1. Best Practices in Breast Feeding during emergencies
Dr Sudarshini Fernandopulle
(MBBS, MSc, MD)
Consultant Community Physician
SF/2009

2. Challenges to Breast Feeding in an Emergency
Priority given to other basic needs such as shelter, clothing, provision of food for adults etc.
Belief that under stressful conditions and/or limited access to food mothers are unable to breast feed
Disorganized environment
lack of privacy for breast feeding
Inadequate support from skilled workers
SF/2009

3. Un-Controlled Donations
Large supply of infant formula at homes,
health centers & distribution points –
SF/2009

4. SF/2009

5. Maliban donates infant milk food for tsunami victims
Maliban in collaboration with the government of Sri Lanka has once again provided assistance to the children of tsunami survivors, by making a contribution of infant milk powder to the value of Rs. 20 million. The donation was handed over… at the President’s House.
Source: Daily News, Sri Lanka. Indian Ocean Tsunami, Sri Lanka, 2004/5
SF/2009

6. “We distributed children's clothes and about 40 mothers showed up with their babies, we…taught them how to use the milk powder we had received in big quantities.”
Source: Real Medicine Foundation News. Sri Lanka, Indian Ocean Tsunami 2004/5
SF/2009

7. “A delegation has begun teaching mothers how to properly use infant formula to feed their children. As a result of the Tsunami many women were traumatised and no longer able to properly breastfeed. Over 60 mothers brought their children aged ½ year to 3, to the camp. They wished to learn how to properly maintain hygiene while feeding their children with the infant formula provided by our feeding centre. Word has spread, and every day new parents arrive.”
Source: IsraAID Press release. Sri Lanka, Indian Ocean Tsunami, 2004/05.
SF/2009

8. Incorrect messages in media
Tsunami Victims Relief in Sri Lanka
Please donate urgently for the one million+ Tsunami victims who have lost everything and need your help immediately to survive. Critically urgent supplies eg. Infant formula and feeding bottles and medical supplies will be airlifted…The remainder will be shipped in 40 foot container and arrive in Sri Lanka in approximately 21 days. Source: McGill Tribune, Canada. Indian Ocean Tsunami, Sri Lanka, 2004/5
SF/2009

9. Mechanisms for successful breast feeding
Breast milk production
Suckling the breast (correct attachment and positioning)
Main reasons for breast feeding problems are due to failures in either or both mechanisms.
SF/2009

10. Factors influencing milk production:
Suckling makes more milk.
SF/2009

11. Oxytocin reflex Good feelings and sensations helps the
oxytocin reflex to work and milk to flow
SF/2009

12. Suckling releases Prolactin and Oxytocin hormones
Suckling releases Prolactin and Oxytocin hormones. Prolactine produces milk for the next feed. Oxytocin acts on smooth muscles on the lactiferous sinuses and milk is expressed to baby’s mouth. Frequent suckling is essential to maintain breast milk production.
SF/2009

13. Dietary recommendations for infants and young child feeding during emergencies
0-6 months:
All infants including those born to the affected population should receive EBF during the first six months.
SF/2009

14. Exclusive Breast Feeding for 0-6/12
Babies should start BF within an hour of birth
EBF and demand feeding until completion of six months
EBF means giving only BM and no food, no water, no drinks and no teats. Medication on doctor’s recommendation only.
Support women and build their confidence for EBF.
SF/2009

15. …cont 0-6/12
If getting both breast milk and formula feeds continue only breast feeding (to minimise risk of infections)
Every effort should be made to identify ways to breast feed infants whose mothers are absent or incapacitated
Those already stopped breast feeding re-lactation should be attempted before considering the use of infant formula.
SF/2009

16. Advantages of breast feeding during an emergency
Prevents infections
Provides optimal nutrition to baby
Strengthens bond between mother and child providing crucial physical and emotional support for the child.
SF/2009

17. Reasons for Higher risk of infections in an emergency
Lack of safe water and sanitation
Poor personal hygiene
Unhealthy/unclean environment
No access to health services
Psychological trauma
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18. 6-24 months:
Start CF on completing six months while continuing to BF for two years or longer
Support women to BF for two years or longer.
BM produces half baby’s nutrition requirement -6 to 12 months
1/3rd during second year
10% during third year
Encourage children to eat CF
6 – 9 m – 2 to 3 times a day
9-23 m 3-4 times a day with 1-2 snacks
Non breast fed – 4-5 meals
Support families to prepare and feed CF
SF/2009

19. Supportive care for women
Should be provided to all those breast feeding
Create an enabling environment for BF
BF corners
One to one counseling
Mother to mother support groups
Mental and emotional support especially for the traumatised women
Support those on mixed feeding to increase BF
Skilled help
SF/2009

20. Skilled support for BF mothers
Assess need of individual mothers
Help to BF
Ensure effective suckling by correcting positioning and attachment
Build mother’s confidence and help milk flow
Increase milk production by:
encouraging frequent and longer feeds
Ensure mother gets enough to drink
Remove interference
Keep mother and baby together
Mobilize family support
Encourage age appropriate feeding
SF/2009

21. Additional support needed
Expressing BM
Cup feeding
Kangaroo care
Help traumatized mothers
Support to LBW babies
Support to malnourished babies
Support to malnourished mothers BF babies
Re-lactation
Breast conditions
SF/2009

22. Correct positioning
SF/2009

23. Good and poor attachment
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24. Supportive care for women
Extra food
Food supplementation
Micronutrient supplementation
Family support
Family Planning
Priority in receiving food
Priority and adequate water
Priority to use toilets and bathing
SF/2009

25. Other measures to support BF during emergencies
Developed a circular on Protecting, promoting and supporting Breast feeding during Emergencies
Developed IYCF guidelines during emergencies
Trained health staff on IYCF during emergencies
SF/2009

26. Indications for formula feeds:
If mother is not available
If child was on formula prior to emergency and re-lactation failed
Scientific evidence for inadequate breast milk in an infant less than six months on EBF
Urine output less than six months
Inadequate weight gain (average of 125 grams per week during first six months while on EBF)
SF/2009

27. Formula feeds
The quantity, distribution and use of breast milk substitutes at emergency sites should be strictly controlled
Those responsible for feeding infant formula should be adequately trained and equipped to ensure safe preparation and use
SF/2009

28. ….cont
Feeding infant formula to a minority of children should in no way interfere with protecting and promoting breastfeeding for the majority.
The use of infant feeding bottles and artificial teats in emergency settings should be actively discouraged and cup feeding promoted instead as cups are easier to keep clean.
SF/2009

29. Risk of formula feeds Higher risk of diarrhoea Aggravates malnutrition
Higher risk of death
No guarantee of continued supplies
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30. If on formula feeds Use cup instead of bottle
First six months – formula one
6-12 months – formula 11/
After one year - full cream/goat or cow’s milk recommended
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31. Breast feeding sick infants
Continue BF
Keep mother and baby together
If baby can suckle encourage the mother to do so
If cannot suckle feed with expressed BM
If unable to feed expressed BM teach mother to express BM to maintain BM production
Teach mother to cup feed when discharging
Give ORS through cup
SF/2009

32. Illness of mother Do not stop Breast feeding Treat mother
Keep mother and infant together and encourage BF
Mobilize family support to help with BF
If mother cannot breast feed help to express breast milk
Help mother to increase production as she recovers
Monitor weight gain and urine output
SF/2009

33. Maternity care Identify pregnant women near term early
Early initiation and EBF
Strengthen BFHI
SF/2009

34. Thank you
SF/2009