During emergencies infants and young children are more likely to become ill and die from malnutrition and disease than older children or adults. Optimal feeding is often disrupted because of lack of basic resources such as shelter and water, and physical and mental stress on families. Breastfeeding may stop because mothers are traumatized, ill, or separated from their babies, and yet it is particularly valuable in emergency situations. Artificial feeding is more dangerous because of poor hygiene, lack of clean water, and unreliability of supplies.
There may be no food suitable for complementary feeding, or facilities for preparing feeds and storing food safely. Breast-milk substitutes including infant formula and feeding bottles may be sent to emergency situations in inappropriate amounts by donors who believe that they are urgently required, but who are poorly informed about the real needs. Without proper controls, these supplies are often given freely to families who do not need them, and stocks run out before more arrive for those who might have a genuine need. The result is inappropriate and unsafe use of breast-milk substitutes, and a dangerous and unnecessary increase in early cessation of breastfeeding. Babies may be given unsuitable foods, such as dried skimmed milk, because nothing else is available.
Management in emergencies
The principles and recommendations for feeding infants and young children in emergency situations are exactly the same as for infants in ordinary circumstances. For the majority, the emphasis should be on protecting, promoting and supporting breastfeeding, and ensuring timely, safe and appropriate complementary feeding. Most malnourished mothers can continue to breastfeed while they are being fed and treated themselves. A minority of infants will need to be fed on breast-milk substitutes, short term or long term. This may be necessary if their mothers are dead or absent, or too ill or traumatized to breastfeed, and no wet-nurses are available; or for infants who have been artificially fed prior to the emergency or whose HIV-positive mothers choose not to breastfeed
Supportive general conditions
A number of general conditions can greatly benefit infant and young child feeding, and staff who are managing an emergency response should endeavor to establish them:
Recognition of vulnerable groups: Pregnant women, infants under 6 months, and young children between 6 and 24 months should be counted and registered separately. Newborn infants should be registered immediately, and the household made eligible for an additional ration for the breastfeeding mother and food suitable for complementary feeding of young children, when appropriate.
Adequate food, water and nutrients: Mothers should receive an adequate general ration, and sufficient drinking water. If the full general ration is not available, food and micronutrient supplements should be provided as a priority for pregnant and lactating women.
Shelter and privacy: Shelters for families should be provided in preference to communal shelters. Breastfeeding women need private areas (as culturally appropriate) at distribution or registration points, and rest areas in transit sites.
Community support: Women need support from their family and communities, so the population should be helped to settle in familiar groups.
Reduction of demands on time: People spend hours queuing for relief commodities such as food, water, and fuel, which is difficult for mothers caring for young children. Priority access for mothers and other caregivers enables them to give children more time. Sanitary washing facilities should be set up near the area assigned to women with infants.
Specific help with feeding in emergencies
In addition to supportive general conditions, mothers need help with infant and young child feeding specifically. An emergency response should aim to include the following forms of support:
Baby-friendly maternity care: The Ten Steps for Successful Breastfeeding should be implemented at both health facilities and for home deliveries. Skilled support from trained breastfeeding counselors and community groups is needed antenatally and in the first weeks after delivery.
Availability of suitable complementary foods: In addition to breast milk, infants and young children from 6 months onwards need complementary foods that are hygienically prepared and easy to eat and digest. Blended foods, especially if they are fortified with essential nutrients, can be useful for feeding older infants and young children. However, their provision should not interfere with promoting the use of local ingredients and other donated commodities for preparing suitable complementary foods.