Course Recognition and Management of Malnutrition

Breast-feeding

Breast milk is the ideal form of nutrition for all infants during the first 6 months of life, making the consumption of other food resources by this age group unnecessary. The World Health Organization (WHO) recommends that breastfeeding be continued until the child is at least 24 months old, progressively supplemented with appropriate complementary foods after 6 months of age. In emergency settings where food supplies are limited, human milk remains an invaluable source of critical nutrients, particularly proteins. Therefore, it is important to provide adequate nutrition to lactating mothers.

Breast milk protects the infant against acute respiratory infections and diarrhea, both causing significant morbidity and mortality among infants and younger children. Overcrowded conditions, and limited access to clean and adequate water supplies, and stool disposal systems significantly increase the risk for these diseases in disaster situations. There is a common misconception that maternal stress or malnourishment leads to an inability to breastfeed. In fact, maternal hormone and neurotransmitter release during breastfeeding can help a mother to relax and attenuate stress and anguish caused by the disaster. The quality and quantity of breast milk has been shown to be adequate in all but the most severe degrees of maternal malnutrition. However, Vitamin D deficiency in the mother is associated with low Vitamin D in the breast milk, so supplementation is warranted in areas where mother’s have a low sun exposure due to cultural factors or where diet is low in Vitamin D.

Introducing nonhuman milk or formula either to supplement or to complement breast milk, decreases maternal milk production to the point where it may compromise breastfeeding when a safe and sustainable supply of formula is no longer available.

Resources needed to safely feed a child non-human milk or formula, namely clean water, appropriate containers and methods for storage, and a safe and effective way to clean the containers or bottles, are always scarce in an emergency setting, as is the continued availability of formula or milk itself.

Consider the careful and judicious use of breast milk substitutes in special circumstances, provided replacement feeding is feasible, affordable, sustainable, and safe. Also consider breast milk substitutes in the case of orphans or children with mothers who were killed during the event. In these cases, a wet nurse may be an alternative to human milk substitutes. Studies show that it is usually safer and easier to give option B ART to the mother during breastfeeding than switch to formula feeds. Check with your national guidelines concerning breastfeeding by HIV positive mothers.