Q4	What can I do when no baby formula/liquid formula isavailable?

Q&A about Babies at
Evacuation Centers in Disaster Areas
Q1	Can my baby get enough nutrients from breast milk?
A	Your baby is fine if he/she is well and pees as usual.
Your baby is fine if he/she is well and pees as usual (i.e. if you change the diaper
6 times a day or more). Breast milk contains nutrients that babies need (even if
their mothers do not eat adequately) and protects babies against diseases that arelikely to break out in disaster areas. Although you may have less milk when you feel
nervous or uneasy, you don’t need to worry as it is only temporary. You will haveenough milk once you can relax to breastfeed. Try to find a place where you feel
comfortable and have some privacy and breastfeed your baby every time and asmuch as he/she wants.

Q2	What can I do if a baby bottle is notavailable?

Your baby can drink from a paper cup.
A	
You can feed your baby with a cup.
Pour milk into a paper cup until it is about halfway full.
1. Make sure your baby is awake and cradle him/her in an upright position.
2. Have the rim of the paper cup touch your baby’s lower lip and let him/her drink
milk little by little.
3. Let your baby drink on his/her own. Since it is not easy for your baby to drink
much milk this way, take about 30 minutes per feeding. You can increase thenumber of feedings as appropriate.
Pour formula orbreast milk intoa paper cup
until it is about
halfway full.

SlowlySlowly

Let your baby
drink inan uprightposition.

Q3	What should I be careful about when using liquidA	You can temporarily use cooled boiled water andsugar.

Dissolve a tablespoonful of sugar in about 200 mL of cooled boiled water and giveit to your baby. You can also give watery rice gruel. Meanwhile, letting your baby
suckle gives you and your baby a sense of comfort (and you might have breast milk
again). If your baby is 6 months old or older, you can also give him/her baby food(e.g. mashed cooked rice, banana, etc. mixed with warm water to make a smoothconsistency, baby rice crackers dipped and mashed in warm water).

Q5	How can I protect my baby from the cold?
A	You can use readily available
items such as towels.

Recommended measures include: wrapping your baby with clothes, towels, shawls,
etc. in layers to keep warm air in; using a raincoat, plastic wrap, etc. to shut off
cold air; putting a cap on your baby’s head; covering the floor with newspapers,
cardboard, etc.; and laying down your baby in a cardboard box with its bottom
covered with newspapers, towels, etc. Make sure none of these measures hinder
your baby’s breathing. Wrapping yourself with your baby in a blanket keeps him/
her warm. Massaging your baby’s arms and legs is also effective. For young
babies, hold your baby in direct contact with your skin to keep him/her warm. Yourbaby is fine if he/she laughs when lulled or cries loudly. If your baby looks paleand ill, immediately consult with healthcare staff.

Q6	What can I do if I cannot keep my baby clean(e.g. cannot bathe, baby wipes not available, etc.)?

A	You can clean your baby’s skin with a small amount ofwarm water.
Clean your baby with a towel dampened with warm water in the order of face,arms, body (chest/abdomen), back, legs, and the butt area, and wipe moisturewith a dry towel. When using soap, make a lather and smooth over your baby’s
body with your hands, and wipe with a wet towel a few times to remove soap
residue. You can use tissues if towels are not available. When you have adequate
warm water, rinse your baby’s genitals. Finally, wipe your baby once again with adry towel if available.

formula?

A	Open the container immediately before use and throw
away leftover liquid formula.

Ready-to-feed liquid formula can be convenient specifically during a time of disaster
when no running water and heat source are available. As with baby formula, liquid
formula can be given by using a cup, paper cup or spoon even when no clean
baby bottles and nipples are available. Liquid formula manufactured overseas issometimes included in relief supplies. Please keep in mind that the expiration dateformat for such formula is different from that for formula manufactured in Japan. If
you have never used liquid formula before, start with small quantities. If you havebeen breastfeeding, you don’t necessarily have to use liquid formula. You cancontinue breastfeeding, which gives your baby a sense of security.

Q7	What can I do if I have only a few diapers left or nodiapers?

A	Make the best use of the diapers you have and craft adiaper out of a plastic bag and a towel.

You can reuse a disposable diaper a few times since the back sheet is waterproof. When you have only a few diapers left, you can reuse a diaper by fitting
a sanitary napkin, towel, cotton cloth, etc. inside. When the absorbent layer gets
wet, you can remove the layer and use the remaining part as a diaper cover. Soakand wash the used cloth in water with oxygen bleach and detergent, rinse well,and dry to reuse. You can also craft a diaper out of a plastic bag and a towel asfollows:
1. Cut the plastic bag handles and sides, open, and lay out flat.
2. Place a towel in the center. It is recommended to put a gauze or fleece patch on
the towel that catches poop.
3. Fasten by tying the handles.

Plasticbag
Plastic bag

Towel,
flyer, etc.

Wrap

Tie handles
and finish!

Q8	How can I avoid and treat diaper rash?
A	Diaper rash can be avoided and treated basically in thesame manner.

1. Wipe off poop with wet tissue, disposable cloth, etc.
2. Fill a plastic bottle with warm or lukewarm water and wash the butt.
3. Wash the butt with soapy water and rinse with warm water at least once a day(once daily washing is adequate).
4. Gently pat your baby dry with dry cloth and put on a diaper. It is important tomake sure that your baby’s skin is dry before putting on a diaper.

Q9	What should I do if eczema worsens?
Take care of your baby’s skinA	
as best as you can.

Baby eczema naturally resolves as your baby grows up. During a time of disaster,
take care of your baby’s skin as best as you can. Using an ordinary soap, make alather, wash the skin, and rinse off soap residue. If your baby has a yellowish scab,
apply a cotton wool pad soaked in baby or olive oil before washing so that thescab comes off easily. When your baby’s skin is dry, apply white petrolatum. You
can thinly apply topical cream to reduce redness or itchiness, if any. If your baby
suddenly develops a rash with fever or sullenness, pus-filled blisters, or eczema
persists, consult with healthcare staff.

Q10	What should I do if my baby getsconstipated?

A 	It is recommended to gently

massage your baby’s tummy
in a clockwise direction.

Lay your baby down on his/her back and gently massage his/her tummy in aclockwise direction. In the same position, you can also hold your baby’s legs withyour hands and move them back and forth and from side to side. If your baby stillcannot poop, looks painful, or his/her belly is more bloated than usual, gently
massage the anus area with your fingers. If a cotton swab is available, dip thecotton swab in petroleum jelly or oil (alternatively, your saliva or water), then insert
only the tip (about 2 cm) inside your baby’s anus, gently circling the swab aroundthe anus. If constipation still persists, consult with healthcare staff.

Q11	What should I do when my baby has diarrhea?
A		Give fluids to your baby.
Even if your baby has diarrhea, you don’t need to worry if he/she can drink breast
milk or formula and the number of poops is 4 to 5 a day or poop and pee can be
distinguished. Give your baby breast milk, formula, isotonic drink for babies, etc.
Keep your baby’s butt clean to avoid diaper rash (see Q8). If your baby cannot
drink fluids including breast milk and formula, or the number of poops leaking outof the diaper is 5 or more a day, consult with healthcare staff. Wash your hands ordisinfect with alcohol after changing a diaper wherever possible.

Q12 What should I do if my baby vomits?
A 	Your baby is fine if he/she is in a good mood andQ15	What should I do if my baby is feverish (and athermometer is not available)?

A 	Your baby is fine if he/she can drink, sleep, and isplayful as usual.

Babies are not good at regulating their body temperature and it rises for a numberor reasons even though babies are not ill. Check if your baby has been staying
close to a heater, if room temperature is high, if he/she is heavily clothed, etc.
Even if your baby has a fever, your baby is fine if he/she behaves as usual (i.e.
drinking breast milk or formula, sleeping, being playful = being in a good mood).
When your baby has a fever, frequently give breast milk, formula, other fluids, etc.
to avoid dehydration, and keep an eye on him/her. If your baby is younger than
3 months of age, vomits frequently, cannot drink breast milk or formula, or looks illand unwell, consult with healthcare staff.

Q&A

about Babies at Evacuation
Centers in Disaster Areas

can drink breast milk or formula.

Babies can vomit for a number of reasons. If your baby is in a good mood after
vomiting and drinks breast milk or formula well, you can wait to see if he/she
vomits again. Meanwhile, throwing up of milk is normal. If vomiting persists due tostomach flu, etc., giving fluid induces vomiting. When your baby vomits twice or
thrice in a row, don’t give him/her any fluids for a few hours. Then give him/hersmall quantities of fluid (breast milk, formula, or isotonic drink). If your baby does
not vomit, gradually increase the amount. If vomiting persists for 2 or 3 days, if yourbaby also has diarrhea, cannot pee, or looks ill, consult with healthcare staff. If
your baby is younger than 3 months of age and has a fever, looks pale, or is dozy,
immediately consult healthcare staff.

Q13	What should I do if my baby suffersfrom a runny or stuffy nose?

A 	Your baby is fine if he/she can

Q16	What should I do if I feel overly tired or stressed?
A 	You have been working very hard and it is time toask your family and those around you for support.

During a time of disaster, everyone can suffer from various symptoms including
having difficulty sleeping, having no desire to do anything, becoming irritated,becoming overly sensitive, and getting nervous. Now that you have your baby
whom you want to take good care of, it is quite natural that you feel stress. Don’t try
to do everything by yourself, but ask your family and those around you for support.
You can take a break and relax by leaving your baby in the care of others even fora short period of time. It is recommended to discuss with others about requests forsetting up of nursing room and rooms for families with children, securing of place
and time for children to play, etc. Typically, the symptoms disappear naturally ina few months. When you find it hard to cope with the symptoms or they persist,consult with healthcare staff.

drink breast milk or formula.

Having a runny or stuffy nose, your baby has trouble drinking milk. You don’t need
to worry, however, if he/she can drink, even if not in large quantities. Give yourbaby breast milk or formula in small quantities while taking regular breaks. Gently
wipe away nasal discharge. If the amount of nasal discharge is so large thatyou think it should be removed, you or another adult can gently suck your baby’s
nose to bring it out. Meanwhile, it has long been known that putting 2 or 3 dropsof breast milk in a baby’s nose works to alleviate stuffy nose. If your baby drinks
obviously less than he/she used to or he/she seems to have difficulty breathing (i.e.
caving of lower throat), consult with healthcare staff.

Q17	What should I do if my baby cries at night frequently?
A		Your baby feels uneasy just like you. Cradle him/her
in your arms.

Normally, babies often cry at night. So, during a time of disaster when evenadults become nervous, it is natural that babies also feel uneasy and cry at night.
If your baby doesn’t stop crying after breastfeeding, changing a diaper, adjusting
temperature, etc., don’t try to stop him/her from crying, but gently cradle him/her
in your arms. When you don’t want to bother people around you, you can leave
your place and go outside to let your baby breathe fresh air for a change.

Disaster Countermeasure Committee
Japan Society for
Neonatal Health and Development

Q14	What should I do if my baby severely coughs or
wheezes?

A		Your baby is fine if he/she can sleep and drink breast
milk or formula.

Even if your baby coughs or wheezes, your baby is fine if he/she can sleep anddrink breast milk or formula. If he/she cannot drink a large quantity of milk at a time,
give milk in small quantities frequently. If your baby cannot sleep due to coughing or
wheezing, seems to have difficulty breathing, vomits when coughs, drinks less milk
than usual (i.e. weak sucking, less than half the usual amount), or coughs with sounds
like a dog’s barking or seal’s call, consult with healthcare staff as soon as possible.

Japan Society for Neonatal Health and Development
Issued by : Disaster Countermeasure Committee, Japan Society
for Neonatal Health and Development
TEL : 06-6398-5625 / FAX : 06-6398-5617
E-mail : jsnhd@jsnhd.or.jp
URL : http://jsnhd.or.jp/   http://jsnhd.or.jp/saigai.html
Illustration & Design : Ayumi Uemi
Issued in April 2011 Revised in March 2020

Japanese Neonatologist Association
Japan Society of Perinatal and Neonatal Medicine
Japan Pediatric Society