Emergency preparedness for infant and young child feeding in emergencies (IYCF-E) : an Australian audit of emergency plans and guidance

BACKGROUND: Australia experiences a high incidence of natural emergencies and Australian governments have committed significant investment into emergency preparedness and response. Amongst the population groups most vulnerable to emergencies are infants and young children with their vulnerability centering around their specific food and fluid needs. For this reason, the World Health Assembly has urged all member states to develop and implement infant and young child feeding in emergency (IYCF-E) plans in line with international guidance. This study aimed to determine the degree to which Australia has complied with this direction by conducting an audit of Australian emergency plans and guidance. METHODS: Australian Federal, State/Territory and a sample of Local government emergency plans and guidance were located via web searches. Documents were searched for key words to identify content dealing with the needs of infants and young children. Plans and guidance were also searched for content dealing with the needs of animals as a comparison. RESULTS: While plans and guidance contained numerous pointers to the desirability of having plans that address IYCF-E, there was a dearth of planning at all levels of government for the needs of infants and young children. Guidance related to heat waves contained information that could prove dangerous to infants. No agency at Federal or State/Territory had designated responsibility for IYCF-E or children in general. This was in stark contrast to the situation of animals for which there was widespread and comprehensive planning at all levels of government with clear designation of organisational responsibility. CONCLUSIONS: Lack of planning for IYCF-E in Australia places infants and young children at serious risk of adverse health consequences in emergencies. Australian Federal, State/Territory and Local governments need to take action to ensure that IYCF-E plans and guidance are developed and deployed in line with international standards. The pathway to successful integration of animal welfare plans provides a method for a similar integration of IYCF-E plans. Government health authorities are best placed to lead and be responsible for IYCF-E in Australia. National governments internationally should similarly take action to ensure that their youngest, most vulnerable citizens are protected in emergencies

'Want to Help the Children? Help the Parents': Challenges and Solutions from the Babies and Young Children in the Black Summer (BiBS) Study

This report presents the findings of the Babies and Young Children in the Black Summer (BiBS) Study. It considers the experiences of caregivers of very young children (0-4 years) of the 2019-20 Black Summer Bushfires and of emergency responders that supported families with very young children in this and other emergencies. Recommendations are made to improve emergency planning and response to better support very young children and their caregivers in Australian disasters

Facilitators and barriers of wet nursing from antiquity to the present : a narrative review with implications for emergencies

Background: If maternal breastfeeding is not possible, wet nursing allows infants to receive the nutrition and protection against disease that breastfeeding provides. Such protection may be particularly valuable in emergencies. However, while wet nursing is recommended in the Operational Guidance on Infant and Young Child Feeding in Emergencies it is underutilized. This narrative review aimed to develop an understanding of wet nursing practice across time and location, and why wet nursing is currently so little supported to inform interventions to support wet nursing in emergencies. Method: Medline and Embase were searched for "wet nursing," "cross-nursing," "shared breastfeeding," and "non-maternal nursing". Included articles were inductively analyzed to identify positive and negative factors associated with previous wet nursing practice. Results: This review included 74 records. Our analysis of the wet nursing literature includes historical and contemporary themes with milk kinship and wet nursing as risky being shared themes across time periods. Our analysis revealed that it is how wet nursing is undertaken that influences whether it benefits women, children, and societies or not. Facilitators and barriers to wet nursing in emergencies related to infant mortality rates, cultural and individual support for wet nursing, availability of wet nurses, and resources to support wet nursing. Conclusion: Understanding the conditions under which wet nursing has positive outcomes and what can be done to facilitate beneficial wet nursing practices will assist in enabling wet nursing to be more commonly implemented in emergencies

Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care

Background: In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. Weighing of risks is necessary in policy development: Such policies are risky as was shown in the early response to the HIV pandemic where efforts to prevent mother to child transmission by replacing breastfeeding with infant formula feeding ultimately resulted in more infant deaths. In the COVID-19 pandemic, the risk of maternal SARS-CoV-2 transmission needs to be weighed against the protection skin-to-skin contact, maternal proximity, and breastfeeding affords infants. Conclusion: Policy makers and practitioners need to learn from the mistakes of the HIV pandemic and not undermine breastfeeding in the COVID-19 pandemic. It is clear that in order to maximise infant health and wellbeing, COVID-19 policies should support skin-to-skin contact, maternal proximity, and breastfeeding

Estimating the prevalence of exclusive breastfeeding with data from household surveys : measurement issues and options

The importance of breastfeeding for infant and maternal health is well established. The World Health Organization recommends that all infants be exclusively breastfed until they reach 6 months of age. The standard indicator to measure adherence to this criterion is the percentage of children aged 0–5 months who are currently being exclusively breastfed. This paper proposes supplementary measures that are easily calculated with existing survey data. First, for an accurate assessment of the WHO recommendation, we estimate the percentage of infants who are being exclusively breastfed at the exact age of 6 months. Second, an adjustment is proposed for prelacteal feeding. These two modifications, separately and in combination, are applied to data from 31 low-and middle-income countries that have participated in the Demographic and Health Surveys Program since 2015. There is considerable variation in the effects across countries. The modifications use existing data to provide a more accurate estimate than the standard indicator of the achievement of the exclusive breastfeeding until 6 months recommendation

Australian foster carers' views and concerns regarding maternal drug use and the safety of breastmilk

Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers’ management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers’ may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother’s breastmilk

'A better alternative' : why women use peer-to-peer shared milk

The process by which women came to use internet-facilitated peer-to-peer shared milk was explored via a written questionnaire administered to 41 peer milk recipients from five countries. Respondents were universally unable to provide some or all of the milk their infants required. Twenty-nine dyads had a medical condition that could have affected their ability to breastfeed. Many respondents had had great difficulty in finding health workers who could assist them with their breastfeeding challenges. Before obtaining peer-shared milk, respondents had tried to increase their own milk supply, used infant formula or sought donor milk from personal contacts. Health workers dealing with breastfeeding women require greater training in the recognition and treatment of conditions that adversely affect breastfeeding including a physiological incapacity to fully breastfeed. Peer-to-peer milk recipients appear to be very satisfied with the solution milk sharing provides to their problem of being unable to fully breastfeed their infants

Perception and management of risk in Internet based peer-to-peer milk-sharing

The perception and management of the risks of peer-to-peer milk sharing was explored via a written questionnaire administered to 97 peer milk donors and 41 peer milk recipients who were recruited via Facebook. All recipients’ respondents were aware that there were risks associated with using peer-shared milk and took action to mitigate these risks; however, their knowledge and risk mitigation was incomplete. Recipient respondents were well informed as to the risks involved in artificial feeding and this contributed to their decision to prefer peer-shared milk. Many donor respondents did not follow guidelines for safe milk expression. Many respondents had not discussed milk sharing with a health provider. It is recommended that health providers be proactive in providing education to minimise the risks of peer-to-peer milk sharing. This is the first study to examine the views and practices of Internet-facilitated peer-to-peer milk sharing and provides insight that may improve the safety of the practice

Mechanisms behind breastmilk's protection against, and artificial baby milk's facilitation of, diarrhoeal illness

It is well known that exclusive breastfeeding provides protection against diarrhoeal infection, but the mechanisms behind this protection are poorly understood. In addition, it is well known that feeding a baby artificial baby milk dramatically increases the risk of diarrhoeal illness severe enough to require medical treatment, including hospitalisation, but the mechanisms by which artificial baby milk facilitates infection are largely unrecognised. This paper uses non-technical language to describe some of the known ways in which breastmilk provides infants with external immune support. Detailed knowledge of the importance of breastfeeding and the risks associated with the use of artificial baby milk will assist more mothers to exclusively breastfeed

Promoting attachment in foster parents : what we can learn from the experience of parents of premature infants

It is advantageous for children in foster care to have caregivers who are strongly attached to them. However, foster parents may have difficulty attaching to the children placed in their care because they fear the grief that they will feel if a child is removed. The parents of premature babies are another group who may face difficulty attaching to their children owing to the fear of loss. Research has found that parent–premature infant attachment can be assisted via the promotion of close proximity and nurturing touch, aiding parents to interpret their child’s cues and understand their needs, and through providing caregiving. These findings may be applied to foster parenting and provide guidance in the methods by which foster parent-to-child attachment can be promoted. While foster parents who attach to their foster children will grieve if children leave their care, the careful facilitation of moves, providing feedback on children’s well-being and offering support through the grieving process will assist them to retain an ability to attach to subsequent foster children and to continue fostering