Thennai Kozhakkattai is a sweet dish popular in South Tamil Nadu and Kerala. It is typically prepared on special occasions, and involves significant preparatory work, usually involving the entire family. Thennai kozhakattai is made of the same ingredients as kozhakattai, but is prepared by inserting into young palm leaves. Manda Pitha is a sweet dish similar to kozhakattai found in eastern state of Orissa. Another variant exists in the state of Kerala which is very frugal and is a staple breakfast among the poorer masses, it is made of Atta flour and grated coconut.
Kozhukkattai form the basis of a number of natal customs among the Sri Lankan Tamil community. There is a custom in the north involving these (dumplings with edges pressed to resemble teeth) being dropped gently on a toddler's head while the family wishes for the infant to develop healthy teeth. In eastern areas, such as Amparai district, piḷḷai kozhukkaṭṭai, a smaller version, are prepared for an expectant mother at about four months time after conception by female family members. These are also commonly exchanged sweets at weddings as auspicious symbols of "plump" health and fertility.