|Handbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)|
|15. Food and Nutrition|
· Breast-feeding is best for babies and must be promoted and continued for as long as possible;
· Ban baby bottles completely;
· Weaning foods must be appropriate; foreign baby foods and special foods often are not;
· Infant formulae should be avoided and used only under strictly controlled conditions, with a cup and spoon;
· Re-stimulate lactation10 in cases where milk production has been affected by stress and use wet nursing where appropriate;
· Milk products, especially powdered milk, and infant formulae can cause health problems (as described below) and they are often inappropriate.
80. Human milk is the best and safest for infants and children under two years. Breast-feeding provides a secure and hygienic source of food, often initially the only source of food, as well as antibodies giving protection against some infectious diseases. Breast feeding must be encouraged for as long as possible. Every effort must be made to promote or re-stimulate lactation even among sick and malnourished mothers. Experience has shown that this can be done. Mothers may need to receive extra food to encourage breast-feeding and provide the additional calories and nutrients required. This should be done through the feeding programmes.
81. The problems associated with infant formulae, milk products and feeding bottles are exacerbated in a refugee emergency. Clean boiled water is essential but rarely available, careful dilution of the feeds is of critical importance but difficult to control, mothers are unlikely to be familiar with the use of infant formulae, and the instructions are often in a foreign language. Infant formulae, if unavoidable, should be distributed from health or feeding centres under strictly controlled conditions and proper supervision. Infant feeding bottles must never be distributed or used; they are almost impossible to sterilize and keep sterile under emergency conditions and are therefore dangerous. Babies should be fed by clean cup and spoon if necessary. Appropriate weaning foods should be introduced while breast-feeding is continuing. Weaning foods should be locally available foodstuffs and as far as possible be prepared in the traditional manner. Overseas donations of tinned baby foods are rarely appropriate.
10 Re-stimulate lactation refers to the re-establishment of an adequate volume of milk release. This is achieved by increasing suckling and through social peer support.
Policy On Use of Milk Powder11
i. Never distribute milk powder, by itself, to take home. It should be mixed with cereal flour, six parts cereal to one part milk powder;
ii. Never let liquid milk be carried home;
iii. Only use dried milk in supervised wet feeding programmes as a high energy drink mixed with oil and sugar;
iv. Dried skimmed milk should always be fortified with Vitamin A and have a Shelf-life Of more than six months.
11UNHCR IOM 88/89/FOM 76/89 Policy Directive for acceptance, distribution and use of milk products in refugee feeding centres, UNHCR, Geneva.