Emergency preparedness for those who care for infants in developed country contexts

The World Health Organization and UNICEF Global Strategy on Infant and Young Child Feeding recommends that infants be exclusively breastfed for the first six months of life and then continue to be breastfed, with the addition of complementary foods, for two years or more [1]. In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation [2]. However, the majority of children in developed countries have their intake of breast milk partially or totally replaced by infant formula in their first year of life [e.g. [3-5]]. In developing country contexts, formula feeding is frequently fatal to the infant [6,7]. In developed countries, good infrastructure, including easy access to clean water, electricity and medical care, means that relatively few infants die as result of formula feeding [8]. The low mortality rate associated with formula feeding in developed countries contributes to the acceptability of partial or total formula feeding. However, when an emergency occurs, any one or all of the aforementioned resources that makes formula feeding relatively safe can be severely limited. Thus, in emergencies, those who care for formula fed infants may be faced with circumstances that make formula feeding extremely difficult and potentially very dangerous.Reports from past emergencies have demonstrated the difficulties faced by those who care for formula fed infants in large-scale emergencies in developed countries (unless it is stated otherwise these reports were told to KG by health professionals who had worked with mothers during these emergencies). In the aftermath of Hurricane Katrina (New Orleans, 2005), dangerous feeding practices were widespread. Gruich [9] described finding a large n