INFANT FEEDING DURING

INFECTIOUS DISEASE OUTBREAKS
A guide for national health authorities, health and nutrition policymakers, professional
associations and other bodies and practitioners working in outbreak preparedness and response.

Standards of care

Ensure appropriate infant feeding
recommendations are in place

WHO and UNICEF recommend:• Immediate skin to skin contact afterbirth• Initiation of breastfeeding within one
hour of birth• Exclusive breastfeeding for the first six
months of life
• Introduction of nutritionally adequateand safe complementary foods at 6months• Continued breastfeeding for at least
the first two years of life
• Responsive caregiving

Global Recommendations

Emergency preparedness iscritical to a timely, efficient andappropriate response

Does WHO have up-to-date infant feeding recommendations for this infectious disease?

RememberNo

In every emergency – including infectious disease
outbreaks e.g. Ebola, Cholera, COVID-19 – assess
and act to protect the nutrition needs and careof both breastfed and non-breastfed infants andyoung children.

Yes

Align existing national/sub-national
recommendations with WHO recommendations ordevelop new recommendations that are aligned

Advice about the care and feedingof infants must consider increases
in illness, malnutrition and death
resulting from deviating from normative
recommendations.

Disseminate rapidly and widely!

The right message at the right time fromthe right source can save lives!

Develop interim infant feeding recommendations based on the best available evidence
DO NO HARM
Breastfeeding provides protection to women and children that is too important to compromise
Prioritise continuing breastfeeding
Maintain recommended standards of care and close mother-infant contact until and unless proven otherwise.

Practice relevant and appropriate Infection Prevention
and Control (IPC) measures (e.g. hand hygiene, facemasks,
preventing nipple damage etc.)!

Breastfeeding provides hydration, nutrition and supports aninfant’s immune system, reducing severity and duration ofmost infectious diseases

IPC measures for the general population (e.g. physical distancing)
may not be appropriate for mothers and their infants

ONLY interrupt breastfeeding or separate mothers and infants if there is good reason to believe thatwithholding breastfeeding and/or depriving infants of close contact with their mothers is justifiable!

For example, a proven high risk of severe illness and death in infants AND evidence indicating that the disease is transmitted throughmother-infant contact and/or breastmilk AND testing is available OR there is a high likelihood of infection in those with suspected infection.
If so, consider the following temporary infant feeding alternatives for suspected and/or confirmed cases

Temporary alternatives for suspected/confirmed cases!
Separation
causes severe stress, harms mental
health, impairs development, weakens
breastmilk’s protection against
infectious diseases, carries a high risk ofbreastfeeding failure and places a highburden on healthcare systems.
The younger the infant,the higher the risk.

!

!

Good option

Donor human milk

Last resort

Wet nursing(Breastfeeding by another woman)in line with OG-IFE key conditions

increases short- and long-term morbidity andmortality, may disrupt breastfeeding in thegeneral population, impairs maternal health andwellbeing, weakens maternal caregiving capacity
so increasing the risk of infant abuse, neglect,and abandonment.

!

Mother’s expressedbreastmilk

Risks are heightened inhumanitarian settings.

!

Interruption is temporary

Separation is temporary
Protect the mother-infant relationship

Interrupting breastfeeding

Best option

Good option!

Breastmilk substituteProtect the mother’s milk supply

Fed by cup/spoon!

While BMS can be necessary, its use carries serious risks. For guidance on minimising the risk of illness, malnutrition and death associated with using BMS, referto the Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) and the the IFE Core Group infographics on BMS support

Part of the Infant Feedingin Emergencies CoreGroup infographic series.
Find out more atwww.ennonline.net/ife

For guidance on multisector actions to take,refer to the IFE Core Group infographic on
Infant Feeding during Infectious Disease
Outbreaks 2 : A guide for decision makers
and programmers working in outbreakpreparedness and response.