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Infant feeding practices in complex emergencies: a case study approach
M E O'Connor1, F M Burkle, K Olness
1University of Colorado Health Sciences Center, Denver, Colorado, USA.
Insights
Infant feeding emergencies in complex crises cause high child mortality, often from preventable diseases. Breastfeeding is crucial for infant survival, outweighing HIV risks in developing nations.
Area of Science:
- Public Health
- Pediatrics
- Emergency Medicine
Background:
- Complex emergencies disproportionately affect infants and children under five, with preventable diseases like malnutrition, diarrhea, and malaria being primary causes of mortality.
- Infant feeding emergencies are a significant factor in complex humanitarian crises, directly impacting child mortality rates, particularly in refugee populations experiencing protein-energy malnutrition (PEM).
Purpose of the Study:
- To review current information on infant feeding in complex emergencies.
- To provide educational tools for managing infant feeding emergencies through case studies.
- To discuss the advantages of breastfeeding and the appropriate use of breast-milk substitutes (BMS).
Main Methods:
- Literature review of infant feeding practices in complex emergencies.
- Analysis of four case studies to illustrate management strategies.
- Review of lactation physiology, including hormones like prolactin, oxytocin, and FIL.
- Summary of WHO and UNHCR guidelines for infant feeding and milk powder distribution.
Main Results:
- Breastfeeding offers significant advantages for children up to two years of age, crucial for survival in emergency settings.
- While breastfeeding can transmit HIV, the risk of infant mortality from malnutrition and infection is higher in non-breastfed infants in developing countries.
- No practical medications were found to augment milk production for complex emergencies.
Conclusions:
- Effective infant feeding strategies are critical for reducing child mortality in complex emergencies.
- Breastfeeding should be promoted and supported, with careful consideration of BMS use.
- Adherence to established guidelines from organizations like WHO and UNHCR is essential for managing infant feeding in crisis situations.
Abstract:
The majority of deaths associated with complex emergencies are attributed to infants and children under the age of five years. Most of these deaths are related to preventable diseases such as malnutrition, diarrhea, and malaria. Infant feeding emergencies have emerged as a major factor in complex emergencies. This paper reviews the current information relative to infant feeding, and uses four case studies as educational tools for the management of infant feeding emergencies. Child mortality rates in refugee population have been linked directly to protein-energy malnutrition (PEM). Breast feeding has many advantages over all other forms of feeding for children up to the age of two years of age. These advantages are discussed in detail in this paper. In addition, the appropriate and inappropriate uses of breast-milk substitutes (BMS) are discussed. Breast feeding also may play a role in the spread of HIV infections from the mother to the infant. However, in the setting of complex emergencies in the developing world, the risk of an infant dying of malnutrition and infection when not breastfed is likely to be greater than is the risk of death due to HIV acquisition through breastfeeding. The physiology of lactation is reviewed with particular reference to the roles of prolactin, oxytocin, and the feedback inhibitor of lactation (FIL) hormone. No medications have been demonstrated to augment milk production that can be used in a practical sense in complex emergencies. Lastly, the principles promulgated by the WHO and UNHCR for the feeding of infants and children in emergencies and for milk powder distribution are summarized.
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