Tuesday, November 13, 2012

Feeding Babies in Emergency Situations

Nursing in a hotel room

In late October 2012 the historic hybrid storm, or "Frankenstorm," named Hurricane Sandy devastated the East Coast of the United States, especially New Jersey, New York, and Connecticut. When disasters such as this happen it conjures up all sorts of feelings, and people are especially compelled to help. But what happens when an act meant to be a good deed results in more death?

This is exactly what can happen when infant formula is donated and improperly distributed in disaster areas. It should also be noted that many relief organizations do not have first responders trained in proper infant feeding protocol and infant formula distribution.

I know it may be hard to wrap your head around why it is so dangerous to donate infant formula to donation drives or shelters. I know the feeling of urgency to help, especially the tiniest victims. And I know that it might feel like I am saying that formula fed babies should not be fed. Of course, formula fed babies need to be fed, but it needs to be done safely to prevent illness and death.

First, I will outline the dangers of formula distribution and improper feeding protocol in emergencies, and then I will offer alternatives and practical ways to make a difference.

Dangers of Infant Formula Distribution:

* The majority of the deaths of infants in emergencies are due to diarrhea from drinking formula mixed with contaminated water and/or unsanitary formula feeding conditions (ie. no way to sterilize equipment).

* It can be difficult or impossible to keep infant formula safe from spoiling if power goes out.

* There is often a disproportionate amount of infant formula donated. This leaves relief agencies with a lot more formula than they need, and/or the wrong type of formula (powdered should not be distributed). Surpluses mean that formula may have to be discarded or it will be handed out to breastfeeding mothers (which has a negative impact on breastmilk supply). Surpluses of any one item also take away from donations that are truly needed.

* Formula should not be distributed without the complementary supplies to make it safe. These supplies include things like bottled water, liquid soap, cups for cup feeding, storage container, paper towels, and a gas stove or other cooking stove for heating water if the formula is not ready-to-serve. Hand sanitizer can be useful, but be aware that it is harmful to children if accidentally swallowed.

Breastfeeding in Emergencies:

Breastfeeding is important under the best of circumstances, but during an emergency it is lifesaving. Breastmilk is clean, full of antibodies, requires no special equipment to deliver, and adjusts to meet the baby's needs (contains more water when it is hot outside and more hydration is needed, for example). The act of nursing is calming for both mother and child. During nursing the mother's breasts will change temperature to either warm or cool the baby, as needed.

But breastfeeding can be undermined in emergencies by well meaning, but uninformed, volunteers. There are many myths that even nursing mothers themselves might believe.

Myths include that breastmilk will "dry up" when a mother is under stress, that a malnourished mother can't breastfeed or will make inadequate milk, and that breastfeeding mothers are safer with some formula "just in case."

In reality, breastmilk supply is not impacted by stress, however the milk ejection response, also known as "letdown," which makes the milk available for the baby to swallow can be impacted when a mother isn't relaxed. Once the baby starts nursing and MER happens, both mother and baby will become more relaxed. The solution is not to discourage nursing or offer formula, but simply to provide an environment where the mother can relax.

Unless a mother is severely and catastrophically malnourished, she will make adequate breastmilk. Her body will protect her baby's nutrition first.

The dangers of formula samples for breastfeeding mothers are magnified in times of crisis. Having formula on hand for "just in case," especially if handed out by someone perceived as an expert (relief worker, shelter volunteer, nurse, etc) can impact breastfeeding, even if the sample is never used. It sends the message that breastfeeding and breastmilk supply are fragile and prone to failure.

Parents of breastfed babies can put together an emergency kit, especially if there is advanced warning of a disaster. Some things to include are diapering or EC supplies, instructions for building milk supply, tips on nursing in an emergency, a baby carrier, and contact information for breastfeeding counselors.

During and after a disaster, there are a few things you can do to preserve breastfeeding. Breastfeed frequently to maintain or increase your supply, as well as keep both mother and baby calm. Nurse while your baby is in a baby carrier so that you are able to have hands free for other things, to make it easier to nurse frequently, and to feel more comfortable nursing in crowded areas.

Infant Formula Feeding in Emergencies:

Extra care needs to be taken to formula feed safely in emergency situations. The first thing that can be done by families is to prepare in advance. An emergency kit for formula feeding can include a 1 week supply of ready-to-serve formula in individual serving sizes, a knife or scissors to open the formula packages, sanitary wipes, bottled water, bottles/nipples or cups, paper towels, and a storage container.

You may want to learn how to cup feed your baby and use disposable cups instead of bottles and nipples. You may be in a situation where it is impossible to clean or sterilize feeding equipment.

Put formula preparation and storage guidelines in your emergency kit. Under times of stress you may not be able to think clearly and it can help to have them written out. It can also be helpful if you get into a situation where someone else needs to prepare the formula.

Consider inducing lactation or relactating, especially with younger babies or babies who have nursed at some point. Put an induced lactation/relactaion instruction sheet with breastfeeding counselor contact information in your emergency kit. You may also want to put some milk inducing herbs in your emergency kit.

Wet nursing, if available, should be offered to and accepted by formula feeding parents. If you have any breastfeeding friends close by make sure to have their contact information in your emergency kit. In emergency situations, wet nursing can be safer than formula feeding.

Mixed Feeding and Breastmilk Expression in Emergencies:

If you have warning prior to an emergency, begin to increase time nursing to build supply. If you lose power, have limited water, or need to evacuate you may need to switch to full time nursing. Put instructions for building milk supply in your emergency kit. You may want to start taking milk inducing herbs, or put them in your emergency kit. All the Breastfeeding in Emergencies tips will also apply.

If you express milk using an electric or manual pump, learn how to express milk by hand. Put instructions in your emergency kit.

Consider how you will protect your frozen supply of breastmilk during a power outage. Consider purchasing a back-up generator in case of loss of power. A deep freezer will keep cold longer than an upright freezer. Move milk to the center of your freezer, but away from any frozen meat. Fill empty spaces with containers of frozen water, "blue ice," or even newspaper.

What you can do:

* Donate money instead of formula so that relief agencies can buy the amount and type of formula that can be used. Excess formula ends up being wasted or given to breastfeeding or mixed feeding babies.

It is best to donate money above anything, not just infant formula, because there are often not enough volunteers to sort donations and money can buy exactly what is needed in the correct amounts. Here is what FEMA says about donations:

Cash Contributions
Cash donations are very useful in situations where supplies must be acquired quickly. This is the most efficient way to make an impact with your donations. If you need help in determining who to give to, the National Voluntary Organizations Active in Disaster website has a list of major nonprofits that are active in disaster work or you can make your offer through the National Donations Management Network.

Don't Send Unsolicited Donations
One of the biggest issues around disasters is the amount of unsolicited item donations that start to come in immediately. It's better to wait until communities assess and confirm their needs before you start to send things in. At that time, you can make your donations through non-profits in the National Donations Management Network.

* Donate your time. Contact a relief agency or local shelter and find out how you can donate your time. Often, this is needed more than donations. FEMA offers great tips and resources for helping in a disaster. This is the page specifically on Hurricane Sandy.

* If you are a breastfeeding counselor or lactation consultant, donate your time and expertise in disaster areas. If you have breastfeeding experience, become a breastfeeding counselor or lactation consultant so that you can volunteer if a disaster strikes.

* Shelters and food distribution centers should have the contact information for local and regional breastfeeding support including lactation consultants, breastfeeding counselors (such as through La Leche League or BACE-NMC), WIC breastfeeding counselors, midwives, and postpartum doulas.

These volunteers can offer help with proper breastfeeding support and information, relactating and building milk supply, teaching mothers to hand express, supporting emergency wet nursing, information on protecting expressed milk stashes, information on proper storage and handling of both expressed breastmilk and infant formula, supporting the emotional needs of all mothers.

* If you are a breastfeeding mother it may be appropriate for you to act as an emergency wet nurse. If you have recently weaned a child, you may be able to relactate.

* Donate complementary items to help infants such as diapers, diaper wipes, sanitary wipes, hand sanitizer, and bottled water. Even baby slings and carriers can be crucial in devastated areas. They can help keep infants and toddlers safely attached to parents, keep children calm, provide a buffer between baby and a stangers' potential germs, and offer a way for breastfeeding mothers to feel more comfortable even in crowded areas.

* Contact relief agencies about the importance of having breastfeeding counselors included in front line responders, and having emergencies workers trained in the proper protocol of infant feeding in disasters.

* Donate blood. When an emergency happens, the need for blood may increase. As a result of Hurricane Sandy, many blood drives across the East Coast were cancelled. Blood products, especially platelets, have a short shelf life.

* Donate breastmilk to a HMBANA milk bank. Milk banks are currently facing critical shortages. Do not donate to Prolacta or National Milk Bank because they are for profit companies rather than non-for-profit.

Resources for Infant Feeding in Emergencies:

World Health Organization:
        Breastfeeding: A vital emergency response. Are you ready?

        Guidelines for the safe preparation, storage, and handling of powdered infant formula

        Breastfeeding a crucial priority for child survival in emergencies

International Medical Corps

United States Breastfeeding Committee

International Breastfeeding Journal (includes detailed information on formula feeding in emergencies)

La Leche League:
        La Leche League Resources

        Infant Feeding in Emergency Situations



Breastfeeding USA

Relief Organizations and Volunteering:

Experts in proper infant feeding protocol, including breastfeeding, in emergencies

Save the Children
Have set up safe breastfeeding areas in Hurricane Sandy shelters

The American Red Cross
Accept blood donations. Volunteers may or may not understand proper infant feeding protocol in emergencies.

Salvation Army
Accepts donations and volunteers

FEMA has updates on coordinated relief efforts and great tips on how to help.

National Donations Management Network
This is a great page to go to if you want to donate cash or supplies, or donate your time.

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