Optimal nutritional care in the neonatal period is critical to ensuring healthy growth, immune competence, and reducing infant morbidity and mortality. Newborn supplementation—such as vitamin A, vitamin D, vitamin K, and other micronutrients—is often recommended in various public health guidelines globally to address deficiencies, prevent disease, and support infant development [1,2]. However, the success of supplementation programmes depends not only on clinical evidence but also on parental knowledge, beliefs, cultural practices, and barriers that influence whether, when, and how parents provide supplements to their newborns. Several studies have highlighted that even in settings with clear recommendations, uptake of newborn supplementation is often suboptimal. For example, in India, although routine vitamin D supplementation is prescribed at birth, adherence among caregivers is low: only about 41.5% of infants had ever received the prescribed vitamin D in one survey, and only a small fraction (8.8%) received it correctly in dose, frequency, and duration. Many parents lacked awareness of the need for supplementation, and health care reinforcement was weak [3]. Such gaps can lead to persistent deficiencies, with both maternal and neonatal vitamin D insufficiency frequently documented—often with a strong correlation between maternal and neonatal vitamin D levels [4]. Parental attitudes and knowledge about supplements also significantly shape behaviors. In a study of expecting parents dealing with vitamin K prophylaxis, many were unaware of the purpose, action, or benefits of vitamin K for newborns; a sizeable proportion had not yet decided whether to accept it after birth. Even among participants with higher education levels, knowledge gaps were considerable [5]. Meanwhile, maternal preferences regarding vitamin D supplementation highlight how beliefs and the form of supplementation (e.g., daily infant drops vs. maternal supplementation) matter: safety was the top concern, and mothers often preferred to take the supplement themselves rather than administer it directly to their infants [6]. Interventions such as neonatal vitamin A supplementation have demonstrated that supplementation can yield significant mortality benefits: a large randomized controlled trial in southern India showed that a two day oral dose of vitamin A in the newborn period reduced mortality by about 22% by six months of age [7]. Yet, despite such strong evidence, parental practices may not align with guidelines, due to limitations in awareness, belief in the sufficiency of breast milk, cultural or religious hesitations, logistical issues (access, cost, supply), or perceptions of potential risks or side effects. Moreover, public health recommendations emphasise that exclusive breastfeeding for the first six months provides the main source of nutrition for infants [8]. However, it is also recognized that breast milk alone may not meet all micronutrient needs—especially for vitamin D, vitamin K, iron, and under certain conditions vitamin A [2,9]. These recommendations often include supplementation for breastfed infants, but the translation into parental practice is mediated by how much parents understand about causes of deficiency, their perspectives on what is “natural,” trust in health professionals, and cultural norms around newborn care. Understanding parents’ perceptions is therefore crucial. Studies of complementary feeding illustrate themes such as variability in guidelines and advice from multiple sources, parental trial and error, the role of daily life constraints (time, cost), and the importance of trusted information sources [10]. Though complementary feeding addresses nutrition beyond the newborn period, many of the same factors—trusted advice, cultural beliefs, understanding of necessity vs risk, and practical barriers—apply to newborn supplementation. This study aims to assess and analyze parental perceptions, knowledge, and practices related to newborn supplementation, and to identify the factors influencing their decisions regarding the administration of supplements such as vitamin D, vitamin K, and other essential micronutrients.

Type of study: Descriptive Study. Place of study: Department of Paediatrics, Mahatma Gandhi Mission Medical College, Plot No14, Sector 8, Nerul, Navi Mumbai, Maharashtra 400706. Study duration: 1 year (August, 2024 – August 2025). Sample size: 380 parents of new-borns. Inclusion Criteria: • Parents or primary caregivers of newborns aged 0–28 days. • Parents willing to provide informed consent to participate in the study. • Parents residing within the study area or attending the selected healthcare facilities during the study period. • Parents who can communicate in the language used for data collection (e.g., English, Hindi, or local language). Exclusion Criteria: • Parents of newborns with severe congenital anomalies or medical conditions requiring specialized supplementation protocols. • Parents who are healthcare professionals or have formal medical training, as their knowledge may bias the results. • Parents unwilling or unable to provide informed consent. • Parents who are not primary caregivers or are temporary guardians. Study parameter: • Awareness of supplementation • Sources of information • Perceived meaning of supplementation • Awareness of Vitamin D supplementation • Supplements actually given • Method of administration • Perceived infant response • Awareness of government-provided supplements • Pay for the supplements • Cultural practices in supplementation • Influence of cultural beliefs • Perception of necessity • Perceived effect on baby’s health Statistical Analysis: Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Awareness, Sources, and Perceptions of Supplementation among Participants Frequency Percent P-value Awareness of supplementation No 92 24.2 <0.0001 Yes 288 75.8 Total 380 100 Sources of information F&F 57 15 <0.0001 Healthcare provider 136 35.8 N/A 92 24.2 News 24 6.3 Social media 23 6.1 TV 48 12.6 Total 380 100 Perceived meaning of supplementation Cultural practice 12 3.2 <0.0001 Food supplement 46 12.1 Growth booster 40 10.5 Immunity booster 36 9.5 Improves Appetite 24 6.3 N/A 92 24.2 Tonic 52 13.7 Vitamins/Minerals 78 20.5 Total 380 100 Awareness of Vitamin D supplementation No 156 41.1 <0.0001 Yes 224 58.9 Table 2: Types of Supplements Administered, Methods of Administration, and Perceived Infant Response Frequency Percent P-value Supplements actually given Calcium 20 5.3 <0.0001 Gripe Water 12 3.2 Honey 9 2.4 Janam-Ghutti 10 2.6 N/A 92 24.2 Swarnaprashan 5 1.3 Vitamin D 224 58.9 Water 8 2.1 Total 380 100 Method of administration Alone 182 47.9 <0.0001 N/A 92 24.2 With breast milk 54 14.2 With formula milk 28 7.4 With Water 24 6.3 Total 380 100 Perceived infant response Can't say 61 16.1 <0.0001 N/A 92 24.2 Negative 15 3.9 Positive 212 55.8 Total 380 100 Table 3: Awareness and Payment Status of Government-Provided Supplements Among Participants Frequency Percent P-value Awareness of government-provided supplements N/A 91 23.9 <0.0001 No 50 13.2 Yes 239 62.9 Total 380 100 Pay for the supplements Don’t know 17 4.5 <0.0001 N/A 141 37.1 No 164 43.2 Yes 58 15.3 Total 380 100 Table 4: Influence of Cultural Practices and Beliefs on Supplementation Practices Frequency Percent P-value Cultural practices in supplementation Colostrum avoidance 36 9.5 <0.0001 Janam Ghutti 92 24.2 N/A 48 12.6 Pre lacteal feeds (Honey/Ghee/Jaggery /Castor oil) 186 48.9 Swarnaprashan 18 4.7 Total 380 100 Influence of cultural beliefs N/A 48 12.6 <0.0001 No 129 33.9 Yes 203 53.4 Total 380 100 Table 5: Perceived Necessity and Health Impact of Supplementation Frequency Percent P-value Perception of necessity No 91 23.9 <0.0001 Not Sure 54 14.2 Yes 235 61.8 Total 380 100 Perceived effect on baby’s health Negative 35 9.2 <0.0001 No effect 125 32.9 Positive 220 57.9 Total 380 100 In our study, which included 380 participants, the majority (75.8%, n = 288) reported being aware of supplementation, while 24.2% (n = 92) were not (P < 0.0001). When asked about sources of information regarding supplementation, the most commonly cited source was healthcare providers (35.8%, n = 136), followed by friends and family (15%, n = 57), TV (12.6%, n = 48), news (6.3%, n = 24), and social media (6.1%, n = 23). Notably, 24.2% (n = 92) reported no source of information (P < 0.0001). Regarding the perceived meaning of supplementation, the most common understanding was vitamins and minerals (20.5%, n = 78), followed by tonic (13.7%, n = 52), food supplement (12.1%, n = 46), growth booster (10.5%, n = 40), immunity booster (9.5%, n = 36), and appetite improvement (6.3%, n = 24). A small number associated it with cultural practices (3.2%, n = 12), and 24.2% (n = 92) did not specify a meaning (P < 0.0001). Awareness of Vitamin D supplementation was reported by 58.9% (n = 224), while 41.1% (n = 156) were unaware (P < 0.0001). Regarding the types of supplements actually given, Vitamin D was the most commonly administered supplement, reported by 58.9% (n = 224) of participants (P < 0.0001). Other supplements included calcium (5.3%, n = 20), Gripe Water (3.2%, n = 12), Janam Ghutti (2.6%, n = 10), honey (2.4%, n = 9), water (2.1%, n = 8), and Swarnaprashan (1.3%, n = 5). A significant proportion (24.2%, n = 92) did not report any supplementation. As for the method of administration, 47.9% (n = 182) gave supplements alone, 14.2% (n = 54) administered them with breast milk, 7.4% (n = 28) with formula milk, and 6.3% (n = 24) with water. Again, 24.2% (n = 92) did not specify any method (P < 0.0001). When asked about the perceived response of the infant to supplementation, a positive effect was reported by 55.8% (n = 212), while 3.9% (n = 15) observed a negative response. 16.1% (n = 61) were uncertain, and 24.2% (n = 92) gave no response (P < 0.0001). In terms of awareness of government-provided supplements, 62.9% (n = 239) of participants reported being aware of such provisions, while 13.2% (n = 50) were not aware. A total of 23.9% (n = 91) did not respond or selected not applicable (P < 0.0001). When asked whether they had to pay for the supplements, 43.2% (n = 164) reported that they did not pay, 15.3% (n = 58) stated that they did pay, and 4.5% (n = 17) were unsure. A significant portion (37.1%, n = 141) did not provide a response or selected not applicable (P < 0.0001). With regard to cultural practices related to supplementation, nearly half of the participants (48.9%, n = 186) reported the use of pre-lacteal feeds such as honey, ghee, jaggery, or castor oil. Janam Ghutti was reported by 24.2% (n = 92), colostrum avoidance by 9.5% (n = 36), and Swarnaprashan by 4.7% (n = 18). 12.6% (n = 48) of respondents did not provide a relevant answer (P < 0.0001). When asked whether cultural beliefs influenced their supplementation practices, 53.4% (n = 203) acknowledged an influence, while 33.9% (n = 129) stated that cultural beliefs did not influence their decisions. 12.6% (n = 48) did not respond (P < 0.0001). When asked about the perceived necessity of supplementation, a majority of participants (61.8%, n = 235) believed that supplementation was necessary. Meanwhile, 14.2% (n = 54) were not sure, and 23.9% (n = 91) felt it was not necessary (P < 0.0001). Regarding the perceived effect of supplementation on the baby’s health, 57.9% (n = 220) reported a positive impact, 32.9% (n = 125) observed no effect, and 9.2% (n = 35) perceived a negative effect (P < 0.0001).

The present study was a Descriptive Study. This Study was conducted from 1 Year at Department of Paediatrics, Mahatma Gandhi Mission Medical College, Plot No14, Sector 8, Nerul, Navi Mumbai, Maharashtra 400706. Study population 380 parents of newborns. In our study of 380 participants, we found that awareness of supplementation was relatively high (75.8 %, n = 288), and over half (58.9 %, n = 224) reported awareness specifically of Vitamin D supplementation. These findings align moderately well with the trends observed in other settings: for instance, Sharma et al. in a survey of pediatricians in Delhi reported that 70–100 % of practitioners prescribed routine vitamin D to infants, reflecting a clinical expectation of supplementation, although parental uptake and awareness were not directly measured in that work [11]. On the caregiver side, studies from other regions have reported lower levels of parental knowledge: for example, compliance to prescribed vitamin D supplementation was found to be only about 66.7 % in infants who ever received the supplement in an Indian cohort, with only one-third of mothers aware of the need for routine supplementation at discharge [12]. With respect to sources of information, our finding that healthcare providers were the predominant source (35.8 %, n = 136) is consistent with other studies emphasizing the role of the health system. Yet, the substantial proportion of respondents who reported no source (24.2 %) or relied on informal contacts (friends/family, social media) highlights a weakness in structured education or counseling. In contrast, some community-based surveys in low- and middle-income countries report that social networks and informal sources often dominate health information, particularly where access to formal health services or trust in them is limited [13,14]. Regarding types of supplementation actually given, our result that Vitamin D was most frequently administered (58.9 %, n = 224) underscores the centrality of Vitamin D in newborn supplementation paradigms. However, the fact that 24.2 % (n = 92) reported no supplementation suggests missed coverage. This “drop-off” phenomenon is echoed in compliance studies: in the Indian Pediatrics cohort, even among infants who had ever been prescribed vitamin D, adherence in the preceding 7 days or 4 weeks was suboptimal (median ~66.7 %) and many caregivers lacked full understanding of the duration required [12]. Thus, the discrepancy between prescription and full uptake remains a consistent challenge. On perceived infant response, a majority (55.8 %, n = 212) in our study reported positive effects. This aligns with an optimism about supplementation seen in caregiver surveys, but must be interpreted cautiously, because perceived outcomes may be subject to expectation bias or recall bias. Some clinical trials suggest that vitamin D supplementation in infants can meaningfully raise serum 25‑hydroxyvitamin D levels (by about 22.63 nmol/L on average, up to 6 months) compared to placebo, although evidence remains of low certainty [15]. Our findings on awareness of government-provided supplements (62.9 %, n = 239) and the fact that 43.2 % (n = 164) reported not having to pay for supplements suggest that public health programs may be reaching a majority. But the fact that 15.3 % (n = 58) reported paying and 37.1 % (n = 141) were unsure or nonrespondent indicate gaps in equitable distribution and clarity. In some national programs, mis‑understandings about program eligibility or stockouts can lead caregivers to purchase supplements in private markets [16,17]. Cultural practices and belief systems emerged strongly in our data: nearly half (48.9 %, n = 186) reported use of pre-lacteal feeds (e.g., honey, ghee), and 53.4 % (n = 203) acknowledged that cultural beliefs influenced their supplementation practices. This is consistent with anthropological and public health observations in various regions where traditional feeding practices and rituals — such as colostrum avoidance, use of Janam Ghutti, or Swarnaprashan — persist alongside biomedical advice [18,19]. Some qualitative studies have emphasized that unless health education actively addresses these culturally rooted beliefs, supplementation programs may meet resistance or inconsistent uptake. Finally, regarding perceptions of necessity and health effects, the fact that 61.8 % (n = 235) believed supplementation to be necessary and 57.9 % (n = 220) perceived a positive health impact suggests generally favorable attitudes. However, the presence of 23.9 % (n = 91) who believed it was unnecessary, and 9.2 % (n = 35) who perceived negative outcomes, indicates heterogeneity. Similar patterns have been documented in caregiver surveys, where misperceptions or anxieties about over-supplementation or side effects complicate acceptance [20]. Health education efforts must therefore not only supply information, but also build trust and address misconceptions.

This study highlights that while the majority of parents are aware of newborn supplementation—particularly Vitamin D—gaps remain in understanding, administration practices, and cultural influences. Healthcare providers are key sources of information, yet traditional beliefs and practices still significantly shape parental decisions. Although most perceive supplementation as necessary and beneficial, inconsistent access and knowledge persist. Targeted health education and culturally sensitive counseling are essential to improve adherence and ensure effective implementation of supplementation programs for newborn health and development.

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