Malnutrition has been responsible directly or indirectly, for 60% of the 10.9 million deaths annually among children under five. Well over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life. Not more than 35% of infants worldwide are exclusively breastfed during the first four months of life: Complementary feeding (too early or too late) along with poor feeding practices are often nutritionally inadequate and unsafe resulting in impaired development and becoming a major threat to socio and economic development [3,11].

The introduction of complementary feeding is a very common cultural practice in south region including Nepal which has a very high burden of malnutrition. The on-feeding practice, Nepal demographic health survey (NDHS) 2006 reported about 70% of children aged 6-8 months children were introduced to complementary foods in Nepal [12]. Similarly, the prevalence of minimum meal frequency, minimum dietary diversity, and minimum acceptable diet were 82, 34.2 and 32% respectively [12]. By 2011, children of 6-23 months of age were offered minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was 76.6, 30.4 and 26.5% respectively showing deteriorating conditions on feeding practices [13]. These data suggest much-needed focus on improvement and monitoring of these practices while the interventions are being implemented in Nepal [14]. The National Demographic Health survey 2011 concluded that complementary foods are not introduced in timely fashion for all children in Nepal. 70% of infants have been given complementary foods by age 6-9 months. Though 87.3% of mothers had knowledge about the time of initiation of complementary feed within 3 months of age and 8.9% of mothers didn’t start complementary feeding even at 6 months of age. Both practices are not only under desirable but also harmful to our children but unfortunately, are being still practiced in the developing world [13]. Only 57% of the mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high i.e. 84% followed by meal diversity 35% and minimum acceptable diet 33% respectively. Maternal education and with their children’s growth monitored were independently associated with receiving minimum acceptable diet [15].

The introduction and use of appropriate complementary feeding are key in determining the healthy development and growth of infants. The early introduction of solids as alternatives to breast milk points that the infants are more likely to be exposed to microbial contaminated foods and fluids; which is especially the case in developing countries resulting malnourishment and/or poor growth experience. A study has also found that young infants under six months of age are not yet ready physiologically to receive complementary food as their neurodevelopment, gastrointestinal systems, and kidneys are still underdeveloped. A systematic review in 2013 found evidence suggesting that the very early introduction of solid foods (at or before an infant reaches 4 months of age), instead of at 4–6 months or > 6 months, may result in an increased risk of infants becoming overweight in childhood [16].

The link between malnutrition and infant feeding has been well established. Infant and young child nutrition has been engaging the attention of scientists and planners since long for the very simple reason that growth rate in the life of human beings is maximum during the first year of life and infant feeding practices comprising of both the breastfeeding as well as complementary feeding (CF) have major role in determining the nutritional status of the child [17]. Infant and young children should be fed a minimum acceptable diet to ensure appropriate growth and development. Without adequate diversity and meal frequency, infants and young children are vulnerable to undernutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. The WHO minimum acceptable diet recommendation, which combines minimum dietary diversity and minimum meal frequency, differs between breastfed and non-breastfed children [7].

Nutrition plays an important role in the health and development of individuals. Adequate nutrition during the first two years of life is very important to ensure optimal physical and mental development. At this stage, children are particularly vulnerable to growth retardation, micronutrient decencies and common childhood illness such as diarrhea and acute respiratory infection. Good nutrition protects young children and mothers, strengthens the immune system and reduces the risk of non-communicable diseases related to foods during the lifecycle. It also enhances the productivity of the population and can help to get out gradually from vicious cycle of poverty and hunger. Regarding the magnitude of the issue this research hence aimed to find out situation of complementary feeding practices and the factors associated with complementary feeding practice in selected urban areas of Nepal.