Pediatrics 115 (2) : 496-506.
Dear California Breastfeeding
Coalition Members,
Due to the recent fires in Southern
California we thought it would be prudent to remind you of the information that
has been established about breastfeeding in emergencies.
Below you'll fined a list of websites and also the text of two publications.
Please dispurse the information to your coalitions and beyond.
Sue Wirth, IBCLC
California Breastfeeding Coalition Leadership Team
Safe Infant Feeding During Emergencies
WHO guiding principles for feeding infants and young children in emergencies.
http://whqlibdoc.who.int/hq/2004/9241546069.pdf
Emergency Nutrition Network
www.ennonline.net
UNICEF website on emergencies and nutrition
http://www.unicef.org/nutrition/index_emergencies.html
United States Breastfeeding Committee
www.usbreastfeeding.org
International Lactation Consultant Association
http://www.ilca.org/katrina/InfantFeeding-EmergPP.pdf
Center for Disease Control
www.bt.cdc.gov/disasters/foodwater.asp
La Leche League International
www.lalecheleague.org/emergency.html
Wellstart International
http://www.wellstart.org/Infant_feeding_emergency.pdf
SUPPORT FOR BREASTFEEDING
IS CRUCIAL FOR INFANT HEALTH
IN THE AFTERMATH OF NATURAL DISASTERS
Under normal conditions in developed countries like the US, infants who are
not breastfed are much more susceptible to infections and other illnesses. As
a result, they are 3 times as likely to require hospitalization and 21% more
likely to die in the first year of life. The costs of these excess illnesses
are considerable for families, insurers, and taxpayers.[i]
In the aftermath of emergencies like hurricanes Katrina and Rita, helping mothers
successfully initiate and continue breastfeeding is even more crucial. Children
in vulnerable situations have special needs for the infection-fighting factors,
the optimal nutrition, the reliable food source, and the comfort provided by
breastfeeding. In contrast to powdered formula, which needs to be mixed with
water, human milk provides ample hydration and spares infants exposure to water
contaminated during the destruction caused by natural disasters. Direct breastfeeding
also prevents the illnesses attributable to bottles and nipples “washed”
in unclean water.
Most mothers in the US want to breastfeed, but many quit sooner than recommended,
citing lack of sufficient societal support as one key reason. Women warrant
extra support during crises like hurricanes and floods. Every effort should
be made to rapidly reunite and keep infants with their mothers, provide space
where they can feel comfortable nursing, and welcome moms to breastfeed whenever
and wherever their babies show signs or hunger or distress.
Relief workers and health care providers should encourage mothers delivering
during the crisis to breastfeed, help moms initiate breastfeeding immediately
after birth, recommend exclusive breastfeeding for approximately 6 months, and
assist mothers who recently stopped to restart breastfeeding (“relactate”).
Myths such as “stress makes the milk dry up” and “malnourished
mothers cannot breastfeed” must be dispelled with accurate information.
Feeding the mother is the safest, most effective way to ensure adequate infant
nutrition during emergencies.
For more information about safe infant feeding in natural disasters follow the
links at www.bfmed.org. The Academy of Breastfeeding
Medicine (ABM) is a worldwide organization of physicians dedicated to the promotion,
protection and support of breastfeeding and human lactation through education,
research and advocacy.
--------------------------------------------------------------------------------
[i]
American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and
the Use of Human Milk
Pediatrics 115 (2) : 496-506.
Breastfeeding in Emergency Situations
Breastfeeding is particularly important in emergency situations because of the
increased risk of diarrhoeal diseases and other infections, inadequacy and contamination
of complementary foods, and the bonding, warmth and care provided by breastfeeding
which is crucial to both mothers and children in emergency situations. The risks
associated with bottle and formula feeding are dramatically increased due to poor
hygiene, crowding and limited water and fuel. The role of breastfeeding is even
more important in emergency situations where it may be the only sustainable element
of food security for infants and young children. Exclusive and prolonged breastfeeding
is often the only form of family planning available to women in emergency situations.
Last but not least, women need validation of their own competence, BF is one of
their important traditional roles that can be sustained during a stressful situation.
Misconceptions about breastfeeding in emergencies
Women under stress CAN successfully breastfeed
Milk release (letdown) is affected by stress. Milk production is NOT. Different hormones control these two processes. The treatment for poor milk release is increased suckling which increases the release of oxytocin, the letdown hormone. Research suggests that lactating women have a lower response to stress, so helping women to initiate or continue to BF may help them relieve stress.
Malnourished women DO produce enough milk
It is extremely important to distinguish between true cases of insufficient milk production (very rare) and perceptions. Milk production is relatively unaffected in quantity and quality except in extremely malnourished women (only 1% of women). When women are malnourished it is the mother who suffers, not the infant. The solution to helping malnourished women and infants is to feed the mother not the infant. The mother will be less harmed by pathogens and she obviously needs more food. By feeding her, you are helping both the mother and child and harming neither. Remember that giving supplements to infants can decrease milk production by decreasing suckling. The treatment for true milk insufficiency is increased suckling frequency and duration.
A mother who has weaned CAN redevelop her milk supply
With enough nipple stimulation and milk removal, it is possible for women to re-lactate, that is to redevelop a milk supply. The stimulation can be provided by a willing baby or even older child, by hand expression and stimulation and/or pumping. The process may take several days or even a couple of weeks. Mothers need much encouragement, a reasonable supply of food and water and protection from stress to the extent possible. Babies, of course, need to be fed in the least hazardest manner until the milk supply returns.
Breastfeeding women need SPECIFIC ASSISTANCE; general promotion of breastfeeding is not enough.
Lessons learned in development programs show that most health practitioners have little knowledge of breastfeeding and lactation management; these lessons apply equally to emergency programs. Women who suffer through violent situations leading to displacement and emergency situations are at increased risk of breastfeeding problems. Mothers need help, not just motivational messages. Relief agencies and field workers need training on how to counsel mothers to help them optimally breastfeed; how to assess proper positioning and suckling and remedy when needed and breastfeeding
physiology. In some situations, breastfeeding specialists may be useful. Maternal perception of risk of breastmilk insufficiency is an important factor in a women’s decision for early termination of breastfeeding. These perceptions may be intensified by the stress of emergency situations. Our first concerns should be ensuring optimal breastfeeding behaviors, which may require the selective feeding of lactating women and trauma counseling for women who may believe they “don’t have enough milk”. Policies and services which undermine optimal feeding such as giving food supplements to infants <6 months and using bottles for ORS delivery, should be avoided. Successful breastfeeding will contribute to the restoration or enhancement of woman’s self-esteem, critical to her ability to care for herself and her family.
Human milk substitutes (infant formula and/or milk) are NOT always needed
Providing infants and young children caught in an emergency situation with substitutes for human milk is extremely risky. It should be undertaken only after careful consideration and full awareness of the problems that may result. Good guidelines exist on the use of human milk substitutes and other milk products in emergencies: the 47th World Health Assembly Resolution WHA 47.5 (May 9, 1994); UNHCR guidelines on use of milk substitutes (July 25, 1989); the International Code of Marketing of Breast-milk Substitutes, WHO (1981). Common elements of these guidelines are that human milk substitutes must be:
These
guidelines should be disseminated and followed by all agencies working in emergency
situations.
Optimal Feeding Practices in Emergencies:
