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		Infant Feeding in Emergencies: A Guide for Mothers (WHO, 1997, 48 p.)
			(introduction...)
			Foreword
			Introduction
			Why is breastfeeding so important?
			Are commercially-made baby milks as good as breastfeeding?
			Why are commercially-made baby milks not so good?
			But can every woman breastfeed?
			But why don't the experts tell us this if breastfeeding is so important?
			Do babies also need tea and water?
			When do babies need more than just breast-milk?
			So a sick baby should go on breastfeeding?
			Do breastfed babies get fewer diseases?
			But my friend's baby got ill and he was breastfed
			So breastfeeding is like a medicine?
			People say that stress stops the milk, so during stressful times how can we breastfeed?
			What about women who have lost a lot of weight? Can they produce milk?
			Do we need special nutrition for breastfeeding?
			But what about anaemic women? Does breastfeeding drain their strength?
			Someone told me breastfeeding stopped you getting pregnant, but isn't that just a story?
			How does breastfeeding work?
			What about women with small breasts or flat nipples?
			You said the baby has a part too. What can he do?
			Why is the baby's suckling-action important?
			How does a baby stimulate the milk?
			The first principle of breastfeeding: good attachment
			Why does good attachment not always come naturally to the baby?
			Why does the baby not always get this right?
			Sometimes it is hard to get a baby close because he is swaddled and his clothing gets in the way
			Even if my baby attaches well, how can I be sure there will be enough milk?
			You said earlier that milk changes during a feed. Can you explain that?
			But I thought you must feed from both breasts?
			You said earlier that confidence was important but not everyone has that. What can we do?
			I know women with breastfeeding problems. Can they be helped?
			My mother told me that you always get sore nipples and you just have to put up with them
			What about special creams for sore nipples? How can we get them during an emergency?
			With this baby-led feeding how can I be hygienic and wash my nipples?
			So if I get my baby well-attached, I will never get sore nipples?
			You say breastfeeding should not hurt, but what about the engorgement that every woman gets a few days after the birth?
			You mentioned blocked ducts, mastitis and abscess. Are they common and how can we treat them?
			All these problems make breastfeeding look too difficult
			You said earlier that you can breastfeed even if you have stopped completely. How can this be done?
			Food supplies can be precarious. How can we feed the babies over 6 months who need more than breast-milk alone?
			What about premature or very small babies?
			I can see the reason for expressing milk for sick or premature babies, but must all women learn to express?
			How do I express milk?
			I can see that breastfeeding is possible in most cases, but we still have to face the times when it is not possible: emergencies create orphans, abandoned babies and severely ill or wounded mothers
			Is it possible to feed a baby artificially without a bottle?
			How do you cup-feed a baby?
			A final word

I can see that breastfeeding is possible in most cases, but we still have to face the times when it is not possible: emergencies create orphans, abandoned babies and severely ill or wounded mothers

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