Posts

Newsletter #43: Total Defence Day – Protecting Babies During Emergencies

By BMSG Editorial Committee

It is significant that we commemorated Total Defence last week on 15 Feb just as the nation is coming to terms with the recent outbreak of COVID-19 (previously also known as the coronavirus). While we grapple with the possible impact of the virus on our community, our resilience was tested as fearful members of the public took to stockpiling household supplies when Singapore raised its DORSCON level to Orange. Racks were swept clean, especially those that housed rice, instant noodles and toilet paper previously.

Sadly, formula milk also fell victim to the hoarding of the public. Some mothers on online forums were lamenting that they were worried about the shortage of formula milk stocks. While the government eventually swooped in to assure Singaporeans of our supplies, the incident is a strong reminder that young babies and infants remain vulnerable in the event of an emergency, whether real or perceived.

As a charity committed to upholding the rights and welfare of young children to be fed and taken care of in times of crises, we line out several measures in this article that parents can take to ensure sufficient feeding of their infants in the event of a national crisis.

Singaporeans took to panic buying when Singapore raised its precaution levels. [Credits: @ikansumbat / Twitter]

Emergency Preparedness
While a disaster or nation-wide crisis may appear unlikely to happen in Singapore, the tagline “Not if but when” on our national security campaigns clearly reminds us that threats such as terrorist attacks and other unexpected dangers are always lurking. The current COVID-19 situation here was something none of us would have expected just a few months ago. Its impact on our economy and safety is unprecedented.

In such situations, especially because threats are unpredictable, it is all the more important that we equip ourselves with knowledge on what infants and/0r young children would need in the event of an emergency.

Australian Bushfires: Lessons Learnt for Feeding Children in Emergencies
The recent Australian bush fires endangered many civilians and affected infrastructure across the country; an annual affair especially with scorching summer heat they were particularly bad this bushfire season. While cyclones, floods and bushfires are common occurrences for the continent, a recent research study by Australian academic Dr Karleen Gribble last year discovered that one-quarter of families who evacuated during the 2011 Queensland flooding and Cyclone Yasi were unable to pack adequate supplies for infant feeding despite the fact that such natural disasters have been happening in Australia almost every year for decades.

It was also found that guidelines for emergency packing were more detailed for adults and pets, as compared to very young children.

Families may not be sufficiently equipped to provide enough supplies for babies in an emergency, which was what academic Kate Gribbles discovered in her study. [Stock photo]

Current Situation in Singapore
While such emergency situations may sound extreme for a country such as Singapore not known for emergencies or natural disasters, BMSG (Singapore) recommends parents, caregivers and agencies remain up to date on the requirements for emergency kits for infant babies, whether breastfed or formula-fed. We also cannot afford to be complacent and expect that supplies will be readily available in the event of an emergency.

Currently, the Singapore Civil Defence Force (SCDF) recommends that citizens prepare a Ready Bag (P43) as written in its Emergency Handbook. The Ready Bag should be pre-packed with items that individuals require, preferably one bag per family member including infants and young children.

The SCDF also writes in its handbook (P44) that there should be food rations enough for two weeks of non-access to food and water for each individual in the household. For infants, it is recommended that one to two tins of formula milk be stocked up for emergencies depending on the age of the baby.

Screenshot of P44 of the SCDF Emergency Emergency Handbook. [Credits: SCDF]

Suggestions for Changes
Unfortunately, current recommendations do not fully detail what are the exact needs for young babies and children.

  • First and foremost the current guidelines assume that babies are formula fed, and the public is encouraged to keep tins of formula. There is a possibility that families who are not formula-feeding may mistakenly feel that formula milk is prefered to breastmilk in emergency situations for some reason. We would like to see guidelines updated to include breastfeeding, expressed breastmilk feeding and mixed feeding. It should be made clear that mothers who are breastfeeding should continue to do so, in fact they should consider taking steps to relactate if they have recently stopped breastfeeding as dried formula milk can only be fed with access to clean potable water which may be limited or even unavailable.

    In fact, it is precisely this that poses danger to vulnerable infants where the threat of contaminated water, unsanitized preparation areas and the lack of hot water make safe formula preparation problematic. In Gribble’s recommendation of guidelines for baby food and milk in times of disasters, she recommended that 15 L of water be set aside for washing of hands and milk preparation areas alone. She also mentions other specifics that would be mandatory for sanitised preparation of formula milk that is safe to drink.

  • Secondly, in the event that parents are not able to secure tins of formula milk to be stocked up, there seems to be no alternatives in place for infants that rely on formula milk. There would also be the likelihood of inflated costs of supplies, including formula milk, in the event that demand is excessive – families with a lower income would be particularly vulnerable. How then do we ensure that all children are able to receive adequate nutrition and hydration during times of crisis, regardless of how they are fed?

  • Thirdly, human milk sharing should be considered in the updated guidelines, i.e. cross-nursing and/or feeding donated expressed breast milk. This is arguably one of the best ways to sustain young infants in emergencies as breastmilk can be transferred without a receptacle in the case of direct latching, or hand expressed into a sterile container and fed to babies straight away.

    While storing expressed breast milk may be challenging when there is limited electricity, the supply of breast milk to vulnerable infants could be maximised by encouraging breastfeeding mothers in disaster areas to come together to help breastfeed or hand express breast milk for other babies. You can read more about similar efforts that have been practiced by the breastfeeding support groups in the Philippines in our interview with a veteran Filipina breastfeeding advocate, Ines Fernandez, last year. Such an example sets precedence for situations we can never imagine.

AP Gribble’s Guidelines for Baby’s Sustenance in Emergencies

Taking a closer look at AP Gribble’s recommendation, we can take stock of how specific these guidelines are. Note that these are supplies meant for three days without any access to clean food, potable water and electricity. It is assumed that after three days, the family would be evacuated or rescued.

Breastfed Babies

Expressed-Milk Fed Babies

Formula Fed Babies

• 10 L water for mother to drink

•36 nappies

•100 nappy wipes

** Gribble and Berry also recommended that mothers learn the national breastfeeding hotline.
** BMGS (Singapore)’s hotline is +65 6339 3558

• 10 L water for mother to drink

•10 – 20 L of water for hand washing

•30 cups/bottles for expressing and feeding

•Detergent to wash receptacles

•100 nappy wipes

** Keep in mind milk storage guidelines e.g. milk can be stored at room temperature for 3 hours in Singapore’s climate and to do a taste test before every feed.

** Feeding cups must only be used once.

• 1 unopened tin of baby formula

•27 feeding bottles and teats

•14 bottles of still water for reconstitution

•15 L of water for washing of hands and preparation areas

•Detergent for washing of hands and preparation areas

•100 sheets of paper towels for drying wet hands and preparation area

•Large storage container with sealing lids for storage; lid can be used as preparation area

•36 nappies and 100 wipes

[Image credits to: Dr Karleen Gribble & Dr Nina J Perry]

Extra Precautions for Formula-Fed Babies

Referring to the table above, you will find that for formula fed babies, preparations are a little more extensive. Additional guidelines include:

  • Each storage bottle must be sterilised and fully dried before being put in a ziplock bag and then stored
  • Washing hands and drying them are important when preparing infant formula
  • Use small bottles of water for reconstitution
  • Always use the correct amount of infant formula. It is not advised to dilute formula to extend its shelf life, especially for babies younger than 6 months old
  • Prepared formula should be fed to baby straight away
  • It is not recommended to keep unfinished formula for feeding later on as it can be a breeding ground for bacteria. In emergency situations, tummy issues would be something unwelcome and challenging to manage, not to mention dangerous, for young children.

Babies Over 6 Months

Babies over 6 months who have started on solids would need sufficient packaged baby food, disposable spoons (unless there is sufficient potable water) and drinking water prepared for emergencies. This is on top of the amount of milk the baby needs as per the guidelines above.

It is also worth noting that babies over 1 year old need not consume any form of formula milk. You can stick to clean plain water for baby’s hydration. 

In times of crises and natural disasters, children remain one of the most vulnerable groups of people who will need extra care. [Stock Photo]

Conclusion

As the number of breastfeeding mothers and babies is growing significantly and in view of the times that we are in, there is a need to unlearn and relearn new ways to support the breastfeeding mother and baby in emergency situations.

Just last year alone, BMSG (Singapore), the sole charity for breastfeeding support, provided counselling to nearly 7000 individuals, including mothers, spouses and family members. This shows that there is a significant number of families who comprise of a breastfeeding baby or child. Their needs remain paramount just like other babies and children.

The recent panic-buying episode also shows how especially vulnerable non-breastfed infants are in times of public anxiety, where there were anecdotes of parents unable to purchase their babies’ formula milk powder in supermarkets due to hoarding. 

We sincerely hope that our suggestions and recommendations will be useful for agencies and families alike who can help citizens and residents of Singapore be better prepared for any forms of emergencies, expected or otherwise.


If you need breastfeeding support, contact our breastfeeding counsellors at no charge on the following platforms:

Dec 2018 Newsletter: Why Artificial Feeding for Infants Should be the Last Resort: Observations from Maureen Minchin’s talk

By Khatim Hamidon, Vice-President, BMSG
Photos courtesy of Alexandria Neoh, Picspirations Photography

Formula milk shrinks penises.

At least, that was one of the revelations about artificial feeding that stuck in my mind during a talk by Maureen Minchin, a renowned Australian breastfeeding researcher. The talk, titled Infant Feeding and Modern Epidemics: Obesity, Allergy, Autism, Diabetes, was organised by the BMSG  last November.

Maureen Minchin has studied the effects of artificial feeding for the short and long term.

Minchin, who pioneered the field of lactation consultancy, was in Singapore under the invitation of the Association for Breastfeeding Advocacy (Singapore) (ABAS), and was also promoting her book, Milk Matters: Infant feeding & Immune Disorder, which took almost five years and not without sweat, tears and sacrifices to complete.

Formula feeding is wrought with sensitivity, with mothers pitted against each other on which mode of feeding is “better”. Minchin, however, did not shy away from the fact that formula milk should only be used as the last resort on what an infant should be fed during her talk. This was also an important tenet that underlies her writing.

Many people know about the benefits of breastfeeding (which is not a “benefit” to begin with, because breastfeeding should be the norm!). Breastfeeding reduces childhood illnesses, improves mothers’ health and promotes bonding between mother and child.

Minchin bravely delved into this further. She posited the milk hypothesis, in which breastfeeding is critical in transitioning a baby from a life inside the womb to a thriving life outside of it.

From health professionals, to breastfeeding counsellors, mothers and members of the public – all were interested to hear what Minchin had to share.

Breastmilk is the species-specific building blocks of the baby’s growth and development. An infant’s gut is permeable for this reason: to absorb stem cells and growth factors, besides the nutrients and antibodies in breastmilk, so as to develop optimally.

When breastfeeding is not realised, and the baby is exposed to formula milk instead, this will trigger epigenetic changes.

Babies exposed to formula milk are developing on ingredients that are not easily absorbed by their tiny bodies, and instead can be harmful to their gut – for example, synthetic nutrients derived from marine algae – which results in the baby’s development not following the same trajectory as that of a breastfed baby. This in turn affects babies right to the cellular level, skews the gut microbiome and this may be manifested both in the short and the long term hence why the various list of modern epidemics that Minchin shared with us in the title of her talk: obesity, eczema, PCOS, precocious puberty…and shrinking penises.

That is not all. These changes are also vertically communicated from the parent (either mother or father) to their children, and compounded through generations, as more and more babies are introduced to the supposedly modern artificial feeding.

It goes without saying that Minchin’s position is not shaming parents who are not breastfeeding their infants. On the contrary, she means that the majority of parents are not fully informed on the harms of artificial feeding. “How many OBGYNs actually talk to mothers about the importance of breastfeeding?” she asked the audience.

Minchin shared that a mother of a sick child cried when she read Minchin’s book, and exclaimed that she was relieved that whatever that her child was going through, was not her “fault” as a mother. That truly pierced my heart, because this was essentially a mother trying her best caring for her child and fighting the inadvertent product of previous generations.

It goes without saying that Minchin’s position is not shaming parents who are not breastfeeding their infants. On the contrary, she means that the majority of parents are not fully informed on the harms of artificial feeding. “How many OBGYNs actually talk to mothers about the importance of breastfeeding?” she asked the audience.

Some of BMSG’s volunteer counsellors and EXCO members with Minchin (centre, in black).

It feels quite bleak when you think about the generations of populations around the world introduced to unnecessary artificial feeding, and the well-meaning but damaging belief that it is a cure-all for almost any ailment: jaundice, weight loss, ineffective suckling, etc. Perhaps so many illnesses and health conditions could have been averted should young infants receive only what their sensitive tummies are meant to only fully digest: breastmilk.

But all is not lost. “Epigenetic changes do persist, but don’t persist forever,” Minchin explained, “…if we can manage to get the right care for breastfeeding babies for a few generations, we may be able to revert back to a better baseline genome.”

As the saying goes, when we know better, we do better. Let’s hope we continue to breastfeed, not just for ourselves, but also for our communities and society.

Minchin concluded with a stirring dénouement that, to me, simply cannot be summarised:

“Every one of you who is actually breastfeeding or has breastfed, has changed history for the better. You’ve helped to make the world a healthier place. You can regard yourself as (a) positive miracle worker, having succeeded in a society that stacked against success, structurally, in every way. If society just understood how really good breastmilk is, every mother would have been paid to stay home and breastfeed, or employ a wet nurse to do the job for her.”

I wanted to burst out crying. Mothers; we are miracle workers. Continue to advocate for breastfeeding for your child’s health, and for your child’s child’s health. We can make this world a better place.

Visit Maureen Minchin’s site here for more information on her work. You may also want to consider getting her book, Milk Matters: Infant feeding & Immune Disorder, which is sold at the BMSG website for $95. Part of the proceeds will go towards the BMSG.