# Prevalence and determinants of inappropriate complementary feeding practices among children aged 6–23 months in Chiang Mai, Northern Thailand: a cross-sectional study

## TL;DR

A study in Chiang Mai, Thailand, found that over 60% of children aged 6–23 months have inappropriate complementary feeding practices, with first-time caregivers and unreliable information sources being key factors.

## Contribution

This study identifies specific determinants of inappropriate complementary feeding in a rapidly urbanizing and culturally diverse region of Thailand.

## Key findings

- Inappropriate complementary feeding was observed in 64.1% of children aged 6–23 months.
- First-time caregivers and those who rely on family, friends, or healthcare providers for feeding advice are at higher risk of inappropriate feeding.
- Unhealthy dietary habits, such as consumption of sweetened beverages, were more common in older children (18–23 months).

## Abstract

Inappropriate complementary feeding (CF) increases the risk of the triple burden of malnutrition, including undernutrition, micronutrient deficiencies, overweight and obesity. Chiang Mai, a major city in northern Thailand, is experiencing rapid urbanization and growing cultural diversity driven by tourism, which may influence CF practices. However, data on these practices remain limited, emphasizing the need for context-specific interventions.

A cross-sectional study involving 1,122 caregivers of children aged 6–23 months was conducted between January and May 2024. Data were collected through face-to-face interviews and 24-hour dietary recalls. Multivariable log-binomial regression was used to identify factors associated with inappropriate CF practices.

Inappropriate CF was observed in 64.1% of the children. Dietary diversity increased with age, from an average of three food groups in infants aged 6–11 months to five food groups in children aged 18–23 months. Unhealthy dietary habits were more prevalent among children aged 18–23 months, with 38.4% consuming sweetened beverages and 47.8% consuming unhealthy foods. The key barriers included caregiver uncertainty about appropriate food textures (88.0%), food types (84.8%), and portion sizes (70.2%). The factors significantly associated with a greater risk of inappropriate CF included being a first-time caregiver (aRR: 1.18; 95% CI: 1.05–1.31) and the caregiver’s perception that the child preferred milk over solid foods (aRR: 1.32; 95% CI: 1.17–1.49). Additionally, receiving feeding information from family or friends (aRR: 1.15; 95% CI: 1.02–1.29) or from healthcare providers (aRR: 1.16; 95% CI: 1.02–1.33) was associated with a significantly greater risk than using unreliable online sources.

Improving CF practices requires focused support for caregivers, particularly first-time parents. Interventions should promote dietary diversity, address common concerns related to CF, and ensure that caregivers have access to reliable nutritional information through accessible and trusted communication channels. Future research should evaluate the effectiveness of context-specific interventions tailored to local needs and caregiver characteristics.

The online version contains supplementary material available at 10.1186/s12889-025-23293-z.