Emergency Management: Infant and Young Children Feeding in Emergencies
KeywordsInfant feeding Evacuation Maternal and child health
The field of infant and young child feeding in emergencies (IYCF-E) is a set of practices, policies, and guidelines related to ensuring safe feeding of infants and young children during disasters and major hazard events.
During large-scale evacuation and sheltering scenarios, families with infants need support for safe infant feeding. In the post-disaster setting, breastfed, bottle-fed, and mixed-fed infants require special care and support. Breastfed infants have a higher likelihood of survival in emergency scenarios (Jakobsen et al. 2003; WHO and UNICEF 2003; WHO 2015). Another benefit of breastfeeding is that infants are less likely to suffer from respiratory illness and other infections (WHO and UNICEF 2003). Breastfeeding improves health outcomes for women and infants (Rollins et al. 2016), and breastfeeding promotion provides resilience and protection for vulnerable groups in disasters (Gribble 2018). Distribution of commercial complementary foods (CCF) in emergency sheltering spaces can also be problematic because it may disrupt breastfeeding (early introduction of solids) and because the CCF may not contain the proper nutritional contents for toddlers and older children. Specifically, fortified complementary foods are nutritionally superior (Theurich and Grote 2017). Another issue for young children in emergencies is meal frequency and malnutrition during displacement and the post-disaster context (Sun et al. 2013).
Natural hazards, crisis and conflict, and other emergency settings can have adverse impacts on families with infants and young children. Breastfeeding is the safest form of infant feeding in disasters and emergencies and is the most cost-efficient intervention in vulnerable populations (Rollins et al. 2016). The context of the disaster event and access to resources are important in designing effective implementations for IYCF-E. For example, lack of access to clean water and supplies to sterilize feeding supplies makes safe bottle-feeding difficult in low-resource contexts, such as in a refugee camp (Gribble 2014; Prudhon et al. 2018). In high-income countries, lack of space in emergency sheltering facilities for breastfeeding, temporary interruptions in utilities, and other factors can pose challenges for families with infants (Callaghan et al. 2007; Gribble and Berry 2011). There are several factors that contribute to problems associated with poor IYCFE adherence. During disasters, media messages often contain myths of inaccurate information about infant feeding (Gribble 2013). These myths influence donor behavior and health workers’ interactions with caretakers. These myths include (1) myths about milk/lactation “drying up” because of stress from the disaster event (e.g., DeYoung et al. 2018), (2) myths about maternal nutrition and breastfeeding, and (3) the myth of formula as essential. Another major problem that unfolds during disasters is the untargeted mass distribution of infant formula. This results in some families receiving breastmilk substitutes (BMS), although they were exclusively breastfeeding, and some families not getting the proper BMS. Other problems related to logistics may affect infant feeding. For example, in a mass-sheltering scenario, relief groups may distribute formula without preparation instructions (and not in the user language).
All efforts should be made by emergency personnel to keep families together, especially infants and mothers. Families should be assessed for feeding status at entry into emergency sheltering (bottle-feeding, breastfeeding, mixed feeding, combined with multiple children). Families that were exclusively breastfeeding before the disaster should be encouraged to continue breastfeeding the infant. A designated space for breastfeeding is essential for the caretakers and infants. A bathroom/toilet facility is not an acceptable space for designated breastfeeding. Families that require infant formula should have access to proper preparation instructions, space for bottle preparation, and access to sterilization supplies or disposable bottles and teats. Crisis communication messaging to shelter volunteers should include information about infant feeding guidelines. Infants requiring breastmilk substitutes (BMS) are at risk for food insecurity during emergencies. Therefore, all caretaker-infant dyads should receive support and assessments in sheltering and relocation locations.
Water and hygiene concerns are important for IYCF-E planning in long-term displacement settings. Diarrheal illnesses are the second leading cause of death of children under the age 5 (WHO 2015), and malnutrition and stunting severely impact infant health. Assessments of each mother-baby dyad to provide feeding support are essential. Relactation, cup feeding, and proper complementary feeding should all be considered when supporting families that are in long-term displacement situations. Mother-baby tent or space can provide a location for displaced families in mass-sheltering scenarios. These spaces may often overlap with other service providers such as psychosocial first aid or reproductive care and planning. Additionally, families should receive adequate age appropriate nutrition for toddlers and young children, such as whole fruits and vegetables. Beliefs, practices, and norms about infant feeding may vary across cultures and locations. Groups providing infant feeding support in emergencies should include cultural competency as a core part of their training and outreach activities. Having local community members as a part of the nutrition assessment team can build rapport with the families and create systems of capacity building (Murphy 2014) for the post-disaster recovery processes and in long-term humanitarian crises.
Implications for practice and policy: Emergency support functions should coordinate to support safe infant feeding. Specifically, mass-sheltering personnel should coordinate with nutrition and medical personnel to create consistent but flexible IYCF-E protocols. Additionally, increasing rates of baseline breastfeeding can improve health outcomes for families vulnerable to hazards and disasters. In complex humanitarian and long-term emergencies, humanitarian groups, in partnership with local governments of the affected area, should prevent mass distribution of BMS and CCF. Finally, proper steps should be taken to ensure that toddlers and small children have access to small but frequent meals that are highly nutritious.
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