It is with great sadness that we note the death of our valued colleague Dr. Heather Trickey. Heather joined DECIPHer in January 2012, completed her PhD with us, developed and led an active programme of research and contributed greatly to the academic and social life of the centre.

Heather was dedicated to improving the lives of others and worked to highlight shortcomings in policy and practice where she saw them.

To honor her memory and recognise her work in this area we are republishing a blog she wrote in July 2017 on the need for proper planning for the care and feeding of infants in emergencies in the UK, in the wake of the Grenfell fire.

She will be missed and our thoughts are with her friends and family.

---

PROTECTING BABIES IN EMERGENCIES

Guidance is needed on infant and young child feeding for families in the UK affected by disasters and emergencies.

Blog by Heather Trickey and Helen Gray, Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group.

Disaster and emergency situations – floods, fires, terrorist attacks and widespread power failures – can affect any country, including the UK. In any disaster or emergency, babies are vulnerable and continued access to adequate and safe nutrition is essential. Families need support to ensure that children continue to be cared for and fed in line with their needs.

There is no UK government plan

The World Health Assembly (Resolution 63/2010) has recommended that all countries implement existing global guidelines on infant feeding during emergencies, including specific operational guidance to help relief agencies protect infant nutrition and minimise risk of infection. Although there is national guidance on care of animals during emergencies, a recent World Breastfeeding Trends Initiative (WBTi) report found that there are no UK-wide or national strategies addressing infant and young child feeding during a disaster. Scotland is the only part of the UK that has a named lead on infant feeding in emergencies. Emergency planning and response is devolved to local authorities; because there is no guidance on the protection of families with infants there is no way to ensure that local strategies consider infant nutrition as part of emergency response.

Risks for formula fed babies

Babies who are fully or partially formula fed are at risk if their caregivers lose access to clean water, are unable to sterilise feeding equipment or suffer disruption or contamination of their formula milk supplies. A suitable environment for preparation and storage of feeds, sterilising equipment, boiling water and safe storage such as a refrigerator, are all needed to prevent bacterial contamination

Risks for breastfed babies

Breastfeeding protects against infection and can be comforting to infants and mothers during difficult times. Mothers’ supply of breastmilk is resilient, however, chaos, displacement and emotional strain, coupled with commonly held misconceptions about how breastfeeding works, can undermine a mother’s confidence and result in less frequent feeding. Breastfeeding mothers need access to the option of feeding in a private space and reassurance that continuing to breastfeed is the best option for their baby.

Skilled support can help mothers resolve breastfeeding problems and maintain the protective effect of full or partial breastfeeding. If breastfeeding helpers are not pre-authorised as part of planned disaster response the immediate help that families need can be delayed.

Risks associated with donated formula milk

The world is a better place than we sometimes think. When a disaster strikes, ordinary people often respond with an outpouring of generosity. We give clothes, equipment and food spontaneously and in response to public calls.

In the absence of guidance, agencies responsible for co-ordinating emergency response and volunteers working on the front line are often not aware that donations of formula milk can put babies at risk. Risks from donated formula milk include inadvertently distributing products that are unsuitable for babies under six months or for babies with special nutritional needs, as well as distributing milk that is contaminated or out-of-date. There is also a risk that donations will be inappropriately provided to parents of breastfed babies, which can undermine the protective effect of breastfeeding and cause parents to become dependent on a continued supply of formula milk.

International guidelines for emergency feeding caution against accepting donations of formula milk. It is recommended that emergency planners and first responders, with expert advice, take responsibility for purchase and distribution of appropriate formula milks in line with the needs of each family.

What’s been done so far?

International guidelines for protecting infants in disasters and emergencies are available.  There is a need to adapt these to a UK context, where, beyond the early weeks, many babies are fully or partially formula fed and which includes a rich mix of cultures and nationalities with different feeding practices.

UK-based emergencies have tended to be highly localised and short-term. However, UK guidance will need to ensure preparedness for longer-term support needs, for UK charities and for displaced families and unaccompanied children who have sought refuge from outside of the UK.

Several UK agencies have developed guidance with limited scope. The Food Safety Agency has issued guidance to support safe preparation of formula milk in response to flooding and contamination of local water supplies. A toolkit has also been developed to support food banks, including preventing and managing unsolicited formula milk donations. [UNICEF UK Baby Friendly Initiative has produced guidance for Local Authorities on infant feeding during the COVID pandemic]. See also Preventing inappropriate donations during emergencies 2021 from the Infant Feeding in Emergencies Core Group:  https://www.ennonline.net/attachments/4050/Preventing-and-Managing-Inappropriate-Donations.pdf.

How to help ensure babies’ nutritional needs are protected

In the absence of national guidance, relief co-ordinators and agencies and members of the public will be concerned to do the right thing in response to a disaster. There is an urgent need to improve planning and raise awareness about the best ways to support infant and child feeding. These key points from have been adapted from UK and international guidance:

1) Members of the public

• DO donate money to key agencies. This is the best way to support parents who need to buy formula milk. Money will allow parents, caregivers or coordinating aid organisations to buy the most appropriate milk to meet the individual needs of each baby. Donated formula milk can inadvertently put babies at risk.
• DO offer your time to help agencies co-ordinating relief. Support and encourage mothers who are breastfeeding. Breastfeeding is protective against infection, and provides the baby with the safest possible nutrition.

2) Relief workers and aid agencies

• DO have a local plan to support infant and young child feeding in emergencies in place for local authorities, first responders and aid agencies. All families should be screened to ensure they receive appropriate support or supplies.
• DO ensure that mothers who are fully or partially breastfeeding have the support they need to continue. Mothers can seek support from their midwife or health visitor. Local emergency planning should have identified appropriate infant feeding support from local health and voluntary services. There are telephone helplines which support caregivers with all aspects of infant feeding:
  • NCT helpline (0300 330 0700)
  • The National Breastfeeding Helpline (0300 100 0212).
• DO encourage donations of money to recognised agencies so that parents, caregivers and agencies can buy any formula or supplies needed, rather than donations of formula products.
• Appropriate support or supplies including cash cards specifically for the purchase of infant formula and complementary foods for young children could be considered.
• DO ensure that formula milk is purchased and distributed only for babies who need formula milk, following basic screening of families (simple triage tools have been recently been developed for use in emergency situations in Greece and Canada).
• DO NOT distribute formula milk in an untargeted way.
• DO ensure that parents are aware of guidance on sterilisation of bottles and teats and how to prepare any powdered formula safely and have access to facilities to carry this out, to reduce the risk of contamination. Liquid ready-to-feed formula may be needed if suitable preparation facilities are not available.

What is needed now?

There is an urgent need for UK governments to ensure infant and child nutrition is protected as part of the planned new strategy for resilience in major disasters. Local authorities and relief agencies require national guidance to develop local strategies so that we can all be better prepared.

This article, with accompanying images, was first published on the World Breastfeeding Trends Initiative website.