Breastfeeding provides optimal and complete nutrition for newborn babies and the health risks associated with infant formula feeding are increasingly documented [1]. During infancy, breastfeeding protects against infectious disease, and in the long term, breastfeeding is associated with benefits in several areas, such as cardiovascular risk factors, intellectual capacity, and allergy [2]. Undernutrition in children demands an urgent need for a comprehensive multipronged evidence-based strategy to tackle the situation. Evidence-based interventions, which include initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of life, and introduction of appropriate and adequate complementary food after 6 months of age, are available to prevent undernutrition in children and improve child survival. Breastfeeding also provides health benefits to women, in terms of less bleeding at the time of birth, fewer cancers, and fewer fractures at later ages [3]. Breastfeeding should continue for up to two years or more and nutritionally adequate, safe, and appropriately fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant [4]. Breastfeeding provides several biochemical and physical barriers to the use of infectious agents. The physical act of breastfeeding limits infants' exposure to environmental pathogens presents on potentially contaminated surfaces. Human milk contains bioactive constituents that aid, develop, and enhance the immune system of a baby. Some of these factors work to regulate the immune response, while others act at the mucosal surfaces to prevent adhesion [5].

The first two years of life are critical stages in a child’s growth and development. Any damage caused by nutritional deficiencies during this period could lead to impaired cognitive development, compromised educational achievement, and low economic productivity [6]. Various factors associated with suboptimal breastfeeding and complementary feeding practices have been identified in various settings. These include maternal characteristics such as age, marital status, occupation, and education level; antenatal and maternity health care; health education and media exposure; socioeconomic status and area of residence; and the child’s characteristics, including birth weight, method of delivery, birth order, and the use of pacifiers [6]. Poor breastfeeding and weaning or complementary feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first two years of life. Therefore, it is essential to ensure that mothers and caregivers are provided with appropriate guidance regarding the optimal feeding of infants and young children. This study was conducted to study the relationship between mothers’ nutritional knowledge, child feeding patterns, attitude, and literacy status, with the nutritional status of their children of 6 months to 2 years of age.

The study to be done in Department of Paediatrics, Bhaskar Medical College and General hospital, Yenkapally, Moinabad, Telangana, India. The study protocol was approved by Ethical committee for research studies of Bhaskar General Hospital.

Study Population was children aged 6-24 months and their mothers. Study design was a cross-sectional, observational study.

Inclusion Criteria:

1. Infants>6 months of age
2. Children <2years of age
3. Mothers of children 6 months to 2 years of age
4. Mothers who give consent for the study

Exclusion Criteria:

1. Infants <6 months of age
2. Children >2years of age
3. Siblings
4. Mothers who do not give consent for the study
5. Low birth weight babies
6. Intrauterine growth retarded babies
7. Infants with congenital anomalies

Methodology for Data Collection

The study will be carried out in the Department of Paediatrics, Bhaskar Medical College, Yenkapally, Moinabad, Telangana state. A pretested questionnaire will be used to collect the information on nutrition knowledge of 200 mothers. The nutrition knowledge of mothers will be assessed regarding various aspects such as feeding practices and the child's diet and essential nutrients using a questionnaire. The mother's literacy status and attitude also will be assessed. A total of 20 questions are formed. For evaluating the knowledge test, one score will be awarded for each correct and zero for each wrong answer. The data on the length and weight (6 months -24 months) of the children of those mothers will be obtained using standard methods. The length will be measured using an infantometer and weight will be measured using an electronic type of weighing scale. The date of birth of each child for age will be obtained from hospital records or birth certificates or by the mother's recall. Based on measurements, data on length and weight will be classified according to standard deviation z-scores (length for age, weight for age, and weight for length) using WHO standards. The child falling between -2SD and -3SD of the standard will be considered moderately stunted, underweight, or wasted and those below -3SD will be classified as being severely malnourished.

Weight for age in kilograms: Weight (6 months -1 year) = age(months) + 9/2. Weight (1year – 2 years) = age(years) X 2 + 8. Length for age in centimeters Length approximately at 6 months at 9 months   70cm at 1-year    75cm Total gain in first year approximately 25cm. A gain of 12.5 cm in 2nd year i.e. 87.5 cm approximately. Weight for length = weight of the child X 100 divided by weight corresponding to the length of the child

Statistical analysis

Data entry and statistical analysis were performed with the help of Microsoft Excel 2010 and SPSS version 20.0, while categorical variables are presented as numbers and percentages. The chi-square test is used to compare differences in categorical variables. The statistical significance level was fixed at p<0.05.

A total of 200 children aged 6–24 months participated in the study. As shown in Table 1, the majority (44.5%) were in the 6–12-month age group, followed by 38% in the 19–24-month group and 17.5% in the 13–18-month group. Girls comprised 51.5% of the study population, while boys accounted for 48.5%.

According to Table 2, 86% of the children had normal length-for-age, while 12.5% were stunted and 1.5% were severely stunted. For weight-for-age, 64.5% were normal, with 34% underweight and 1.5% severely underweight. In terms of weight-for-length, 60.5% were classified as normal, 26% were wasted, and 4% were severely wasted.

Maternal knowledge, attitude, and practice (KAP) scores are presented in Table 3. Good KAP scores were recorded in 42.5% of mothers, while 34% had average, 19% had excellent, and 4.5% had poor KAP scores.

Feeding practices reported by mothers (Table 4) revealed that 94% initiated breastfeeding immediately after birth, and 49.5% introduced complementary feeding at six months. While 71% practiced handwashing before feeding, 51.5% reported restricting their child's diet during illness.

As illustrated in Table 5, 36.5% of mothers had completed secondary education, 31% had primary education, and 9% were illiterate. The majority of households had a monthly income between ₹5,001–10,000 (34%) and ₹10,001–15,000 (33.5%).

The relationship between maternal KAP and child nutritional status is summarized in Table 6. Statistically significant associations were found between poor KAP scores and higher rates of underweight (p=0.001) and wasting (p=0.001). However, no significant association was observed between KAP scores and stunting (p=0.25).

These findings highlight the influence of maternal knowledge and practices on specific indicators of child nutritional status, particularly underweight and wasting, emphasizing the need for targeted educational interventions.

for reducing malnutrition and promoting growth, development, and survival during early childhood. Based on the Global strategy for infant and young child feeding developed jointly by World Health. Recommends early initiation of breastfeeding with exclusive breastfeeding for the first six months. Continued breastfeeding up to two years or beyond along with timely and appropriate complementary feeding beginning from six months of age was recommended by WHO in 2003. [7] UNICEF has advocated that the first 1000 days from conception to a child's second birthday are crucial for nutritional interventions [8]. In this study, we found that 86% of children aged 6–24 months were of normal height-for-age. However, 12.5% were stunted and 1.5% among them were severely stunted. The prevalence of stunting in this study was in agreement with the findings of Pokharel et al. [9] who found 19.2% of cases with moderately and 15% were severely stunted. The underweight prevalence in this study was 34% and 1.5% were severely underweight which is in agreement with the results of Udoh et al. [10] where they found 33.3% of the infants were underweight.

In this study, we found wasting was present in 26% of infants, and 4% were severely wasted. Overweight, risk of overweight and obesity was found to be present in 3.5%, 5%, and 1% respectively. A similar study by Dinesh et al. [11] found that 26.1% of infants were wasted.  The analysis of stunting, underweight, and wasting showed no significant differences statistically these findings are in agreement with Adeladza et al. [12].  The Baby-Friendly Hospital Initiative WHO endorses multiple practices for exclusive breastfeeding support through early breastfeeding establishment and on-demand feeding and rooming-in care (WHO, 2016) [16]. Results from our study indicate that 94% of mothers offered breast milk right after birth as the initial nourishment source while 49.5% started giving complementary foods when their babies reached six months of age. WHO recommendations appear to be followed reasonably well by mothers however additional improvement measures are necessary for their complementary feeding behavior. Maternal education plays a pivotal role in IYCF. In this study, we found that 36.5% of mothers were educated up to secondary level, and only 0.5% were postgraduates. A higher KAP (Knowledge, Attitude, and Practices) score is associated with higher maternal education and family income, similar report has been shown by Uchendu et al. [14] and Yeganeh et al. [15] where they found maternal education to be a strong determining factor for higher KAP scores. It was been shown by Agize et al. [16] that higher paternal education was positively associated with knowledge of dietary diversity. The KAP score reflected good knowledge in 42.5% of our studied mothers. The statistical comparison showed an association linking underweight status to KAP scores which suggests that higher knowledge affects nutritional results for the better. The research by Saaka et al. [17] demonstrated that 13.8% of children within the 6–23-month age range failed to consume proper complementary foods and maternal understanding of child nutrition proved crucial in this scenario. The successful provision of adequate feed challenges healthcare providers with cultural feeding traditions and maternal occupation types as well as childbirth methods. Postoperative pain and delayed maternal-infant bonding after Caesarean delivery led to delayed breastfeeding initiation according to Vieira et al. [18]. Insufficient support from healthcare personnel along with negative public views restrict mothers from practicing exclusive breastfeeding Thurman et al. [19]. We found gaps in knowledge about micronutrients existed in our cohort with 28% of mothers unaware of iron-rich foods 34% reporting a lack of awareness of calcium-rich foods and 66.5% of the cases were not aware of food-enriching agents. This lack of awareness is detrimental to better growth and may contribute to poor dietary diversity. In summary, although the breastfeeding practices in our study population were satisfactory, however, complementary feeding practices and maternal nutritional knowledge require further enhancement. Interventions focused on maternal education, dietary counseling, and community-based programs could improve child nutritional outcomes.

The study highlights that while breastfeeding practices are relatively well followed, complementary feeding and maternal knowledge remain suboptimal. A positive correlation between maternal KAP scores and child nutritional status underscores the importance of education and awareness. Targeted interventions focusing on improving maternal knowledge, promoting dietary diversity, and addressing cultural and socioeconomic barriers are essential. Strengthening community-based programs and integrating nutrition education into routine maternal and child health services can significantly improve feeding practices and child health outcomes.

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