Feeding Babies During Emergencies: What should you do?

⑤④

Helpful RISU (squirrel)“That's a common
misunderstanding!”“We know that milk will flow
again when a mother feelssafe.”

Worried Mom “I’ve heardthat in emergency
situations, stress canmake my milk dry up.”“And I've seen infant
formula being distributed
during emergencies…”⑦⑥

Protection from
Norovirus,
Salmonella,
E. coli,
Campylobacter,
Rotavirus,
Influenza virus“Breastmilk
contains
immune factorsthat protect
babies frominfections,especially inthe event ofemergencies.”⑦“Because
breastfeeding cancalm babies, andmoms need tobreastfeed during
the night, it’s goodto have familyfriendly spaces.”

③

②

①

In stressful times,
milk may not flow
easily, but it is still
produced bymothers.

In times of danger,
it is not the time tosit and breastfeed,
it is time to escape!

Milk flow is controlled by hormones, andcan be affected by threats of danger - butit resumes again in a safe environment.

⑤“Thiscreates themisconcepti
on thatstress stops
breastmilk
production.”⑥“Breastmilk can bemade even if mom
doesn't eat much.
But we want moms
to get plenty of foodfor their own health.”
Mom “I eat and makemilk for my baby!”④“If the frequencyof breastfeeding
decreases orinfant formula isadded in thissituation, theamount of milk
produced mightdecrease.”⑤“Of course,a safe
environmentis alsoimportantfor formula
feedingbabies.”

Grrr(Imagine if drops of milk helped a predator
track down their prey!)③②

FIL: Mechanism to suppress andcontrol milk production “We aren'tusing milk very much right now.
Shall we reduce production?”
Prolactin: Hormone to produce milk
“I have already made some milk, butshould we reduce it for now?”
Oxytocin: Hormone to eject milk
(Sensitive to stress) “Let's take abreak for now...”

Mom“But weprobably
tend tobreastfeed
our babies
less inemergencies
ordisasters…”④“Therefore, it isespecially
important forbreastfeeding
mothers to have asafe environmentthat allows them
to focus onbreastfeeding.”③(RISU’s note:“We aretalking aboutprotecting themother’s rightto breastfeed,
not saying that
all mothers
mustbreastfeed.”)①②
One teaspoon ofbreastmilk contains
3 million germ killingcells! (Infant formulavs breastmilk)
Mom “Then I guess
I could try tobreastfeed more…”

RISU “Therefore, it
is very important to
prepare a safe
place for mothers
duringemergencies.”
Screen, separate
room, tent, privateroom.
A safeenvironment!

①
RISU “Somemothers reportthat they
produce morebreastmilk thanusual when
they breastfeed
morefrequently.”⑦“Afterwards,always throw
away anyleftover milk!
Dispose ofleftover milk
immediately asbacteria willgrow!

⑤

Mom “That willprotect bothbreastfed andformula-fedbabies.”⑥
Sit the baby upright on yourlap．Choose a quiet place,not too bright!
Hold the small cup of milk tothe baby's lips.
The cup rests lightly on thebaby’s lower lip, and theedges of the cup touch thebaby’s upper lip.
Tilt the cup so that the milk
just reaches the baby's lips.
The baby then starts licking
the milk.
Try practicing at home in caseof an emergency.

④RISU “Listen to
parents first
before giving
advice, so thatthey can continue
looking after theirchildren in theirown way.”

RISU “Ifyou don't
have asterilizedbaby
bottle, youcan use acup.”(A pile ofpaper cups
can easily
be stored!)⑤〔Ready-tofeed liquidformula〕
should be
stored at room
temperature,
which falls
from 15℃ to25℃.
(Refer tomanufacturer'sinstructions.)
Shake well.

③④〔International standards〕WHO’s
International Code or Operational Guidanceon Infant Feeding in Emergencies
ASSESS the individual needs and distributeinfant formula only to those who need it.
Do NOT distribute infant formula without
assessment during disasters.
Do NOT give samples of infant formula innon-emergency settings.

③〔Powderedformula〕Mix with
hot water above
70℃．(Necessaryto kill any bacteria
in the powder!!)
Cool it to feeding
temperature (bodytemperature).
Note – Hypoallergenic formulais only available inpowdered form.

②“Everyone should
be sympathetic tomothers withbabies. Supporters
should think of how
to help moms lookafter their children
in the same way
they did before theemergency.”②Washhands.
Use asterilizedcontainer.

①

RISU “Forthose who
are feeding
infantformula,thoroughhygienemanagement
is important!”①

RISU “Whether you areformula feeding or
breastfeeding, you areworking hard looking
after your children.
Even during
emergencies, youdeserve people’s
respect for your own
feeding methods!”

This is based on the IFE’s Operational Guidelines on Infant Feeding in Emergencies. https://www.ennonline.net/operationalguidance-v3-2017
Comic by Yasuko Emura
Published by Risu Ando & Hiroko Hongo
Medical supervisor: Kikuko Oku, MD
English translation: Iona Macnab, IBCLCReferences
American Academy of Pediatrics. Infant Feeding in Disaster and Emergencies, 2015.
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Breastfeeding Issues During Disasters（AAP/ACOG）in Breast-feeding Handbookfor Physicians 2nd ed. p.239-244, 2014.
Gribble KD, Berry NJ. Emergency preparedness for those who care for infants in developed country contexts. Int Breastfeed. J. 6(1):16, 2011.
Gribble K, Fernandes C. Considerations regarding the use of infant formula products in infant and young child feeding in emergencies (IYCF-E) programs. World Nutrition2018;9(3):261-283.
IFE Core Group. Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Programme Managers, version 3.0, 2017.
Sphere Association. The Sphere Handbook, 2018.
UNHCR, ENN. Infant and Young Child Feeding Practices: Standard Operating Procedures for the Handling of Breastmilk Substitutes (BMS) in Refugee Situations for Children
0 - 23 months, 2015.
WHO. International Code of Marketing of Breast-milk Substitutes, 1981.
WHO, UNICEF. Infant Young Child Feeding Counselling: An Integrated Course, 2006.
Other references are listed at https://andorisu.jimdo.com/