Maternal, infant and child nutrition

In short

Maternal, infant and child nutrition covers the nutritional needs, assessment and interventions across the "first 1,000 days" — from conception through pregnancy, lactation, infancy and the second year — plus the pre-school and school years. It matters because undernutrition in this window causes irreversible losses in growth, immunity and cognition, and because maternal nutritional status directly sets birth weight and early survival. It is examined in every B.Sc Nutrition and Dietetics paper on human nutrition (RDA computation, growth monitoring, IYCF, national programmes) and in M.Sc/NET and dietitian-registration (IDA RD) entrance tests. Employers test it in interviews for ICDS/NHM nutrition posts, hospital dietetics (antenatal and paediatric wards), FSSAI-regulated infant-food companies, and nutrition roles in NGOs and development agencies.

Explained

The first 1,000 days and the life-cycle approach

• First 1,000 days = ~270 days of pregnancy + 365 days of infancy + 365 days of the second year. Brain growth, linear growth velocity and immune programming peak here; deficits after ~24 months are only partly recoverable.
• Intergenerational cycle of malnutrition: an undernourished girl → short, thin adolescent → low pre-pregnancy weight and anaemia → intrauterine growth restriction → low-birth-weight (LBW) girl child → cycle repeats. Breaking it needs adolescent and pre-conception nutrition, not just antenatal care.
• Developmental origins (Barker) hypothesis: foetal undernutrition triggers metabolic "thrifty" adaptation; such infants, if later exposed to energy-dense diets, carry higher risk of obesity, type 2 diabetes, hypertension and coronary disease — the double burden now visible in India (NFHS-5 shows both high child stunting and rising adult overweight).
• Critical versus sensitive periods: organogenesis (weeks 3–8) is critical for structural defects (e.g. folate and neural tube closure by day 28); the whole of pregnancy and infancy is sensitive for growth and micronutrient stores.

Maternal nutrition in pregnancy

• Physiological changes: plasma volume rises ~45% and red cell mass ~20–30% → haemodilution (physiological anaemia); cardiac output, GFR and basal metabolism rise; gut absorption of iron and calcium is upregulated; progesterone slows GI motility (constipation, heartburn).
• Components of weight gain: foetus, placenta, amniotic fluid, uterus and breast tissue, expanded blood volume, extracellular fluid and maternal fat stores. Recommended total gain for a normal-BMI Indian woman is about 10–12 kg (IOM-based ranges by pre-pregnancy BMI: underweight 12.5–18 kg, normal 11.5–16 kg, overweight 7–11.5 kg, obese 5–9 kg); ICMR-NIN uses ~10–12 kg as the reference gain. Gain is minimal in the first trimester and ~350–400 g/week later.
• Energy: ICMR-NIN 2020 RDA adds about +350 kcal/day for the second and third trimesters (no extra in the first trimester) over the woman's own requirement, assuming a reference gestational weight gain; the older 2010 figure was +350 kcal for the whole of pregnancy.
• Protein: ICMR-NIN 2020 gives an additional requirement rising by trimester — roughly +1 g/day (T1), +7 g/day (T2) and +23 g/day (T3) above the adult woman's RDA (earlier RDA used a flat +23 g/day). Quality matters: include milk, egg, pulse–cereal combinations.
• Key micronutrients:
  • Iron: pregnancy RDA ~27 mg/day; needed for expanded red cell mass and foetal/placental stores. Programme practice: one IFA tablet daily containing 60 mg elemental iron + 500 µg folic acid for 180 days in pregnancy and 180 days post-partum (Anemia Mukt Bharat).
  • Folate: ~570 µg DFE/day in pregnancy; 400 µg/day pre-conceptionally prevents neural tube defects.
  • Calcium: ~1,000 mg/day; programme practice gives 500 mg calcium twice daily (1,000 mg/day) from the second trimester through 6 months of lactation.
  • Iodine: ~220 µg/day; deficiency causes cretinism, stillbirth and impaired cognition — universal iodisation of salt (minimum 15 ppm iodine at consumer level under FSSAI rules) is the control measure.
  • Vitamin B12, vitamin D, zinc, vitamin A (do not give high-dose retinol in pregnancy — teratogenic; limit to RDA levels).
• Deworming: single dose albendazole 400 mg after the first trimester in endemic areas (programme guidance; check current NHM circular).
• Common problems and management: nausea/vomiting (small frequent dry carbohydrate meals, fluids between meals), heartburn (small meals, avoid lying down, avoid spicy/fatty), constipation (fibre, fluids, activity), pica, gestational diabetes (medical nutrition therapy with carbohydrate distribution across 3 meals + 3 snacks), pregnancy-induced hypertension (adequate calcium and protein, sodium not severely restricted).
• Avoid: alcohol (foetal alcohol spectrum disorder), tobacco, excess caffeine, raw/undercooked meat and egg, unpasteurised milk, high-mercury fish, self-prescribed megadose supplements.

Lactation

• Physiology: prolactin drives milk secretion; oxytocin drives the let-down/ejection reflex (triggered by suckling, inhibited by pain and anxiety). Milk output is demand-driven — effective, frequent suckling is the single best galactagogue.
• Output: roughly 750–850 ml/day in the first 6 months and ~600 ml/day in the next 6 months.
• RDA additions (ICMR-NIN 2020): about +600 kcal/day for 0–6 months and +520 kcal/day for 6–12 months, with part of the first-6-month need met from pregnancy fat stores; protein additions of roughly +13.6 g/day (0–6 months) and +10.6 g/day (6–12 months). Extra fluid, calcium (1,000 mg), vitamin A, B-vitamins and iodine are needed; iron need falls during amenorrhoea but IFA is continued post-partum in programmes.
• Milk stages: colostrum (first 3–4 days — thick, yellow, low volume, very high in IgA, lactoferrin, leucocytes, vitamin A, low fat/lactose; acts as the first immunisation and a laxative clearing meconium) → transitional milk → mature milk (foremilk is watery and thirst-quenching; hindmilk is fat-rich and satisfying — hence one breast should be emptied before offering the other).
• Contraindications/cautions: maternal cytotoxic or radioactive therapy, some psychiatric drugs; infant galactosaemia. In HIV, current policy supports exclusive breastfeeding with maternal antiretroviral therapy — follow the latest national guideline.

Infant feeding: breast milk, formula and complementary feeding

• Human milk versus cow's milk: human milk has less total protein with whey:casein ≈ 60:40 (soft, digestible curd), more lactose, more essential fatty acids (LA, ALA, DHA, ARA), lipase and lactoferrin, lower renal solute load, and lower calcium, phosphorus, protein and sodium than cow's milk. Cow's milk is unsuitable before 12 months (renal solute load, occult GI blood loss, low iron).
• WHO/MoHFW IYCF recommendations: initiate breastfeeding within 1 hour of birth; exclusive breastfeeding for 6 months (no water, no honey, no gripe water); timely complementary feeding from completed 6 months; continue breastfeeding to 2 years and beyond.
• Why 6 months: before that the infant's renal and GI function, amylase activity and oral-motor skills are immature and extra foods displace milk and bring infection; after 6 months breast milk alone cannot meet energy, iron and zinc needs.
• Complementary feeding — the four rules: right time (6 months), adequate frequency (2–3 meals at 6–8 months, 3–4 meals at 9–23 months, plus 1–2 snacks), right consistency (thick, mashed, not watery — a spoon-coating porridge), right quantity and density (start 2–3 tablespoons, raise gradually; target ~0.8–1.0 kcal/g).
• Energy gap to be filled by complementary food: about 200 kcal/day at 6–8 months, 300 kcal/day at 9–11 months and 550 kcal/day at 12–23 months (breast milk supplying the rest).
• Practical Indian foods: mashed dal–rice (khichdi) with ghee, ragi/wheat porridge with jaggery and milk, suji kheer, mashed banana/papaya, idli or upma mashed, egg, curd, well-mashed vegetables; add oil or ghee for energy density, and amylase-rich flour (ARF, from germinated cereals) or malting to reduce bulk viscosity.
• Responsive feeding: feed patiently, actively, with the child, using a separate bowl; avoid force-feeding and bottle-feeding (bottles cause diarrhoea and dental caries).
• WHO IYCF core indicators: early initiation of breastfeeding, exclusive breastfeeding under 6 months, introduction of solid/semi-solid foods at 6–8 months, minimum dietary diversity (≥5 of 8 food groups), minimum meal frequency, minimum acceptable diet, consumption of iron-rich foods.
• Legal control on substitutes: the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992, amended 2003 ("IMS Act") bans all advertising and promotion of infant milk substitutes, feeding bottles and infant foods up to 2 years, bans free samples and gifts to health workers, and mandates prescribed labels and the warning that mother's milk is best. Composition and labelling of infant foods are also governed by FSSAI regulations on foods for infant nutrition.

Growth monitoring and nutritional assessment

• Anthropometry: weight, length (lying, <2 years) or height (standing, ≥2 years), MUAC (mid-upper arm circumference, 6–59 months), head circumference (<2–3 years), skinfolds.
• Reference: WHO Child Growth Standards 2006 (0–5 years, prescriptive, breastfed children of 6 countries including India) and WHO 2007 growth reference for 5–19 years. MCP (Mother and Child Protection) cards in India carry WHO-based weight-for-age charts with lines at −2 SD and −3 SD.
• Indices and what they mean (WHO classification):
  • Weight-for-age < −2 SD = underweight (composite, acute + chronic).
  • Height-for-age < −2 SD = stunting (chronic/past undernutrition).
  • Weight-for-height < −2 SD = wasting (acute/current undernutrition).
  • < −3 SD = severe in each case.
• SAM (severe acute malnutrition), 6–59 months: weight-for-height < −3 SD, or MUAC < 11.5 cm, or bilateral pitting oedema. MAM: weight-for-height −3 to −2 SD or MUAC 11.5–12.5 cm.
• Management of SAM: children with complications/no appetite → facility-based care at a Nutrition Rehabilitation Centre (NRC) in 3 phases (stabilisation with F-75, transition, rehabilitation with F-100/RUTF), with antibiotics, correction of hypoglycaemia, hypothermia, dehydration (ReSoMal) and electrolytes, and cautious feeding to avoid refeeding syndrome; uncomplicated cases → community-based management with energy-dense local therapeutic food and follow-up.
• Older classifications still asked in exams: IAP weight-for-age grades (Grade I 71–80%, II 61–70%, III 51–60%, IV ≤50% of expected weight), Gomez classification, Waterlow (stunting + wasting), Jelliffe's standard.
• Other assessment tools: clinical signs (ABCD — Anthropometry, Biochemical, Clinical, Dietary), biochemical (haemoglobin, serum ferritin, retinol, zinc, albumin), dietary (24-hour recall, food frequency, weighment), and ecological/socio-economic data.
• Deficiency diseases of childhood: PEM — *kwashiorkor* (oedema, flaky-paint dermatosis, fatty liver, apathy, hair changes; mainly protein deficit with oedema) and *marasmus* (gross wasting, "old man" face, no oedema, alert but irritable), plus marasmic-kwashiorkor; iron-deficiency anaemia; vitamin A deficiency (night blindness, Bitot's spots, xerophthalmia, keratomalacia); rickets (vitamin D); iodine deficiency disorders; zinc deficiency (diarrhoea, poor growth).

Indian programmes, standards and current status

• ICDS / Anganwadi Services under Saksham Anganwadi and POSHAN 2.0: supplementary nutrition for children 6 months–6 years, pregnant women and lactating mothers, plus pre-school education, immunisation, health check-up and referral. Supplementary nutrition norms (per beneficiary per day): children 6–72 months ~500 kcal and 12–15 g protein; severely malnourished children ~800 kcal and 20–25 g protein; pregnant and lactating women ~600 kcal and 18–20 g protein. Take-home ration for under-3s and morning snack + hot cooked meal for 3–6 years. Fortified rice and double-fortified salt are being used under POSHAN 2.0.
• POSHAN Abhiyaan (National Nutrition Mission, 2018) targets: reduce stunting and underweight by 2% a year and anaemia by 3% a year; uses the Poshan Tracker app for real-time growth monitoring; Poshan Maah (September) and Poshan Pakhwada for behaviour change.
• Anemia Mukt Bharat (6×6×6 strategy): six beneficiary groups, six interventions (prophylactic IFA, deworming, behaviour change including delayed cord clamping, testing and treatment, fortification, addressing non-nutritional causes), six institutional mechanisms. Weekly IFA Supplementation (WIFS) for adolescents; biweekly IFA syrup (1 ml = 20 mg elemental iron + 100 µg folic acid) for children 6–59 months.
• Other schemes: PM Matru Vandana Yojana (PMMVY) — conditional maternity benefit (₹5,000 for the first living child, with additional benefit for a second child if a girl — verify the current amount and conditions, which have been revised); Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram; PM POSHAN (mid-day meal) for Classes I–VIII plus Balvatika, ~450 kcal/12 g protein for primary and ~700 kcal/20 g protein for upper primary per child per school day; National Iodine Deficiency Disorders Control Programme; Vitamin A prophylaxis (9 doses: 100,000 IU at 9 months with measles vaccine, then 200,000 IU six-monthly to 5 years); Mothers' Absolute Affection (MAA) for breastfeeding promotion; Home-Based Newborn/Young Child Care by ASHAs.
• Vital definitions and Indian levels (NFHS-5, 2019–21): stunting in under-5s 35.5%, wasting 19.3%, severe wasting 7.7%, underweight 32.1%, overweight 3.4%; anaemia in children 6–59 months 67.1%, in pregnant women 15–49 52.2%, in all women 15–49 57.0%; exclusive breastfeeding under 6 months 63.7%; early initiation 41.8%; adequate diet at 6–23 months only ~11%. NFHS-6 results, when released, will supersede these.
• Birth weight terms: LBW < 2,500 g (India roughly 18% — about one in five births), very LBW < 1,500 g, extremely LBW < 1,000 g; preterm < 37 completed weeks; small for gestational age = birth weight below the 10th percentile for gestation. Normal Indian birth weight averages ~2.8–3.0 kg.
• Fortification standards: FSSAI's fortification regulations specify levels for fortified salt (iodine and iron), wheat flour, rice, edible oil (vitamins A and D) and milk, carrying the +F logo.

Key points

• First 1,000 days - conception to 24 months; the window where undernutrition causes largely irreversible damage.
• Pregnancy energy addition - about +350 kcal/day in trimesters 2 and 3 (ICMR-NIN 2020); protein addition rises by trimester to about +23 g/day in T3.
• Lactation addition - about +600 kcal/day (0–6 months) and +520 kcal/day (6–12 months), with protein +13.6 g and +10.6 g respectively.
• Recommended gestational weight gain - about 10–12 kg for a normal-BMI woman; ~350–400 g/week in the later trimesters.
• IFA in pregnancy - 60 mg elemental iron + 500 µg folic acid daily for 180 days antenatal and 180 days post-partum; calcium 1,000 mg/day from T2.
• Folic acid pre-conception - 400 µg/day closes the neural tube by day 28; deficiency causes spina bifida and anencephaly.
• Colostrum - first 3–4 days' milk; rich in secretory IgA, lactoferrin and vitamin A; the newborn's first immunisation, never to be discarded.
• Prolactin and oxytocin - prolactin makes milk, oxytocin ejects it; suckling frequency, not maternal diet alone, drives supply.
• Exclusive breastfeeding - only breast milk (plus medicines/vitamins) for 6 months; initiate within 1 hour; continue to 2 years with complementary foods.
• Complementary feeding gap - roughly 200, 300 and 550 kcal/day to be supplied at 6–8, 9–11 and 12–23 months.
• Energy density - complementary food should give ~0.8–1.0 kcal/g; thick consistency, oil/ghee and malting (ARF) reduce bulk.
• Three growth indices - weight-for-age (underweight), height-for-age (stunting, chronic), weight-for-height (wasting, acute); < −2 SD moderate, < −3 SD severe.
• SAM criteria (6–59 months) - weight-for-height < −3 SD, or MUAC < 11.5 cm, or bilateral pitting oedema; treated with F-75/F-100 or RUTF at an NRC.
• Kwashiorkor versus marasmus - oedema, fatty liver and apathy versus gross wasting with no oedema.
• WHO Child Growth Standards 2006 - the prescriptive 0–5 year reference used on India's MCP card.
• IMS Act, 1992 (amended 2003) - bans promotion of infant milk substitutes, feeding bottles and infant foods up to 2 years.
• ICDS supplementary nutrition - ~500 kcal/12–15 g protein for 6–72 months, ~800 kcal/20–25 g for severely malnourished, ~600 kcal/18–20 g for pregnant and lactating women.
• NFHS-5 benchmarks - stunting 35.5%, wasting 19.3%, underweight 32.1%, child anaemia 67.1%, exclusive breastfeeding 63.7%.

Formulas and examples

Example 1 — Energy and protein for a pregnant woman. A 26-year-old sedentary woman, 52 kg, 1.58 m, in her third trimester. Non-pregnant sedentary requirement taken as 1,660 kcal/day and protein RDA 0.83 g/kg → 43 g/day (rounded from 52 × 0.83 = 43.2 g).

• BMI = 52 / (1.58)² = 52 / 2.4964 = 20.8 kg/m² → normal; target gain 10–12 kg.
• Energy = 1,660 + 350 = 2,010 kcal/day.
• Protein = 43 + 23 = 66 g/day.
• Iron 27 mg, folate 570 µg DFE, calcium 1,000 mg; distribute energy as ~5 small meals because of heartburn.

Example 2 — Lactation and milk output. A mother exclusively breastfeeding a 3-month-old secretes 800 ml/day.

• Energy in milk = 800 × 0.67 = 536 kcal/day.
• At ~80% efficiency of milk synthesis, dietary energy needed for milk = 536 / 0.80 = 670 kcal/day; about 70 kcal/day is drawn from maternal fat stores laid down in pregnancy, so the diet addition is ≈ 600 kcal/day — exactly the RDA increment.
• Protein addition = 13.6 g/day → for the same 52 kg woman, 43 + 13.6 ≈ 57 g/day.

Example 3 — Complementary feeding gap at 9 months. A 9-month-old weighs 8 kg; take the energy requirement as 80 kcal/kg/day and breast-milk intake as 600 ml/day.

• Total requirement = 8 × 80 = 640 kcal/day.
• From breast milk = 600 × 0.67 = 402 kcal/day.
• Gap = 640 − 402 = 238 kcal/day (the ~300 kcal programme figure allows for lower milk intake).
• If the complementary food has an energy density of 1.0 kcal/g, the child must eat ~238 g/day — about 4 feeds of 60 g. At a watery 0.4 kcal/g it would need ~595 g/day, which the stomach cannot hold — this is why consistency must be thick.

Example 4 — Classifying a child. A 24-month-old girl: weight 8.4 kg, height 79 cm. WHO medians: weight-for-age 11.5 kg, height-for-age 85.7 cm; weight-for-height median at 79 cm ≈ 10.4 kg. MUAC 12.1 cm, no oedema.

• Weight-for-age = 8.4 / 11.5 × 100 = 73% → IAP Grade I–II (73% falls in Grade I, 71–80%); by WHO Z-score she is below −2 SD → underweight.
• Height-for-age = 79 / 85.7 × 100 = 92.2% → below −2 SD for height → stunted.
• Weight-for-height = 8.4 / 10.4 × 100 = 80.8% → between −3 and −2 SD → moderately wasted; MUAC 12.1 cm confirms MAM.
• Action: community-based management of MAM, energy-dense local food, deworming, IFA syrup, fortnightly follow-up; refer if MUAC falls below 11.5 cm or oedema appears.

Example 5 — ICDS ration check. An Anganwadi take-home ration gives 100 g fortified wheat–soya mix (360 kcal, 14 g protein), 20 g oil (180 kcal) and 20 g jaggery (76 kcal) to a 2-year-old.

• Energy = 360 + 180 + 76 = 616 kcal; protein = 14 g.
• ICDS norm for 6–72 months is ~500 kcal and 12–15 g protein → the ration meets both norms (energy exceeds by 116 kcal), and the oil raises energy density, which suits a small stomach.

Where it is used

• Hospital and clinic dietetics: antenatal and gestational-diabetes diet counselling, lactation support, paediatric ward and PICU feeding plans, NRC management of SAM in district hospitals and medical colleges (AIIMS, PGIMER, CMC Vellore, state district hospitals).
• Government programmes: nutritionist and Child Development Project Officer roles under ICDS/POSHAN 2.0, District Programme Coordinators under NHM, Anemia Mukt Bharat and PM POSHAN monitoring, Poshan Tracker data review.
• Food industry and regulation: product development and labelling of infant formula, follow-up formula, cereal-based complementary foods and fortified staples at firms such as Nestlé India, Amul, Britannia and Hindustan Unilever, under FSSAI and IMS Act compliance.
• Development sector and research: nutrition advisers in UNICEF, WFP, Alive & Thrive, Akshaya Patra, Annamrita, PATH and state nutrition missions; survey work for NFHS, CNNS and ICMR-NIN diet surveys.
• Community practice: training ASHAs, ANMs and Anganwadi workers on IYCF counselling, MUAC screening, growth-chart plotting and MCP card use; Village Health, Sanitation and Nutrition Days.
• Clinical specialisations and private practice: pre-conception and fertility nutrition, PCOS and GDM counselling, paediatric allergy and feeding-difficulty clinics, corporate maternity-wellness programmes.

Interview questions

• Q: What are the "first 1,000 days" and why are they critical? A: Conception to a child's second birthday — the period of fastest brain and linear growth, when undernutrition causes largely irreversible loss of height, immunity and cognitive potential.
• Q: How much extra energy and protein does an Indian woman need in the third trimester? A: About +350 kcal/day and about +23 g/day of protein over her own requirement, as per ICMR-NIN 2020, with a reference weight gain of 10–12 kg.
• Q: Why is colostrum important and why do families sometimes discard it? A: It is packed with secretory IgA, lactoferrin, leucocytes and vitamin A and clears meconium; its small volume and yellow colour make families think it is insufficient or "stale", so counselling is essential.
• Q: Differentiate foremilk and hindmilk and give the practical implication. A: Foremilk is watery and quenches thirst; hindmilk is fat-rich and satisfies hunger — so one breast should be emptied before offering the second, or the baby gets volume without calories.
• Q: Why is exclusive breastfeeding recommended for 6 months and not 4? A: Breast milk alone meets all nutrient and fluid needs to 6 months, while earlier foods displace milk, raise infection risk and meet an immature gut and kidney.
• Q: Define SAM and state how you would screen for it in a village. A: Weight-for-height below −3 SD, or MUAC under 11.5 cm, or bilateral pitting oedema in a 6–59-month-old; MUAC tape plus a check for pedal oedema is the quickest field screen.
• Q: What is the difference between stunting and wasting? A: Stunting is low height-for-age reflecting chronic, cumulative undernutrition; wasting is low weight-for-height reflecting recent, acute weight loss and carries higher immediate mortality risk.
• Q: How do you make a complementary food energy-dense without increasing bulk? A: Add oil or ghee, use a thick consistency, add malted (amylase-rich) flour to cut viscosity, include jaggery and milk, and feed small amounts more often.
• Q: What does the IMS Act prohibit? A: All advertising, promotion, free samples and sponsorships for infant milk substitutes, feeding bottles and infant foods up to 2 years, and it prescribes mandatory labelling including the statement that mother's milk is best.
• Q: A mother says she has "no milk" on day 2. What is your response? A: Reassure her that colostrum volume is normally small, correct attachment and positioning, encourage skin-to-skin contact and frequent on-demand suckling, and treat pain and anxiety, which inhibit the oxytocin reflex.
• Q: Why is cow's milk not advised below 12 months? A: It has a high protein, sodium and renal solute load, poorly bioavailable iron and can cause occult intestinal blood loss, adding to iron-deficiency anaemia.
• Q: What is refeeding syndrome and how is it avoided in SAM? A: A dangerous shift of phosphate, potassium and magnesium into cells when a severely malnourished child is fed too fast; avoided by starting with low-protein, low-sodium F-75 at cautious volumes before stepping up to F-100 or RUTF.

Common mistakes

• Adding the pregnancy energy increment from the first trimester, or applying the flat "+23 g protein for all of pregnancy" when the question asks for the 2020 trimester-wise values.
• Confusing stunting with wasting, or quoting weight-for-age as proof of "acute" malnutrition.
• Treating the IAP percentage grades and WHO Z-scores as the same system, or mixing the two in one answer.
• Writing "exclusive breastfeeding" while still allowing water, honey, gripe water or *janam ghutti* — exclusive means breast milk only (medicines, ORS and vitamins excepted).
• Forgetting that elemental iron ≠ tablet weight (a 300 mg ferrous sulphate tablet supplies ~60 mg elemental iron).
• Recommending high-dose vitamin A or herbal supplements in pregnancy — retinol megadoses are teratogenic.
• Giving a complementary-feeding plan in volumes without checking energy density, so the prescribed porridge cannot physically fit in the child's stomach.
• Quoting NFHS-4 or pre-2020 RDA figures as current, or giving scheme amounts and durations without noting that they are revised periodically.

Related topics

Energy and macronutrient requirements: ICMR-NIN RDA and EAR · Vitamins and minerals: functions, sources and deficiencies · Meal planning for the life cycle · Food groups and the Indian food composition tables (IFCT) · Nutrition basics · Functional foods, nutraceuticals and dietary supplements