|Infant Feeding in Emergencies: A Guide for Mothers (WHO, 1997, 48 p.)|
Yes of course. Let us confront the issue of substitute feeding.
1. The best possible substitute used to be for another lactating mother to breastfeed the baby. We must now be cautious because in some situations there might be a risk of HIV transmission through breast-milk if the lactating foster mother happens to be infected with HIV. In some regions there may be very few people with HIV but it is always difficult to know when rates of the infection are rising.
In an emergency your own breast-milk may be the only source of food for another baby. If you are feeding your own baby, another baby will not 'steal' his milk, but will stimulate a larger supply. Women have done this for sisters and friends who were extremely ill or had died. This can be a life saver.
2. The next best substitute is expressed breast-milk given by another mother or mothers. This should be heated to 57°C for 30 minutes. This kills viruses (including HIV) and bacteria. Most breast-milk does not carry infection, but it is best to be cautious. You will need the support of a health professional and equipment to be able to do this. You can help organize donation and collection of expressed breast-milk.
In an emergency you may have no choice and must use raw breast-milk. The safest way to give the expressed breast-milk is in a clean cup.
3. If breast-milk is not available, you can use commercial baby milk (also called infant formula). Only use commercial milk if you know you can get a regular supply and you can afford it. Always use this product very carefully. Sterilize all the utensils before every feed. A cup is safer than a bottle.
You must also boil the water for each feed. Follow the instructions on the tin carefully. The babyfood companies are obliged to provide label instructions in your local language. If the labels are not in your language try to report this to the health authorities or aid workers. Such labels break the WHO/UNICEF International Code Of Marketing Of Breast-milk Substitutes.
Ask a health professional or aid worker to get a proper translation and to explain the instructions carefully. Different products need different measures of milk powder to water. Never save left-over milk for the next feed. When food is short give the left-over feed immediately to an older child or drink it yourself.
4. If you cannot get any commercial baby milk and you can obtain a regular supply of local cow's milk. Use the following recipe:
- Boil 1/3 cup of water and
- 2/3 cup of boiled cow's milk, to make 1 cup (200 mls) of feed.
- Add 1 level teaspoonful (5 g) of sugar.
You can also use this recipe if you make up the milk from tinned whole milk powder. First make up the milk to the label instructions, then modify it to the recipe.
Never use whole milk (whether fresh or tinned) for a baby under 6 months without modifying it to the recipe above
5. An artificially fed baby will not be getting the perfect balance of nutrients that a breastfed baby gets. It therefore may be necessary to introduce solid foods a little before 6 months to widen the intake of nutrients. If you decide to do this make sure these foods are prepared as hygienically as possible. Remember he will not be getting the anti-infective protection of breast-milk and will be more vulnerable to any germs in solid food.
6. Sterilization is important in all artificial feeding. Wash your hands thoroughly with soap and water before preparing any feed for a baby. If you have fuel, boil all utensils for at least 20 minutes in water. You must do this before every feed.
If you can obtain hypochlorite (bleach) keep utensils in a covered container or pan. Add one dessertspoonful (10 ml)11 of hypochlorite to a litre of water. Household bleach may be a different strength. If the label says it is 0.5%, add 2 dessertspoonfuls (20 ml).
11 Please investigate and use local common measures for translation.
Keep this out of the reach of children. You will need to change this solution daily. You can use the discarded fluid to soak cloth nappies or to disinfect the toilet area.
Wash the hypochlorite off with boiled water before you use the cup and other utensils.
If fuel is scarce and hypochlorite unobtainable, scrub everything very thoroughly with soap or detergent. Never use feeding tubes (for relactation) or a bottle unless you know you have continuous means of sterilization.
Cups are safer than bottles