WHO and UNICEF call for support for appropriate infant and young child feeding in the current Asian emergency, and caution about unnecessary use of milk products

During emergency situations, such as the earthquake and tidal wave in Asia, disease and death rates among under-five children are generally higher than for any other age group. Mortality may be particularly high due to the combined impact of a greatly increased incidence of communicable diseases and diarrhoea and soaring 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 and UNICEF note that donations of infant formula and other powdered milk products are often made by well-intentioned but poorly informed donors; 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. WHO and UNICEF therefore reiterate 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 does not need 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; extra fluids and foods 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 havens for mothers and infants. 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) or through re-lactation.

For these reasons, any provision of breast-milk substitutes for feeding infants and young children should be based on careful assessment of needs. They should be used only under strict 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. There should be no general distribution. If donations have been given in a country, they can be combined with a milled fortified staple for distribution as a complementary food for children over 6 months of age.

For treatment of children who are severely malnourished, milk-based therapeutic foods are usually needed for use by specialized agencies and trained personnel. They should be used following strict protocols and under close supervision. Standard commercial infant formula is not suitable for this purpose.

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

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

For more information contact:

André Briend
Medical officer,
Email: brienda@who.int

Randa Saadeh
Scientist,
Telephone: +41 (22) 791 3315
Email: saadehr@who.int