Sarbottam Pitho & Baby Feeding in Nepal: IYCF and Weaning Guide

The foundation of infant and young child feeding (IYCF) in Nepal is breastfeeding. The World Health Organization (WHO), UNICEF and Nepal's Department of Health Services (DoHS) under the Ministry of Health and Population all recommend that breastfeeding begin within the first hour of birth. This first feed delivers colostrum (the thick yellowish first milk, called bigauta in Nepali), which is rich in antibodies and acts as the baby's first natural vaccine. Pre-lacteal feeds such as honey, sugar water, ghee or cow's milk should not be given.

For the first six months (roughly the first 26 weeks), a healthy baby needs nothing but breast milk — no water, no other liquids, no lito, no jaulo, and no formula. This is called exclusive breastfeeding. Breast milk alone provides all the water, energy and nutrients a baby needs in this period, and giving water or other foods too early raises the risk of diarrhoea and infection, which remain leading threats to young children in Nepal.

Mothers should breastfeed on demand, day and night, whenever the baby is hungry — typically 8 to 12 times in 24 hours. Frequent feeding, correct latch and emptying the breast keep milk supply strong. Nepal's Mother's Milk Substitutes (Control of Sale and Distribution) Act, 2049 BS (1992 AD) restricts the promotion of infant formula precisely to protect and promote breastfeeding, and health workers are barred from advertising milk substitutes.

Complementary feeding (weaning) means adding foods alongside breast milk once milk alone can no longer meet a growing baby's needs. In Nepal this begins at the completed sixth month — not before, and not delayed beyond. By six months most babies can sit with support, hold their head steady, show interest in food and no longer push food out with the tongue, all signs of readiness. Breastfeeding should continue on demand up to two years of age or beyond.

Follow the principle of thick, frequent and varied. Start with smooth, semi-solid foods that are thick enough to stay on a spoon rather than watery, because thin gruels carry too few calories. Begin with small amounts — 2 to 3 tablespoons once or twice a day — and increase gradually. Introduce one new food at a time and watch for any reaction over a couple of days.

Hygiene is critical during weaning, when infection risk rises. Wash hands with soap before cooking and feeding, use clean utensils, cook food thoroughly, and feed freshly prepared food. Avoid feeding from a bottle, which is hard to clean; use a clean cup and spoon instead. Do not add salt, sugar or chilli to a young baby's food, and avoid honey in the first year.

Sarbottam Pitho literally means "best flour" or "super flour." It is a home-processed weaning food developed in Nepal in the early 1970s by nutritionist Miriam Krantz of the United Mission to Nepal (UMN), working with Nepali mothers and the crops they already grew. It has since become the standard low-cost, home-made complementary food promoted through Nepal's National Nutrition Program and taught at health posts and Female Community Health Volunteer (FCHV) sessions.

The core formula is a simple ratio: 2 parts cereal grain to 1 part pulse (legume). Combining grains with pulses raises the protein quality of the mix, because the amino acids in cereals and legumes complement each other — together they supply a more complete protein than either alone. Adding a small amount of oil or ghee at feeding time boosts the energy density, and a pinch of green leafy vegetable, fruit or egg adds vitamins and iron.

A common example uses roasted grains such as rice, maize, wheat or millet for the two grain parts, and roasted soybean for the pulse part; soybean is favoured because it is especially high in protein and fat. Because the flour is dry and roasted, it stores well in an airtight container for weeks (about one to three months) and cooks into porridge in minutes, making it practical for busy households.

Preparing the flour is a one-time batch task. Clean and sort the grains and pulse to remove stones and dust. Roast each ingredient separately on a dry pan (tawa) over low-to-medium heat, stirring until it turns light golden and gives off a nutty aroma — grains and pulses roast at different rates, which is why they are done separately. Let everything cool, then grind each into a fine flour and pass it through a fine sieve. Mix the flours together in the 2:1 grain-to-pulse ratio and store in a clean, dry, airtight container away from moisture.

To make lito (the porridge) for a feed, take 2 to 3 tablespoons of the flour and mix it into a smooth paste with a little cold or warm clean water so there are no lumps. Bring some clean water to a boil, add the paste slowly while stirring, and simmer for a few minutes until it thickens into a smooth, spoon-coating porridge. Take it off the heat, let it cool to a safe warm temperature, and stir in a few drops of oil or ghee. Test the temperature on the back of your hand before feeding.

A single example home batch might use 1 kilogram of soybean with 2 kilograms of grains — for instance 1 kg wheat and 1 kg millet, or 1 kg rice and 1 kg maize. The exact grains can be swapped for whatever is locally available and affordable, which is a key strength of the recipe: it uses ordinary household ingredients and needs no special equipment beyond a pan and a mill or grinder.

Beyond Sarbottam Pitho, Nepali families use several traditional weaning foods. Lito is the general word for a cooked flour porridge; plain rice-flour lito is mild and easily digested and is often a baby's very first food, though on its own it is low in protein, so mixing in pulse flour (as in Sarbottam Pitho) is much better. Saatu (roasted grain-and-pulse flour) is similar in spirit and can be used the same way.

Jaulo is a soft, well-cooked rice-and-lentil (daal) porridge, cooked with extra water until semi-solid and mashable. Plain jaulo made from rice alone is a weak weaning food, but a good jaulo made with daal, a little oil and mashed soft vegetables such as spinach (palungo), pumpkin or potato becomes nourishing and easy to eat. Dhindo (a thick cooked flour mash) suits older babies who can handle firmer textures.

Whatever the base, the aim is the same: make it energy- and nutrient-dense. Enrich porridges with mashed egg yolk, well-cooked pulses, seasonal fruit (banana, ripe mango, papaya), soft cooked vegetables, and a spoon of oil or ghee. Variety across the day matters more than any single "perfect" food, and continued breastfeeding remains part of the diet throughout.

Feeding changes in amount, thickness and frequency as the baby grows, following WHO and Nepal IYCF guidance. The figures below are a general guide; every baby is different, and breast milk remains an important part of the diet through the whole first two years.

At 6 to 8 months, keep breastfeeding on demand and give 2 to 3 meals a day of thick, mashed or pureed food, starting at 2 to 3 tablespoons and building toward about half a cup per meal. At 9 to 11 months, offer 3 to 4 meals plus 1 to 2 healthy snacks; food can now be finely chopped or mashed with soft finger foods, at roughly half a cup per meal. By 12 months, the child eats 3 to 4 family-food meals plus snacks and can manage most foods the family eats, cut small and not too spicy. By 24 months the toddler shares the family diet at three meals with two snacks, and breastfeeding may continue for as long as mother and child wish.

Iron and micronutrients deserve special attention across all ages, as iron-deficiency anaemia is common in Nepali children. Pulses, dark green leafy vegetables, egg, meat or liver where available, and government-provided micronutrient powders or supplements all help. Health posts and FCHVs also provide vitamin A and deworming through national programmes, and growth monitoring at the local health facility helps catch feeding problems early.

Two frequent mistakes are starting complementary food too early (before 6 months, which displaces breast milk and adds infection risk) and starting too late (after 6 months, which slows growth because breast milk alone can no longer keep up). A third common error is making lito too thin: watery porridge fills the stomach without enough calories, so keep it thick enough to coat a spoon.

Avoid bottle-feeding, which is hard to keep clean and linked to diarrhoea; use a clean cup and spoon. Do not give honey in the first 12 months (risk of infant botulism), keep salt, sugar and chilli out of babies' food, and be cautious with whole nuts, hard chunks and other choking hazards. Never leave a baby alone while eating.

Feed responsively: sit with the child, feed slowly and patiently, talk and encourage, and stop when the child is full — do not force-feed. During and after illness, keep feeding and breastfeeding, offer extra fluids, and add an extra meal for a couple of weeks in recovery. If a baby is not gaining weight, refuses food repeatedly, or shows signs of illness, visit the nearest health post, and for severe cases a Nutrition Rehabilitation Home (NRH).