Facts About Infant Feeding During Emergencies

Mothers experiencing stress

Even under stress, mothers can breastfeed

Mothers can continue to produce breast milk during times of physical and emotional stress. However, the release (or letdown) of breast milk can be affected by stress. Lactating women who are under stress may need support to encourage the letdown of milk. Keep breastfeeding women in close contact with their babies so they can nurse frequently.

Timely practical and emotional support can reduce stress related to infant feeding concerns. Because of the release of certain hormones, breastfeeding may even reduce stress for the mother and baby during challenging situations.

Feeding infant formula

Extra precautions are needed

Ready-to-feed infant formula (RTF) is the safest option for formula feeding during an emergency or disaster. This is because it does not need to be mixed with water and is available in sterile individual single-use containers. When powdered infant formula is the only option, extra care must be taken to ensure that it does not get contaminated.

Extra precautions include:

• Preparing infant formula with safe water and a clean measuring scoop.
• Storing the infant formula in a cool, dry place with the lid tightly closed.
• Carefully cleaning all infant feeding supplies such as bottles and nipples.

Prepare powdered infant formula using the exact amount of water and formula listed on the container. Use the exact measurement of the scoop provided. Do not dilute infant formula. Too much water may not meet the nutritional needs of the infant. Too little water may cause an infant's kidneys and digestive system to work too hard and cause dehydration.

Use prepared infant formula within 2 hours of preparation and within 1 hour from when feeding begins. Discard any infant formula left in the bottle after feeding.

Learn more about how to safely prepare and store powdered infant formula during emergencies.

Formula feeding may require more effort

Powdered infant formula feeding requires safe water to prepare the formula and cleaning supplies to clean bottles, nipples, and other parts. These resources may not be readily available in an emergency. Powdered infant formula cannot be made in advance without adequate refrigeration. These requirements can create difficulties for families using infant formula.

Breastfeeding is the safest way to feed a baby during an emergency. It provides the nutrients and infection protection that babies need. Infants unable to breastfeed or be fed expressed breast milk can be fed with RTF infant formula. Unlike powdered formula, RFT does not require water to prepare.

Expressed breast milk

Some mothers may be unable to feed their baby at the breast or are feeding their baby expressed breast milk. For these mothers, learning how to express milk by hand can help them continue to provide breast milk to their child.

Expressing milk by hand is preferred over using a breast pump when proper cleaning of pump equipment is not possible or when power is not available.

Relief staff can make sure a designated safe, private space is available for lactating women to express milk by hand. Lactation support should be available to teach mothers how to hand express milk, if needed.

Expressed breast milk can be fed to a baby in a disposable cup. This is an option if water is not safe for cleaning bottles or nipples.

Frozen breast milk may not be safe

Access to a refrigerator with electricity may be limited during a natural disaster. During an emergency, families should continue to follow CDC's guidelines for proper storage and preparation of breast milk.

In a power outage, take these precautions to ensure frozen breast milk is safe.

• Keep the freezer door closed. This will help prevent the milk from completely thawing.
• If possible, before an anticipated power outage, move all breast milk to the back of the freezer (the coldest part).
  • Ensure that the freezer is full or empty spaces are filled with crumpled newspaper to help reduce air flow.
  • A full freezer stays frozen longer than a partially full freezer.
  • Milk is still considered frozen if ice crystals can be seen in it.

Once milk has thawed, use it within 24 hours. Thawed milk cannot be refrozen. After 24 hours, throw out unused, thawed milk. When it comes to safe storage of breast milk, remember "when in doubt, throw it out."

Breast Milk Storage Guidelines:

• Breast Milk Storage and Preparation
• Breast Milk Storage Questions and Answers

Illness and diet

Infants can usually be breastfed even when mothers or infants are sick

Breast milk contains antibodies and other factors that boost immunity that can help protect infants from illness. This is true even if the lactating mother is ill with conditions such as the flu or diarrhea. When an infant is sick, the mother can usually continue to nurse or feed their baby expressed milk to keep them hydrated.

In rare exceptions, breast milk or breastfeeding is not recommended. Examples are when the lactating woman is ill with specific transmissible conditions or taking certain medications.

Mothers can breastfeed even when hungry

Breastfeeding mothers support their health and their baby's health by eating nutritious meals and snacks and drinking plenty of water. However, women who are hungry or have limited access to healthy foods are still able to breastfeed. Breast milk provides the appropriate number of calories and optimal nutrition to support the growth and health of the infant. Feeding infant formula instead of offering the breast will decrease a mother's milk supply and effect their ability to provide a full supply of breast milk to their infant.

Relactation

Mothers may be able to start breastfeeding again

Relactation is when a mother starts breastfeeding again after having stopped for some time, such as weeks or months. A mother may wish to relactate as a safe way to feed an infant during a natural disaster or disease outbreak.

Breastfeeding is a supply-and-demand process encouraged by nipple stimulation and milk extraction. A mother may be able to re-establish milk production by frequently stimulating her nipples by pumping, hand expression, and/or nursing directly at the breast.

Relactation depends on many factors. Support and careful monitoring by a lactation consultant or other breastfeeding specialist is important for mothers wishing to relactate.

Infants who are receiving human milk from a mother who is relactating must be carefully monitored to make sure the child is getting enough calories to have normal weight gain.