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[pronut-hiv] Lebanon: Infant Feeding in Emergency


  • From: "ProNut-HIV" <pronut-hiv@healthnet.org>
  • Date: Mon, 07 Aug 2006 12:10:54 -0400

WHO Press Release:
http://www.reliefweb.int/rw/RWB.NSF/db900SID/AMMF-6SCCZ3?OpenDocument


WHO calls for support for appropriate infant and young child feeding in
the current emergency in Lebanon, and caution about unnecessary use of
milk products during emergency situations, such as the conflict in
Lebanon, disease and death rates among under-five children are generally
higher than for any other age group. The risk of mortality and morbidity
may be particularly high due to the combined impact of an increased
incidence of communicable diseases and diarrhoea and increased rates of
under-nutrition.

The fundamental means of preventing malnutrition and mortality among
infants and young children is to ensure their optimal feeding and care.


WHO notes that donations of infant formula and other powdered milk
products are often made, whilst experience with past emergencies has
shown that without proper assessment of needs, an excessive quantity of
milk products for feeding infants and young children are often provided,
to the detriment of their well-being. WHO, therefore reiterates that no
food or liquid other than breast milk, not even water, is normally
needed to meet an infant's nutritional requirements during the first
six months of life. After this period, infants should begin to receive a
variety of foods, while breastfeeding continues up to two years of age
or beyond. The valuable protection from infection and its consequences
that breast milk confers is all the more important in environments
without safe water supply and sanitation.

There is a common misconception that in emergencies, many mothers can
no longer breastfeed adequately due to stress or inadequate nutrition,
and hence the need to provide infant formula and other milk products.
Stress can temporarily interfere with the flow of breast milk; however,
it is not likely to inhibit breast-milk production, provided mothers and
infants remain together and are adequately supported to initiate and
continue breastfeeding. Mothers who lack food or who are malnourished
can still breastfeed adequately, hence extra fluids and foods for them
will help to protect their health and well-being.

If supplies of infant formula and/or powdered milks are widely
available, mothers who might otherwise breastfeed might needlessly start
giving artificial feeds. This exposes many infants and young children to
increased risk of disease and death, especially from diarrhoea when
clean water is scarce. The use of feeding bottles only adds further to
the risk of infection as they are difficult to clean properly.

In exceptionally difficult circumstances, therefore, the focus needs to
be on creating conditions that will facilitate breastfeeding, such as
establishing safe corners for mothers and infants, or helping mothers
relactate. Every effort should be made to identify ways to breastfeed
infants and young children who are separated from their mothers, for
example by a wet-nurse (if culturally acceptable).

For these reasons, any provision of breast-milk substitutes for feeding
infants and young children should be based on careful assessment of
needs. These products should be used only under strict medical control
and monitoring and in hygienic conditions, in accordance with the
International Code of Marketing of Breast-milk Substitutes and
subsequent relevant World Health Assembly resolutions, as well as
humanitarian agencies' policies and guidelines. There should be no
general distribution. If donations have been given in a country, they
can be mixed with a milled fortified staple for distribution as a
complementary food to make porridge for children over 6 months of age.

For treatment of children who are malnourished, milk-based therapeutic
foods are needed to be used by specialized agencies and trained
personnel following strict protocols and ensuring close supervision.
Standard commercial infant formulas are not suitable for this purpose.

Children from the age of six months require nutrient-rich complementary
foods in addition to breastfeeding. Provision of fortified foods or
micronutrient supplements such as vitamin A or zinc in supervised
programmes for young children represent a much more appropriate form of
food aid than sending milk products. In rations for general food
distribution programmes, protein sources such as pulses, meat, or fish
are preferred to powdered milk.

WHO urges all who are involved in the provision of emergency supplies
to refer to the extensive guidance available on this topic.