World Breastfeeding Week World Breastfeeding Week, celebrated August 1 to 7, helps support breastfeeding women to give their children the best start in life. ©UNICEF, 2017.

By Sarah DeYoung

Of all of the images captured in the wake of Hurricane Harvey, one of the most stirring was of a first responder carrying a woman and her infant out of floodwaters in Houston. As powerful as the image is, the reality is that the needs of infants and very young children are often overlooked in mass evacuation and disaster sheltering.

There are a high number of infants and young children living in all of the areas heavily impacted by Hurricanes Harvey, Irma, and Maria. According to the Texas Healthy Babies Report, there were more than 400,000 babies born in the state in 2015. In Harris County, where Houston is located, nearly eight percent of the population is below the age of five. In Hillsborough County, Florida, where Tampa is located, the 2016 birthrate was 12.8 percent. In Puerto Rico, 30,000 babies are born in each year (with 4.7 percent of the population under the age of five). During disasters infants are vulnerable. They need proper nutrition, hydration, and comfort. My research underscores the importance of safe feeding during emergencies.

A mother feeds her child in a medical tent after the Bam Earthquake in Iran. ©Direct Relief, 2003.

What Is Safe Infant Feeding?

Safe infant feeding is the process of providing nutrients that protect infants from illness, dehydration, and malnutrition. The safest form of feeding for infants under the age of six months is exclusive breastfeeding. Breastmilk provides all of the nutrition and hydration that infants need. Young children, toddlers, and infants over 6 months need access to nutritious and fresh foods. In an emergency, exclusively formula feeding families face the greatest risk as they need the most external support to keep their infants safe. They are in a food insecure position, where breastfeeding families have food security for their youngest member. In the response phase of a disaster, when a family and their infant is stranded without food or water for some time, breastfeeding has saved the lives of infants. This is one major reason why infant feeding support is a critical piece of emergency response.

Evacuation shelters also need to accommodate infants who are fed formula, either exclusively or in combination with breastmilk. However, it is often difficult or impossible to clean bottles and artificial nipples in shelters. In mass shelters, caregivers must often wash feeding supplies in the shared bathrooms where many hands touch the same surfaces where parents are trying to clean bottles, increasing the risk of contamination. Additionally, there are usually no provisions for people to boil water for sterilization of feeding supplies. Multiple families living in close spaces and a lack of infant-specific bathing spaces and proper diapering supplies can lead to gastro-intestinal outbreaks, food contamination, and rapid spread of illness. Therefore, providing safe and proper feeding spaces and supplies for families with infants is a key aspect of protecting the health and wellbeing of all evacuees.

In the findings from my research on infant feeding in disasters, numerous families have reported that worry about feeding their babies added a layer of stress to the overall evacuation experience. Families evacuating might have multiple children that become anxious or bored in a sheltering scenario. Thus, providing a safe and quiet space for caregivers to feed their babies could also bolster mental health for families.

What Are Key Ways to Support Safe Feeding as a Volunteer or Responder?

  • Keep mothers/caregivers and babies together to ensure breastfeeding can continue through the acute phase of the hazard.
  • Assess, empower, and support. Ask the mother how she was feeding the baby before the disaster and how she is feeding the baby currently. Support her by listening to her responses and her experiences.
  • Refer the mother/caregiver to the resources needed for infant feeding (skilled lactation specialist, nutrition experts, and trained health workers).
  • Make sure that mothers have safe, quiet places to breastfeed, such as mother-baby tents.
  • Encourage pregnant mothers to breastfeed as soon as babies are born and remind new mothers to keep the baby skin-to-skin.
  • If the infant requires formula, ensure that the caregiver has access to formula that is ready to use and addresses special nutritional needs or medical conditions, such as allergies.
  • Ensure that instructions for infant and young child feeding in emergencies are available in multiple languages.
  • In shelters, make feeding equipment disposable whenever possible– disposable bottles and nipples or cups are safer than those that require cleaning.
  • Discourage donations of infant formula from groups and individuals. Instead, encourage cash donations to organizations that provide direct support to mothers and infants such as Save the Children, and other groups that adhere to the World Health Organization Code.
  • Feed appropriate complementary solid food to older babies and toddlers, including fresh fruits and vegetables.
  • Make sure that mothers in shelters know about breastfeeding hotlines; Women, Infants, and Children (WIC) resources; and other potentially lifesaving supplies and resources.

These steps and resources are not just important for shelter coordinators and health workers. Every person who works in a response, relief, or recovery capacity during a disaster can take part in making sure that infants are protected and that families are supported. Healthy families stand a greater chance of recovering from the disruptions and loss from the hazard event.

For additional resources and information, the author recommends:

Infant Feeding Support in Disasters (Safely Fed USA)

Texas Women, Infants, and Children

Florida Women, Infants, and Children

Puerto Rico WIC

Breastfeeding USA

United Nations High Commissioner for Refugees IYCFE Guide

Early Childhood Development and Emergency Feeding Programs