Are You Prepared? Infant and Young Child Feeding in Emergencies

by Lourdes Santaballa, IBCLC, IYCFS

Military families see mass emergencies from both sides: military medical personnel, National Guard, and other components may be activated to provide humanitarian aid and response domestically or internationally at any time. And, as we have seen this year with Hurricane Florence in North Carolina and Hurricane Michael in Florida, military families may also be evacuated, displaced, or otherwise impacted by natural disasters or other large-scale emergencies. We are very pleased to share this guest post by Lourdes Santaballa, IBCLC, IYCFS, and Executive Director of Alimentacion Segura Infantil (ASI). Lourdes founded ASI in Puerto Rico following the devastation of Hurricane Maria, when she realized the tremendous impact that can be made by providing accurate information and respectful counseling on Infant and Young Child Feeding in Emergencies (IYCF-E).

For those of us who live in the United States, or for US citizens living overseas, including military families, infant feeding is presented as a choice. In fact, it is a choice what we give to our babies, just as we choose what we ourselves eat. Infant feeding is also a health issue, because the choices about what we put into our babies and our own bodies affect our health.

It is October of 2018 and Hurricanes Florence and Michael are fresh on our minds, people still living under water and struggling to find refuge, protection of their property, and food stability with new winds and rains arriving daily. In recent years, around the world, there were floods, earthquakes, mudslides, monsoons, hurricanes, heavy rains and tsunamis. We have survived or lost loved ones to war, riots, bombings, terrorism, uprisings, massacres, gang fights, and immigration raids. We have witnessed bridges collapse, buildings topple, highways buckle, and nuclear reactors fail.

Imagine being a mother, a parent, a caregiver of a baby or small child, with all this planetary and global unrest around you. Whether you think that the systems are getting worse because of global warming, or that these are natural occurrences on a planet that’s in constant motion, whether you fear that international relations are more strained or that history always has wars and civil unrest, and whether you think that engineering keeps improving or that the quality of aging infrastructure is just getting worse, you still love your baby. You still want your baby to grow and be healthy. You still want to be prepared.

Some babies breastfeed. This is the biologically normal way of feeding babies, uniquely designed for their bodies and containing all the nutrients, water, and immunological factors that they need to grow and be healthy. Some babies drink expressed human milk in bottles or cups, providing the perfect nutrition in a different package. Many babies drink formula, sometimes because their parents chose not to breastfeed, but usually because it’s hard and they weren’t provided the help to make it work or experienced great social pressure to stop.

Children under the age of five are vulnerable and at great risk of death. Their bodies don’t have fully developed immune systems and they depend on adults to meet their basic needs. Among the leading causes of child death not related to accidents between day 2 and 5 years are disease and hunger. These are both food related issues. A baby who consumes contaminated food or whose immune system is not protected by human milk is in the greatest danger.

When a disaster strikes, food is scarce, water may be rationed or nonexistent, stress is high, and families are just looking to survive. The first 24-48 hours after a disaster are times of greatest risk to abandon breastfeeding when it is precisely a time when it is most important it be preserved. Some of the reasons breastfeeding may stop:

-A family could be evacuated from a warning zone and must travel long distances and in heavy traffic to escape the danger. Stopping to feed the baby is a hindrance.

-A mother or parent goes to run an errand that they anticipate will take a few hours and is gone for much more, returning home with engorged breasts that don’t flow easily and a baby who may have consumed other milks in the parent’s absence, and a baby who may reject the breast.

-Stress, which although doesn’t inhibit milk production, does cause the milk ejection or letdown to be slow and causes a fussy baby, which may lead a parent to think they’re not making enough milk. This creates a real danger for supplementation.

-Shelters don’t provide separate space for feeding or food preparation for parents. It may feel uncomfortable to breast or chestfeed in front of strangers. Shelter staff are not prepared as breastfeeding counselors and don’t provide support to assure its success, regardless of their personal beliefs that breastfeeding is good.

-Navigating help agencies is time consuming and often doesn’t feel like the right place to take the baby.

-Formula is easily available at disaster relief areas or community based food pantries and sometimes given, or air dropped, without asking if the baby is breastfed.

-Mothers and parents are hot, sweaty, or cold and scared, touched out, and maybe tired of having to feed the baby from their own body with frequency.

-Parents and babies could be physically separated because of the catastrophic event.

Because disasters can strike any time, the best thing is to be prepared. Each community has its own seasons and highest risk of natural disasters (earthquakes in the Pacific and tornadoes in the Midwest, for example) but often disaster gives almost no warning. Now is the best time to plan, when things are good, or you are recovering from the last disaster but not in the midst of survival. Infant and young child feeding in emergencies only works as well as the feeding in times of greater stability.

Mom2Mom Global has some excellent links for parents and professionals to learn about what are the recommendations to help families prepare in depth.

In 2017, while living in Puerto Rico, my family survived Hurricane Maria. I was lucky because despite the high winds and destruction all around me, my children were older (9 and 11), my house was made of cement and we lived on higher ground which was not affected by flooding. After the hurricane I started an organization, Alimentacion Segura Infantil, which is focused on helping families with babies and small children feed their families in safer ways. My best advice to families is don't

let the gas get lower than a half tank, stash cash for emergencies, store food and water for the whole family, and keep together whenever possible. You will find a lot of advice on how to safeguard your home, possessions and documents.

If you are breastfeeding or chestfeeding, keep it up! It has all the nutrients that your baby needs until 6 months and then complements the nutrients with food until at least two years, and it also has special properties that no other milk can provide. It’s free and available even when the stores are closed, and water and cash are low. In the case of feeding your baby directly, you don’t need to wash anything, and if you’re pumping, you can hand express instead of using a machine and feed your baby with a cup if there’s no electricity to operate the pump or water to clean parts or bottles. It is especially important if you’re looking for help to take your baby with you or send someone else and stay home with the baby so that breastfeeding isn’t interrupted or threatened.

If you are combo feeding or exclusively formula feeding, it may still be possible to produce milk or ask another parent who is breastfeeding to feed your child or give you milk. If you need to give formula, liquid ready to feed in single 3-4 ounce bottles is the easiest and cleanest. If the only formula that’s available is another brand, read the label, usually types of formula (regular, soy, hypoallergenic, amino acid) have the same ingredients despite manufacturer differences. If powdered formula is the only formula that’s available, the World Health Organization has very specific preparation recommendations which involve a lot of hand washing, bottle and cup sanitation, and preparation with freshly boiled and still hot water, whether it’s from the tap or in a bottle, to kill pathogens that may be in the powder already or picked up from the air after opening. Even if you don’t normally boil the water, after an emergency the environment is teaming with germs. The cleanest and easiest way to feed a baby is with a cup, ideally a disposable one, though reusable cups are easier to clean than bottles. You’d be amazed how adaptable babies are, even if they protest a little at the beginning, and will lap up the milk!

If you are a health or shelter worker, or military responder deployed in a humanitarian mission, encourage breastfeeding! Familiarize yourself with established operational guidance and best practices, and share with your colleagues and supervisors. Help families keep babies at the breast or feed at the breast a little more if they are combination feeding. If they have doubts about their production, don’t offer formula as a solution unless it is medically necessary, and take advantage of lactation specialists and peer counselors from your community or relief workers with those skills who may arrive to help. Support them with risk reduction when formula is being fed and remember that infant feeding is a health issue, just like other concerns that arise after a disaster. Offer separate feeding space for families with babies, privacy if they need it, and space to clean and disinfect feeding equipment, ideally with heat in the kitchen, although cold water sanitation is possible with chlorine bleach and potable water. And if you are a lactating parent yourself, remember to have a plan to express your own milk and protect your health!

Do you have a disaster plan in place for your family? Have you thought about what to do to prepare? Many people don’t because we don’t have the money, time or true belief that it could happen. Last year I thought I was ready but really wasn’t. This year I feel a lot more confident, and it didn’t take so much to get there. We hope that this article has been helpful to get you thinking about what to do, especially when there are babies involved.

Lourdes Santaballa, IBCLC, IYCFS is Executive Director of Alimentacion Segura Infantil, an organization which she founded after surviving Hurricane Irma, then Hurricane Maria's devastation of Puerto Rico. Lourdes is an activist, community organizer, and leader in the field of community-driven response to infant feeding in emergencies, as well as peer lactation support. She is currently pursuing a Master's Degree from Maryland University of Integrative Health.