SUPPORTING INFANTS DEPENDENTON ARTIFICIAL FEEDING
DURING EMERGENCIES

Guidance for Frontline Workers (including health, nutrition and child protection staff)
Infants and young children who are fed with Breastmilk Substitutes (BMS) such as infant formula are at high riskof malnutrition, illness and death during emergencies. Act immediately to protect them and to support mothers
and other caregivers to minimise risk and meet their infant's nutritional needs.

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1

In emergencies, the use of BMS requires a contextualised, coordinated and sustained package of careand skilled support to protect and support ALL children (both breastfed and non-breastfed). Refer to theinfographic on Planning and Managing Artificial Feeding Interventions during Emergencies for guidanceon how to establish this support.

Carefully check eligibility for BMS support though 1-1 assessment1
Artificial feeding needs should be determined throughindividual-level assessment by a qualified health or nutrition
worker trained in breastfeeding and infant feeding issues.

Saferalternatives are
not possible	Mother's own
expressed breastmilk.	Re-starting supplyANDto return tobreastfeeding(relactation).	Breastfeeding by ahealthy woman otherthan the child’s mother.	Donor human milk.

Short-term
eligibility

Long-term
eligibility

Mother severely ill.	Relactation (withinfant formula as thesupplement).	Waiting for othersafer alternatives.	Increasing supply toreturn to exclusive
breastfeeding (U6M).	Short-term separation.	Not breastfed preemergency.	Replacement feedingfor HIV.	Mother deceased orabsent.
Rare medical condition.2
	Mother has rejected
infant.	Sexual and Gender Based
Violence (SGBV) survivor
who may not be ready tobreastfeed.

OR

2 Determine if BMS can be used hygienically at home
PowderedInfant Formula(PIF)

What is needed

Ready to use
Infant Formula(RUIF)

Yes

Handwashing facilities

Yes

Yes

Clean and dry storage

Yes

Yes

Heat source

Yes

Yes

Washing facilities (safe waterand sink/washing up bowl)

Yes

No

Correct, hygienic
preparation*
1-1 practical demo

Responsive
feeding

Remember!

Remember!
Over- and
under-dilution
is DANGEROUS*Instructions for preparation
Ready-to-use
infant formula

Steps Powdered infant formula
1

Wash hands thoroughly with soap and water for at least 20 seconds.

2

Carefully sterilise the feeding (e.g. cup) and preparation equipment.
Ensure a clean preparation surface.

3

Boil fresh, safe water. Leave the covered water to cool to no less than 70⁰C.
Tip: It takes 1 litre of water about 30 minutes to cool to 70⁰C – do not wait longer.
Following the product's instructions, combine the correct amount of hot water with theexact amount of powder in a cleaned and sterilised measuring jug (using the measuring
scoop provided with the product).

XX

5

Mix well with a cleaned and sterilised spoon.

X6

Cool the prepared formula until it feels lukewarm, not hot, when dripped on theinside of a wrist.

X

7

Pour the infant formula into a cleaned and sterilised feeding cup and offer it to the infant.

8

Throw away any feed that has not been consumed within 2 hours (mix in family food, or consume it yourself
as the caregiver/offer it to an elderly family member).

9

Thoroughly clean feeding and preparation equipment after use.

a regular follow-up schedule
5 Establish(every 2 weeks or more frequently)

Use disposable cups if heat sourceand washing facilities are not available.

Monitor growth and healthRe-assess eligibility,including feasibility ofsafer alternatives(e.g. relactation)

3 Discreetly provide BMS and associated supplies (BMS Kit)
An appropriate* BMS that is labelled in the correct language and iscompliant with the WHO International Code.
*Refer to the infographic on Planning and Managing Artificial
Feeding Interventions during Emergencies for guidance on what
constitutes an appropriate BMS, depending on the child’s age
and the context.
Feedingcup

Safe storage
in a cleanand drylocation

Where andwhen to seekmedical care

Feeding bottles
are NOT
recommended

Provide on-site feeding with 24/7 access

Storage, preparation andcleaning equipment

Cup feeding3
1-1 practical demo

Yes

Can a BMS kit be provided to ensure hygienic preparation at home?
Provide the kit

Counsel and demonstrate how to feed the child as safely as possible

4

Potable water for reconstitution

Yes

4

SafewaterHygiene
supportRemember!

6Counsel on infant andyoung child feeding andother topics (as needed)

Check caregiver wellbeing

Resupply BMS

Refer to additional
services (as needed)

Similar to medication, BMS can be necessary and lifesaving, but must be given
carefully, only when needed and under strict control and monitoring.

Repeat step 5 until the child can be fed withbreastmilk or reaches at least 6 months of age*

BMS should be provided for as long as the infant needs it.
Health and nutrition workers have a professional responsibility
to protect, promote and support recommended infant and young child feedingpractices. Breastfeeding saves lives during emergencies. The WHO International Code calls on you toensure that caregivers and their children are protected from harmful BMS marketing practices whilst
in your care. The Code is especially important during emergencies.

Remember!

At all times, health and nutrition workers should follow the WHO International Code.
1 In circumstances where individual-level assessment, support and follow-up are not possible, such as where population access iscompromised, consult with the IFE coordination authority.
2 Refer to WHO for a small number of acceptable medical reasons:https://apps.who.int/iris/bitstream/handle/10665/69938/WHO_FCH_CAH_09.01_eng.pdf*Milks other than infant formula may be used as a BMS in children aged six months and older (e.g. full fat UHT milk).
3 Where bottles are used by caregivers, act to help mitigate risks. Refer to 6.23 in the OG-IFE.

Part of the Infant Feeding in Emergencies Core Group infographic series.
Find out more at www.ennonline.net/ife