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close this bookInfant Feeding in Emergencies - Module 2, Version 1.0 for Health and Nutrition Workers in Emergency Situations (ENN, IBFAN, Terre des hommes, UNHCR, UNICEF, WFP, WHO; 2004; 186 pages) View the PDF document
close this folderCore Manual for Training, Practice and Reference
View the documentIntroduction
open this folder and view contents1 How Breastfeeding Works
close this folder2 Supportive care for all women
View the document2.1 Adequate nutrition
View the document2.2 Helpful maternity services
View the document2.3 Appropriate health services
View the document2.4 Continuing assistance and social support
open this folder and view contents3 Assessment of mother/child pair
open this folder and view contents4 Providing help to improve infant feeding
open this folder and view contents5 More skilled help with breastfeeding
open this folder and view contentsAdditional Material
View the documentOverhead Figures for use as transparencies or flip chart
open this folder and view contentsAnnexes

2.1 Adequate nutrition

Food needs during lactation

A breastfeeding woman needs an about 450 more kcal of energy per day than when she is not lactating.

Also, the micronutrients in breastmilk that are not stored in a woman's body, need to come from her food or from micronutrient supplements.

This means a breastfeeding woman needs an extra, small, nutritious snack or an extra fifth more of her usual daily food amount.

It is often customary for breastfeeding women to eat special foods (e.g. special soups or porridges). These may not be nutritionally necessary, but they can be important for building a woman's confidence in her milk supply because she believes they are good for her.

In emergencies the general ration1 should provide sufficient energy and protein and some micronutrients if women get their full share and all they want. But it may not provide enough of all the micronutrients women need.

1 The UN recommendation is a general ration of 2100 kcal per day per person whether adult or child. However, this is given on a population basis, not an individual basis, and is intended to cover individual variations in need, (such as during pregnancy and lactation, or at different ages). It also assumes that food is shared according to need between household members. An infant should be registered immediately following birth, so that the household is eligible for an additional general ration. Usually the general ration includes grains, pulses, a fortified blended food, and concentrated forms of energy such as sugar or oil.

Supplements for lactating women

Where vitamin A deficiency is likely to occur, give lactating women 400,000 IU of vitamin A as two doses, at least a day apart and not more than six weeks after delivery.

Other micronutrient supplements may also be needed.

Food supplements help to ensure that a woman is not undernourished if she becomes pregnant again.

All lactating women should eat supplementary food for at least six months and preferably for as long as they are breastfeeding. The supplementary food should provide 450 kcal a day and essential micronutrients.

Usually the supplementary food is a fortified cereal-pulse blend that provides 10-12% of energy from protein, 20-25% of energy from fat, and two thirds of the daily requirements of all the important micronutrients.

For on-site feeding, give each lactating woman the amount of supplementary food that supplies 500/450 kcal per day.

For home preparation, give each woman the amount of dry supplementary food that supplies 1000-1200 kcal per day (to allow for sharing among the family).

Effects of malnutrition on breastmilk

Mild or moderate malnutrition rarely affects the amount or quality of breastmilk that a woman produces. She uses her own body stores of nutrients to produce breastmilk. If her diet remains inadequate for along time, the milk may contain fewer vitamins and fats as her own body stores are used up.

However, her breastmilk continues to be nourishing for her child, and provides anti-infective factors that help to protect the child against infections. No breastmilk substitute contains these protective factors.

A severely malnourished woman's body has very low nutrient stores. She produces less breastmilk that contains lower amounts of fat and micronutrients. But her milk still protects the baby from infections.

A malnourished mother breastfeeds
IFE 2/11

Sierra Leone, 2001

Feed the mother and let her feed the infant

Monitor the weight and urine output.

Temporary supplements by cup may be needed while the mother's milk production increases.

© Joyce Kelly (ENN) 2001

Breastfeeding by malnourished women

For most women, if a mother is thin and malnourished, or has an inadequate diet, this is not an indication to stop breastfeeding.

A mother should not stop breastfeeding if she is malnourished or has an inadequate diet.

Stopping means her infant would not get any of the nutrients or the anti-infective factors in her breastmilk.

A thin, weak or malnourished woman needs food:

• to rebuild and protect her body stores of nutrients, and
• to enable her to produce more breastmilk.

Give any available food to the mother, and actively see what further support and care you can help her to access. Feeding the mother means she is able to produce enough milk without depleting her own body's nutrient stores.

Closely monitor the weight of any infant whose mother is malnourished and observe the amount of urine produced by the infant (see Section 1.3). The infant may need temporary supplements of other milk (as well as his/her mother's breastmilk) until the mother's condition improves and her milk production increases (see Part 5.5).

However, giving a mother food alone does not increase breastmilk production. Her infant must also suckle often to stimulate the production of and breastmilk.

Health and nutrition workers need to make sure that every mother receives adequate food for her own health as well as support for a good breastfeeding pattern. (See Section 5.5.)

Food alone does not increase breastmilk.

Effective suckling and frequent unlimited breastfeeds build milk production.

Case study: A thin and worried mother

Mariam is thin (Mid upper arm circumference (MUAC) 20.2 cm). She feels weak, and worries that her milk may be decreasing. Her three-month old son is still exclusively breastfed. He is lively and does not look thin, and passes urine quite often.

Mariam's household receives a full emergency ration consisting of maize meal, beans, oil and sugar. She goes to a supplementary feeding centre where she receives two meals a day (700-1000 kcal/day) of a porridge made from corn soy blend (CSB), oil and sugar. Groundnuts or milk powder are added to the meal when available. On weekends, when the on-site feeding centre is closed, Mariam receives a dry take-home ration that is premixed (CBS/UNIMIX, oil and sugar).

1. Will the supplementary food increase Mariam's breastmilk production?
2. What could she do to produce more breastmilk?
3. Should she give the blended food as gruel to her son?
4. Should the baby be given supplements of infant formula?
5. What does Mariam need most to stop her feeling worried?


1. The supplementary food will not increase her milk production, but it may improve her own nutrient status and her energy.

2. Effective suckling and a good breastfeeding pattern will increase her milk.

3. She should not give gruel to her infant at this age. She should continue to breastfeed exclusively until the infant is six months old, and eat the supplementary food herself.

4. Supplements of formula will interfere with increasing the mother's milk, and will needlessly expose the infant to health risks.

5. Mariam needs emotional support to build and maintain her confidence.


Dehydration may interfere with breastmilk production. Mothers may arrive at refuges or intake sites already dehydrated.

Fluid intake is especially likely to be a concern when there are:

• populations on the move
• severe drought conditions
• natural disasters that contaminate water, such as floods.

Health and nutrition workers caring for mothers should:

• Ideally, ensure that drinking water is freely available to breastfeeding mothers so that they can drink the amount they need.

• Ensure, if supplies are limited, that every breastfeeding mother gets an extra litre of water per day.

• Provide drinking water wherever women queue or wait in the sun a long time.

• Provide drinking water at transit rest areas for populations on the move.

• If a mother has diarrhoea, then she will need rehydration with Oral Rehydration Salts (ORS).

Prevent dehydration
IFE 2/12

Provide plenty of drinking water wherever there are breastfeeding women in:

• transit rest areas
• registration/intake centres
• long queues for health and other services


Adapted from UNICEF. BFHI News

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