One only needs to think of Hurricane Katrina to realize that no one is immune to the possibility of disaster. Consequently, knowing what to do when disaster strikes is paramount, particularly for healthcare professionals. One of the best sources for information about disaster planning and infant nutrition is the World Health Organization (WHO). WHO (2004) has developed a set of principles related to infant nutrition to assist with decision making during emergencies. Although we may think issues addressed by WHO are relevant only to persons who reside in third world countries, their information is relevant to nurses throughout the world.
Breastfeeding Takes Precedence
Clearly breast milk does not depend on supplies that may not be available during disasters. In some instances, a woman may need to undertake measures to initiate relactation. WHO (2004) even recommended that "in environments where there is high prevalence of HIV infection, the risk[horizontal ellipsis]through breastfeeding should be carefully weighed against the risk of their becoming seriously ill or dying[horizontal ellipsis]if they are not breastfed" (p. 7). Not only should women be encouraged to continue to breastfeed during a disaster, but also safe environments should be created to support this activity.
Although some might consider it important to procure and encourage formula use in a disaster, such a strategy is not recommended (IFE Core Group, 2007). According to the American Academy of Pediatrics (AAP) (2007), there are several disadvantages to formula use during an emergency or disaster: It may become contaminated (or the water used to mix it may be contaminated), sterilization of bottles may not be possible, or electricity may not be available for refrigeration. Should formula need to be used, ready-to-feed formula is recommended. Powdered formula should be considered a last resort (AAP, 2007). Moreover, formula should be used only until a point when breastfeeding can be re-established.
Equally important to any discussion is the need for local, state, and national agencies to have clear policies about how to support infant nutrition during disasters. Professional and nonprofessional staff should receive appropriate training so that all staff can support the most appropriate methods of infant nutrition.
What Can Nurses Do?
An essential first step is to be knowledgeable about recommended practices. Several Web sites are included at the end of this column to help you become better informed. Because nurses are the most common healthcare providers to care for women after birth, they are ideally positioned to offer support for the continuation of exclusive breastfeeding for the first 6 months. Nurses can reinforce the essential nutritional value of breastfeeding for the first year of life, which is especially important during times of disaster. Nurses are adept at creating environments in which a breastfeeding mother's privacy is maintained. Nurses also recognize the importance of providing time for mother and infant to interact and know that such interventions can counteract the negative effects of stressful events. In fact, breastfeeding can help reduce a mother's tension and calm her infant.
Where Are the Nurses in This Discussion?
For a large part of the world, nurses are the most numerous of the healthcare providers, and parents often seek information from us. Nursing organization Web sites should provide us with information about disaster preparation, but a quick check of three relevant nursing organization Web sites revealed that disaster planning in relation to infant nutrition is painfully absent. In order to be effective healthcare providers, nurses must have access to the most relevant and current information. Thus, I challenge us to make certain that such information is readily available to us on our clinical organization Web sites. I know I plan to address this absence with my clinical organization. Will you?
Key Web Sites
http://www.cdph.ca.gov/healthinfo/healthyliving/childfamily/Pages/EmergencyPrepa
A great Web site with links to others, including the Academy of Breastfeeding Medicine, Centers for Disease Control and Prevention, International Lactation Consultant Association, and the World Health Organization.
http://www.cdph.ca.gov/programs/BreastFeeding/Documents/MO-BF-EmergencySupplies.
A great handout to offer parents.
References