Kajal, ghutti and honey for newborns, and what to tell grandmothers

Some newborn traditions are lovely and safe, and a few can harm a baby. Kajal in the eyes, honey, ghutti and water before 6 months, and oil in the nose are the ones Dr Dutta asks families to stop. Grandmothers are the people at home all day with the baby, so when they understand the reason, they become the baby's best protectors.

Is it safe to put kajal in a newborn's eyes?

No. Dr Dutta advises against putting kajal or surma in a baby's eyes. Many of these products contain lead, and applying them with a finger can carry germs into the eye.

Families tell Dr Dutta that kajal makes the eyes bigger and brighter, or protects against the evil eye. It does not change the size or health of the eyes. What it can do is add lead to a baby's body. She also regularly sees newborns with sticky, red eyes after kajal. If the family wants to keep the custom, there are safer ways, explained below.

Does kajal contain lead?

Some kajal and surma products do, sometimes in large amounts. In one study of kohl bought in several countries, including some made in India and Pakistan, 7 of 22 samples were more than half lead.¹

A recent American study found much more lead in surma and kohl than in kajal, but warned that these names are used loosely and products vary by region.² The same study found these products being used on children as young as newborns, raising their blood lead.² You cannot tell from the packet or the colour whether a product contains lead. Homemade and unbranded products carry the most uncertainty.

How does lead harm a baby?

Lead is a poison to the developing brain. Even small amounts can affect learning, attention and behaviour, and the damage is usually permanent.

A pooled analysis of children from seven countries found lower IQ scores as blood lead rose, and the biggest drop came at the lowest levels.³ This is why doctors say no level of lead is safe for children. Kajal irritates the eyes, so children rub them and then suck their fingers. Swallowing in this way is the main route by which lead from kohl gets into the body.¹

Where else can a baby be exposed to lead at home?

Apart from kajal and surma, lead can come from sindoor and other coloured powders, some unregulated herbal or traditional remedies, old peeling paint, and some imported pots and toys. Some cultural powders tested in the American study contained lead too.²

To lower the risk:

• Keep sindoor, kumkum and coloured powders away from the baby's skin and toys
• Do not give any herbal remedy, bhasma or tonic without asking your paediatrician
• Wash your hands and the baby's hands often
• Wet-mop floors and windowsills, especially in older homes

Is a black dot (nazar tika) safe for my baby?

A small black dot behind the ear or on the sole of the foot is a compromise many families accept. Use a product that is clearly labelled lead-free, and keep it away from the eyes, mouth and cord.

A dot on the forehead is near the eyes and easily rubbed in by little hands, so Dr Dutta prefers behind the ear. Never apply anything inside the eyelids. If the skin under the dot becomes red or itchy, stop using it.

Is it okay to give ghutti or honey water to a newborn?

No. Anything given before or instead of breast milk in the first 6 months, including ghutti, honey, sugar water, jaggery water or animal milk, is not advised.⁴

WHO says mothers should not give any food or fluid other than breast milk unless there is a medical reason.⁴ Ghutti given at birth often delays the first breastfeed. Babies who start breastfeeding later than the first hour have a higher risk of dying in the newborn period.⁵ Prelacteal feeds in India have fallen a lot, from 57 percent of babies in the 2005-06 national survey to 15 percent in 2019-21, but they have not disappeared.⁶

How can we keep the ghutti ritual without harming the baby?

Let the respected elder be the person who places the baby at the mother's breast for the first feed. The honour stays with them, and the baby's first taste is colostrum, the best first food there is.

Dr Dutta suggests this in her clinic often, and most families like it. Some also ask the elder to give the baby's name, or to hold the baby for the first photograph. The meaning of the ritual is welcome and blessing. That meaning stays intact without putting anything in the baby's mouth.

Why is honey dangerous for babies under one year?

Honey can carry spores of the germ that causes botulism. In a baby's immature gut, the spores can grow and make a toxin that weakens the muscles.

Honey is the only food that has been consistently confirmed as a source of infant botulism.⁷ Health authorities everywhere advise no honey before 12 months of age.⁷ Signs include constipation, a weak cry, poor sucking, drooping eyelids and growing floppiness. Some babies need help with breathing. So no honey in any form before the first birthday: not on the tongue at birth, not on a dummy, not mixed into ghutti.

Does my newborn need water in the summer heat?

No. A breastfed baby does not need water, even in a Kolkata summer. Breast milk is mostly water, and feeding on demand gives the baby all the fluid they need.

A study in Indian villages at 35 to 40 degrees C found that exclusively breastfed babies under 6 months stayed well hydrated without extra water.⁸ Water fills the small stomach without calories, can carry infection, and in large amounts can dangerously dilute the salt in a baby's blood.⁹ WHO advises only breast milk until 6 months.¹⁰ If the baby seems thirsty, offer the breast more often.

Is it safe to put mustard oil in a baby's nose or ears?

No. Oil in the nose can be breathed into the lungs and cause lipoid pneumonia, a stubborn lung inflammation.

Doctors in South India described this in babies whose noses and throats were cleaned with oil.¹¹ Oil in the ears does not prevent colds or ear infections and can irritate the ear. For massage, Dr Dutta prefers coconut or sunflower oil over mustard oil on a newborn's skin. Whatever oil you use, nothing should go into the nose, ears or eyes.

Is tight swaddling with straight legs bad for my baby's hips?

Yes. Wrapping the legs straight and tight together can harm the developing hip joints.

In a trial in Mongolia among babies born with immature hips, those swaddled in the traditional way, with legs straight and pressed together, developed more hip dysplasia (a loose or badly formed hip joint) than those who were not swaddled.¹² In an Indian survey, most caregivers swaddled this way, often believing it would straighten bowed legs.¹³ Very few knew about hip-safe swaddling.¹³

Bowed legs in newborns are normal and straighten by themselves. Swaddle so the legs can bend up and fall apart, like a frog.

When should I stop swaddling my baby?

Stop swaddling once your baby shows signs of trying to roll. A swaddled baby must always sleep on their back.

In a review of studies, the risk of sudden infant death with swaddling was highest when babies were put down on their front or side.¹⁴ The risk also seemed to rise as babies got older.¹⁴ WHO advises putting babies to sleep on their back throughout the first year.¹⁰ Keep the wrap light, especially in hot weather, and never cover the face.

Should we put anything on the umbilical cord?

No. Clean, dry care is best.¹⁰ Ash, cow dung, oil, turmeric, coins and tight bands are still used in some homes.

WHO counts substances like animal dung on the cord as harmful.¹⁰ Oils keep the stump moist and attract dirt. Coins and binders do not push in a belly button hernia. Keep the stump clean, fold the nappy below it, and let air do the rest.

Is it okay to press my baby's nose or shape the head?

There is no need, and it can hurt the baby. Gently pressing the nose to make it sharper, or moulding the head into a rounder shape, does nothing useful.

A newborn's head often looks long or uneven after a vaginal birth. This is called moulding, and it settles on its own over the first days to weeks. To prevent a flat spot later, give your baby supervised tummy time while awake and change the direction the head faces in the cot. If a flat spot worries you, ask your paediatrician.

Which traditions are good for babies?

Many customs are wonderful. Forty days of rest for a new mother, while relatives cook and she focuses on feeding, is excellent postnatal care. Lullabies, talking to the baby and extended family holding the baby all help development.

WHO says parents may consider a gentle massage of the whole body for healthy term babies.¹⁰ The annaprashan ceremony around 6 months fits well, because WHO advises breast milk alone until 6 months of age.¹⁰ A loose black thread around the waist is fine if it is checked daily and removed if it leaves a mark.

How can grandparents help a new mother and baby?

Grandmothers have a strong effect on how babies are fed. In a review of studies, babies were more likely to be exclusively breastfed when grandmothers had breastfed themselves or supported it.¹⁵

The most useful help from grandparents is practical:

• Cook and bring the mother food and water during feeds
• Hold, burp and settle the baby between feeds
• Protect the mother's rest and keep visitors short
• Encourage breastfeeding, especially in the hard early days
• Learn the danger signs and keep the hospital number handy

How do I talk to grandparents about new baby advice?

Start from respect. Dr Dutta usually says: "You raised healthy children with what was known then. We now know a few things that were not known before. These changes keep your grandchild safe, and we need your help."

Explain the reason, not just the rule. A grandmother who understands why honey is risky will stop it herself and correct others. Bring the grandmother along to your baby's check-up so she can hear it from the doctor directly. In Dr Dutta's experience, she often becomes the strongest supporter of the new advice.

When should I see a doctor after a traditional remedy?

See a doctor the same day if your baby has been given honey, ghutti, kajal, oil or any herbal mixture and you notice:

• Sticky, red or swollen eyes
• Poor feeding or a weak suck
• Constipation with weakness, a weak cry or drooping eyelids
• Growing floppiness
• Cough, fast breathing or noisy breathing after oil in the nose
• Fever, vomiting or diarrhoea

Tell the doctor exactly what was given. We will not judge you. The information helps us treat your baby faster.