When Anjaly Thankappan, a nursing officer at JIPMER, Pondicherry, became a mother for the first time, she thought her professional training would guide her through the early weeks. Yet, the realities of postpartum life and cultural expectations played out differently.
At 28 days, her family wanted to conduct nookukettu, a traditional ceremony where relatives gather to bless the newborn. “I didn’t have the energy to oppose it,” she says. The rituals brought crowds, incense, and countless hands reaching for the baby. Soon after, her newborn developed fever and nasal congestion. While relatives dismissed the symptoms as “common,” Anjaly, aware of infection risks, knew otherwise. “Even with my medical knowledge, I felt vulnerable to suggestions of giving honey, gripe water, or sugar water,” she says.
Her experience highlights a broader challenge in India: the tension between traditional newborn practices and evidence-based care. According to the World Health Organization, neonatal infections remain a leading cause of newborn mortality in India, often linked to overcrowding, unhygienic handling, and unsafe feeding practices.
Feeding myths and risks
Arun Kumar Sundaram, senior consultant in neonatology at SIMS Hospital, Chennai, notes that misconceptions about newborn feeding persist widely. “Many people still don’t believe exclusive breastfeeding is enough for the first six months,” he says. This belief often leads to unsafe practices, including giving honey, sugar water, dates water, or gripe water. “Honey is particularly dangerous. Infants under one year can develop botulism because their immature gut cannot neutralise Clostridium botulinum spores,” Dr. Sundaram explains. Gripe water, even when alcohol-free, can induce sleepiness, vomiting, or loose stools, while sugar water irritates the gut.
Breast milk, he emphasises, provides adequate hydration and all necessary nutrients.
Dr. Rajasree S., senior consultant in paediatrics and neonatology at Rela Hospital, Chennai, adds, “Traditional prelacteal feeds: honey, sugar water, dates water, or gripe water can increase the risk of infections, severe diarrhoea, sepsis, and allergic reactions. Even discarding colostrum deprives the baby of vital antibodies.” She cites clinical cases where honey-induced botulism, though rare, can be fatal. “Prelacteal feeds delay exclusive breastfeeding, which is essential for immunity and growth.”
Meena Thiagarajan, senior consultant paediatrician and neonatologist at Apollo Children’s Hospitals, Chennai, notes, “In India, festivals and family celebrations often prompt elders to give sweets or a drop of honey to a newborn. I’ve seen families struggle to balance cultural practices with medical advice. Honey can be neurotoxic, and gripe water, though improved today, is not recommended for newborns.”
Other harmful practices involve oil instillation in the nose, which can lead to lipoid pneumonia, and applying harmful substances like kajal, which can cause infection or lead poisoning. These practices can lead to infections, illness, and increase the risk of infant mortality.
Exclusive breastfeeding matters
Exclusive breastfeeding for the first six months is recommended by the World Health Organization and paediatric organisations globally. Dr. Sundaram explains: “Breast milk provides essential nutrients, antibodies, and growth factors that improve immunity, reduce infections, and support growth and development. Early introduction of cow’s milk, herbal preparations, or complementary feeds increases the risk of allergies, infections, and feeding intolerance.”
Dr. Rajasree highlights additional risks, “Cow’s milk before 12 months is low in iron, high in protein, and can stress immature kidneys. Herbal concoctions may carry contaminants or infections.” Dr. Thiagarajan adds, “Sugar should be avoided up to age two, as infants quickly develop a preference for it. Breast milk remains the safest, most complete nutrition in the first six months, and provides significant nutrition even beyond that.”
Navigating generational conflict
One of the most frequent statements parents hear from elders is, “We followed all this and nothing happened.” Dr. Sundaram says, “While maybe well-intentioned, still these practices can be harmful. Bringing grandparents to clinic visits often opens space for respectful, evidence-based discussions.”
Dr. Rajasree advises, “Parents can gently provide updated information from trusted sources. Emphasising modern understanding of newborn physiology and the potential hidden harms of traditional practices helps bridge gaps.” Dr. Thiagarajan notes, “Cultural rituals are deeply ingrained. Professionals can support families by addressing myths without dismissing their values, gradually promoting safe practices.”
Recognising adequate feeding
Parents often worry whether their newborn is feeding adequately. Dr. Sundaram outlines clear indicators: at least six wet diapers per day, feeding every 2–3 hours, appropriate sleep, activity, and regaining birth weight by two weeks. Signs that require urgent attention include lethargy, poor feeding, low urine output, or inadequate weight gain.
Dr. Rajasree adds that infants should feed 8–10 times in 24 hours after day four, with steady weight gain. Dr. Thiagarajan advises mothers to maintain a balanced diet, hydration, and rest to support milk production. Any concerns should be promptly discussed with a paediatrician. For mothers whose milk output seems low, experts recommend timely evaluation by a paediatrician or lactation specialist to rule out underlying issues such as latch problems, hormonal imbalances, or postpartum complications.
Supporting safe newborn care
Strengthening newborn care requires coordinated efforts. Dr. Sundaram emphasises early counselling during the antenatal period. Mothers need support not only from healthcare professionals but also from families and the wider community.
Dr. Thiagarajan suggests leveraging breastfeeding week and ongoing campaigns to reinforce correct practices. “Messages should be visible in public spaces, workplaces, hospitals, and social media,” she says. Dr. Rajasree notes that engaging elders in community-based awareness efforts increases acceptance and effectiveness.
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