Transcript Maternal and Child Nutrition during emergencies

Best Practices in Breast
Feeding during
emergencies
Dr Sudarshini Fernandopulle
(MBBS, MSc, MD)
Consultant Community Physician
SF/2009
Challenges to Breast Feeding in an
Emergency
 Priority given to other basic needs such as
shelter, clothing, provision of food for adults etc.
 Belief that under stressful conditions and/or
limited access to food mothers are unable to
breast feed
 Disorganized environment
 lack of privacy for breast feeding
 Inadequate support from skilled workers
SF/2009
Un-Controlled Donations
Large supply of infant formula at homes,
health centers & distribution points –
SF/2009
SF/2009
Maliban donates infant milk
food for tsunami victims
Maliban in collaboration with
the government of Sri Lanka
has once again provided
assistance to the children of
tsunami survivors, by making
a contribution of infant milk
powder to the value of Rs. 20
million. The donation was
handed over… at the
President’s House.
Source: Daily News, Sri
Lanka. Indian Ocean
Tsunami, Sri Lanka, 2004/5
SF/2009
“We distributed children's clothes and about 40 mothers showed up with their
babies, we…taught them how to use the milk powder we had received in big
quantities.”
Source: Real Medicine Foundation News. Sri Lanka, Indian Ocean Tsunami
2004/5
SF/2009
“A delegation has begun teaching mothers how to properly use infant formula to feed their
children. As a result of the Tsunami many women were traumatised and no longer able to
properly breastfeed. Over 60 mothers brought their children aged ½ year to 3, to the camp.
They wished to learn how to properly maintain hygiene while feeding their children with the
infant formula provided by our feeding centre. Word has spread, and every day new parents
arrive.”
SF/2009
Source: IsraAID Press release. Sri Lanka, Indian
Ocean Tsunami, 2004/05.
Incorrect
messages in
media
Tsunami Victims Relief in Sri Lanka
Please donate urgently for the one million+ Tsunami victims who
have lost everything and need your help immediately to survive.
Critically urgent supplies eg. Infant formula and feeding bottles
and medical supplies will be airlifted…The remainder will be
shipped in 40 foot container and arrive in Sri Lanka in
approximately 21 days.
Source: McGill Tribune, Canada.
Indian Ocean Tsunami, Sri
SF/2009
Lanka, 2004/5
Mechanisms for successful breast
feeding
1. Breast milk production
2. Suckling the breast (correct attachment and positioning)
Main reasons for breast feeding problems are due to failures
in either or both mechanisms.
SF/2009
Factors influencing milk
production:
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Prolactin
• Secreted during and after feed to produce next feed
Sensory impulses from
nipples
Prolactin in blood
Baby suckling
• More prolactin
secreted at night
• Suppresses ovulation
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Suckling makes more milk.
Oxytocin reflex
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Oxytocin reflex
• Works before or during feed to make milk flow
Oxytocin in blood
Sensory impulses from
nipples
Baby suckling
• Makes uterus contract
Good feelings and sensations helps the
oxytocin reflex toSF/2009
work and milk to flow
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Dietary recommendations for infants
and young child feeding during
emergencies
0-6 months:
1. All infants including those born to the affected population
should receive EBF during the first six months.
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Exclusive Breast Feeding for
0-6/12
 Babies should start BF within an hour of birth
 EBF and demand feeding until completion of six
months
 EBF means giving only BM and no food, no
water, no drinks and no teats. Medication on
doctor’s recommendation only.
 Support women and build their confidence for
EBF.
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…cont 0-6/12
 If getting both breast milk and formula
feeds continue only breast feeding (to
minimise risk of infections)
 Every effort should be made to identify
ways to breast feed infants whose
mothers are absent or incapacitated
 Those already stopped breast feeding relactation should be attempted before
considering the use of infant formula.
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Advantages of breast feeding during
an emergency
 Prevents infections
 Provides optimal nutrition to baby
 Strengthens bond between mother and child
providing crucial physical and emotional support for
the child.
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Reasons for Higher risk of
infections in an emergency
 Lack of safe water and sanitation
 Poor personal hygiene
 Unhealthy/unclean environment
 No access to health services
 Psychological trauma
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6-24 months:
 Start CF on completing six months while
continuing to BF for two years or longer
 Support women to BF for two years or longer.
BM produces half baby’s nutrition requirement -6 to 12 months
1/3rd during second year
10% during third year
 Encourage children to eat CF
6 – 9 m – 2 to 3 times a day
9-23 m 3-4 times a day with 1-2 snacks
Non breast fed – 4-5 meals
 Support families to prepare and feed CF
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Supportive care for women
Should be provided to all those breast feeding
 Create an enabling environment for BF
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BF corners
One to one counseling
Mother to mother support groups
Mental and emotional support especially for the
traumatised women
 Support those on mixed feeding to increase BF
 Skilled help
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Skilled support for BF mothers
 Assess need of individual mothers
 Help to BF
 Ensure effective suckling by correcting positioning
and attachment
 Build mother’s confidence and help milk flow
 Increase milk production by:
 encouraging frequent and longer feeds
 Ensure mother gets enough to drink
 Remove interference
 Keep mother and baby together
 Mobilize family support
 Encourage age appropriate feeding
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Additional support needed
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Expressing BM
Cup feeding
Kangaroo care
Help traumatized mothers
Support to LBW babies
Support to malnourished babies
Support to malnourished mothers BF babies
Re-lactation
Breast conditions
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Correct positioning
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Good and poor attachment
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Supportive care for women
 Extra food
 Food supplementation
 Micronutrient supplementation
 Family support
 Family Planning
 Priority in receiving food
 Priority and adequate water
 Priority to use toilets and bathing
SF/2009
Other measures to support BF
during emergencies
 Developed a circular on Protecting,
promoting and supporting Breast feeding
during Emergencies
 Developed IYCF guidelines during
emergencies
 Trained health staff on IYCF during
emergencies
SF/2009
Indications for formula feeds:
 If mother is not available
 If child was on formula prior to emergency and
re-lactation failed
 Scientific evidence for inadequate breast milk in
an infant less than six months on EBF
 Urine output less than six months
 Inadequate weight gain (average of 125 grams per
week during first six months while on EBF)
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Formula feeds
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The quantity, distribution and use of
breast milk substitutes at emergency sites
should be strictly controlled
 Those responsible for feeding infant
formula should be adequately trained and
equipped to ensure safe preparation and
use
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….cont
 Feeding infant formula to a minority of
children should in no way interfere with
protecting and promoting breastfeeding for
the majority.
 The use of infant feeding bottles and
artificial teats in emergency settings
should be actively discouraged and cup
feeding promoted instead as cups are
easier to keep clean.
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Risk of formula feeds
 Higher risk of diarrhoea
 Aggravates malnutrition
 Higher risk of death
 No guarantee of continued supplies
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If on formula feeds
 Use cup instead of bottle
 First six months – formula one
 6-12 months – formula 11/
 After one year - full cream/goat or cow’s
milk recommended
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Breast feeding sick infants
 Continue BF
 Keep mother and baby together
 If baby can suckle encourage the mother to do
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so
If cannot suckle feed with expressed BM
If unable to feed expressed BM teach mother to
express BM to maintain BM production
Teach mother to cup feed when discharging
Give ORS through cup
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Illness of mother
 Do not stop Breast feeding
 Treat mother
 Keep mother and infant together and
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encourage BF
Mobilize family support to help with BF
If mother cannot breast feed help to express
breast milk
Help mother to increase production as she
recovers
Monitor weight gain and urine output
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Maternity care
 Identify pregnant women near term early
 Early initiation and EBF
 Strengthen BFHI
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