Complementary feeding is giving other foods or fluids to infants in addition to breast milk. Timely complementary feeding is giving to infants other foods or fluids in addition to breast milk at six months of age (1). Even though exclusive breastfeeding is crucial and adequate for the first six months of age, providing breast milk alone after six months does not satisfy the nutrition requirement of infants. Therefore, timely introduction of nutritionally adequate, safe, and age appropriate complementary feeding at sixth month is important for the better health and development of children (2). Good complementary feeding practice enhances growth and prevents stunting in children. Infants are particularly vulnerable to malnutrition and infection during the transition period when complementary feeding begins (3). Although, there was an optimum breast-feeding, children are at risk of being stunted if adequate quantity and quality of complementary food is not given starting at six months of age (4). The effect of appropriate child feeding practice has vital role in developing countries where access to basic needs and health services are not adequately accessed (5). To develop estimates of the minimally adequate energy density of complementary foods, it is necessary to take feeding frequency into consideration (6). Appropriate complementary feeding means giving enriched and proper nutrient in every day and provides additional nutritious snacks between meals, for example mashed ripe fruit (7).
The World Health Organization (WHO) guideline for complementary feeding to those breastfed children describes other important aspects such as safe preparation, meal consistency and meal frequency. Foods with high energy density should require nutrient content in complementary food (8). Introduction of complementary foods too late results in an inadequate intake of energy and leading to stunting and poor growth, as well as iron and other nutrient deficiencies. Starting complementary food before six month is a common practice for infants with many reasons. Most mothers claim to introduce complementary foods early because they do not have enough amount of breast milk, or the baby keeps crying (9). Informal sources of weaning advice appeared to be most influential in younger mothers and those of lower educational attainment, and result in earlier weaning (10). As children grow, the consistency of complementary foods should change from semisolid to solid foods and diversified foods. By eight months, infants can eat ‘finger foods’ and by 12 months, most children can eat the same types of food as the rest of the family eat (11).
Malnutrition is one of the directly or indirectly, for over half of all childhood mortality in the world today. Infants and young children are at increased risk of malnutrition starting from six months of age, because breast milk alone is no longer sufficient to satisfy all nutritional requirements (11). Proportion of children 6 to 23 months of age who received foods of four or more groups of food from the seven recommended guidelines in the WHO were only 41.93% in South Asian country (8).
In Ethiopia, complementary feeding practices were alarmingly poor among children aged 6–23 months old (4). Even some mothers did not get appropriate information about the right time of complementary food (5).
From the physiological point of view, the taste function of children matures at around 6 months; an infant of this age can eat foods of different tastes and discover new foods that is differ from mothers' milk. The capacity to absorb and digest starches and fats is sufficient in a child aged 4 to 6 months. The pancreatic amylase is active from the first month of age, and bile salts and the pancreatic lipase are active before the age of three months (6).
The worst effect of malnutrition occurred during pregnancy and early childhood time which is from conception to two years of age that means the first 1000 days. Undernourished children have weaker immune systems and are thus more susceptible to infections and illnesses. Long-term insufficient nutrient intake and frequent infections can cause stunting; whose effects in terms of delayed motor and cognitive development are largely irreversible (12).
More than two out of every five children in Ethiopia are stunted. About 81% of all cases of children with under nutrition and related pathologies are untreatable. Nearly 44% of the health costs associated with under nutrition occur before the child reach one year old, and the annual costs associated with child under nutrition are estimated at Ethiopian birr (ETB) 55.5 billion, which is equivalent to 16.5% of GDP. Low school performance and other health problem are associated due to inappropriate complementary feeding in the country (13)
In Nepal, lack of getting information or knowledge regarding to appropriate complementary feeding practice found to be the most important factor associated. Others like education of mother, profession of father, maternal occupation was important association factors (14). The analysis showed that significant association between timely initiation of complementary feeding and maternity care, religion, exclusive breastfeeding, numbers of siblings and breastfeeding as independent predictors of timely initiation of complementary feeding (15). The result of study done on complementary feeding patterns in rural Western Chins revealed that maternal education, family income status, and the availability of food status were highly associated with complementary feeding practices (16). In unadjusted analyses done in US infants on timing of initiation of complementary foods revealed that, early introduction varied by breastfeeding status; race/Hispanic origin; Special supplemental nutrition program for women, infants, and children participation; and maternal age (17). Study done in Aligarh, Uttar Pradesh on feeding practices were found to be significantly associated with various socio-demographic factors such as sex of child, and literacy status of mother (18).
As the result of the research conducted in France on introducing new food texture complementary food depicted that ANC and PNC follow up were the most frequently listed source of oral information for complementary feeding practice. More than half of parents also looked for more information in books and on the internet and has association on complementary feedings practice (20). Research conducted in Ireland on complementary feeding revealed that maternal age and knowledge on appropriate complementary feeding has highly associated with the outcome of the result. This mean, mothers of infants who commenced complementary feeding prior to 17 weeks were younger. The first food was usually baby rice (69 %), infant breakfast cereals (14 %) or fruit/vegetables in this study area, which was (14 %) (21). Research done in Kenya 2013 revealed that 81(75%) of mother had appropriate knowledge for correct complementary feeding time (22).