Infants and Toddlers

 "When an emergency occurs, breastfeeding saves lives."

• Breastfeeding protects babies from the risk of a contaminated water supply.
  
  
• It provides protection against respiratory illnesses and diarrhea--diseases that can be fatal in populations displaced by disaster.
  
  
• The basics of breastfeeding during an emergency are much the same as they are in normal times. Continuing to breastfeed whenever the baby seems hungry maintains a mother's milk supply and provides familiar comfort. The release of hormones while a mother is breastfeeding relieves stress and anxiety and is calming to both mother and baby.

See the La Leche League LLL information on resources on breastfeeding during emergencies, including ways a mother can breastfeed even if she has been feeding her baby formula: Breastfeeding During Emergencies Additional information on breastfeeding during an emergency can be found at the World Health Organization Infant Feeding in Emergencies.

You may wish to store several months supply of formula, as well as a few bottles and nipples. These can be used if mother is sick, or dies or in case a friend or loved one has a baby and needs it.

 If You Will Use Formula

1. If you will formula feed your infant: Store at least a three month supply. Ready-to-use formula, plus disposable bottles and nipples, are most convenient, but any unused portion must be refrigerated once opened. Powdered formula is more expensive, but you can mix up just the right amount, which avoids waste. However, powdered formula requires an adequate supply of purified water for preparing the formula and cleaning bottles and nipples.


• Preparing formula if water/fuel is scarce:
  
  The Center for Disease Control (CDC) recommends bottled water if using powdered formula. If bottled water is not available, use boiled water. Use chemically treated water to prepare formula only if you do not have bottled or boiled water.
  
  Take Care! If you prepare formula with boiled water, let the formula cool sufficiently before giving it to an infant. Wash your hands before preparing formula and before feeding an infant. You can use alcohol-based hand sanitizer for washing your hands, if the water supply is limited.
  
  
• Preparing feeding utensils if water/fuel is scarce: Clean feeding bottles and nipples with bottled, boiled, or treated water before each use. Consider cup feeding, even for a newborn infant (with proper precautions to avoid choking), as a cup is easier to completely clean and sterilize than a bottle and nipples.
  
  
Learn How: See page 41 of this WHO document: ‘Infant Feeding In Emergencies'


2. How much powdered formula is a 12 week supply? The amount greatly varies with age and size of the infant. As a general guideline, consider storing per infant:


• At least 12 large cans (25 to 32 oz.) powdered formula
  
• At least 18 to 24 gallons bottled water (for formula preparation).
  
  
Some infants have difficulty digesting one type of formula or another. You may wish to wait to stockpile formula until you have settled on a suitable brand for your infant, before stocking a 3 month supply.


3. If you have no formula: If breastfeeding is impossible, commercially-prepared formula is what pediatricians and nutritionists recommend for infants. However, in an emergency, it is possible that you may run out and be unable to re-supply. If so, you will have to make do with the resources you have on hand.

The following advice, is intended for women in developing countries, and may be adapted for your own use if there are no alternatives:

From the book "Where There Is No Doctor"; The Best Diet for Small Children; pg.120.

"If a mother's breasts produce little or no milk, she should continue to eat well, drink lots of liquids and let the baby suck her breasts often. After each breast feeding, give the baby, by cup (not bottle), some other type of milk—like boiled cow's or goat's milk, canned milk, or powdered milk. (Do not use condensed milk.) Add a little sugar or vegetable oil to any of these milks.' Note: Whatever type of milk is used, some cooled, and boiled water should be added. Here are two examples of correct formulas: Homemade formula #1 2 parts boiled, cooled cows milk 1 part boiled, cooled water 1 large spoonful sugar or oil for each large glass Homemade formula #2 2 parts canned evaporated milk 3 parts boiled, cooled water 1 large spoonful sugar or oil for each large glass

If non–fat milk is used, add another spoonful of oil." (1)
Copyright Hesperian Foundation. See 'about this site' for details.

• If possible , boil the milk and water. It is safer to feed the baby with a cup (or cup and spoon) than to use a baby bottle. Baby bottles and nipples are hard to keep clean and can cause infections and diarrhea (see p. 154). If a bottle is used, boil it and the nipple each time before the baby is fed.
  
  
• If you cannot buy milk for the child, make a porridge from rice, cornmeal, or other cereal. Always add to this some skinned beans, eggs, meat, chicken, or other protein. Mash these well and give them as a liquid. If possible add sugar and oil. WARNING: Cornmeal or rice water alone is not enough for a baby. The child will not grow well. He will get sick easily and may die. The baby needs a main food with added helper foods.”
  

The Best Diet for Small Children, The First 6 Months of Life

Feeding Older Infants and Toddlers 

• Many people choose to feed their older infants and toddlers commercial baby foods. For convenience and comfort, you may wish to stock up on a few weeks worth of these foods, if your child is used to and likes them. However, if you haven't done so and are unable to get commercial baby food, you can make your own from foods you may have on hand for older children and adults.
  
• For infants under one year old, keep giving breast milk or formula, first. Then you can add a thin cooked cereal. Com m ercially prepared cereals are what most people use, but if you do not have access to these, you can just use regular “adult” grains such as rice, oatmeal or cornmeal cooked with water or milk. Add a little cooking oil for extra calories.
  
  
• Little by little, introduce other fruits, vegetables and meat. These need to be cooked, mashed or strained, and mixed with a little breast milk or other milk to make them easier to swallow. Here are three ways to do this:
  
  1. Mash your table food thoroughly with a fork. Feed in small amounts.
     
     
  2. Purchase a variety of commercially-prepared baby food jars. These may be labeled as junior food instead of baby food. The advantages are convenience and minimum clean up. The disadvantage is cost.
     
  
  
• Make you own "junior food." Simply take "adult" food and grind it in a food mill. An example product is the KidCo Manual  Food Mill, costing less than $15.00 and designed just for this purpose. It is small, manually-operated (non-electric), and easy to clean. The advantage is cost savings. The disadvantage is clean up.

• Feed baby often, at least 5 times a day. Follow directions in any baby book as to what types of foods to avoid with babies (peanuts and other nuts, shellfish, whole eggs) if at all possible, and be careful baby doesn't choke on foods that are difficult to chew.

Diapers

Why This is Important

There are many unknowns in preparing for a pandemic.  Water and electricity for washing may be unavailable.  Garbage collection for disposable diapers might be interrupted.  The ability to re-supply is also uncertain, as there may be a slow down in production. You may not be able to go out to get diapers, or they may be sold out.

Good hygiene is important, particularly in an already stressful situation.  Clean diapers reduce secondary infections.  Have a supply of diapers on hand.  Additionally, learn other ways of managing your child's elimination if disposable diapers are not available.  This will remove one area of concern, allowing you to focus on more pressing matters during a pandemic.

Diapers and Dealing with Waste

Plan for at least 3 months of interruption to your usual way of handling your infant's waste.

1. Disposable diapers. If you use disposable diapers, stock up on three months of them – a case of diapers may last one month. Buy a size one larger than your child currently wears. (Use a too-big diaper by pulling it a little more tightly.)  This way you will always have a 3 month supply the child can wear or can grow into, and you will avoid buying too many of the wrong-size diaper.
• How to dispose of them.  If your trash pickup is interrupted, you will not want to have bags of soiled diapers lying around for any length of time.   If left outside they will attract pests.  Do not bury the soiled diapers, as they will not decompose.  Instead, scrape any solid matter from the diapers into the toilet as this will leave much less to be stored in the plastic bags for eventual trash pick up. Store extra garbage bags.
  
  
  
  
  
  
• Cloth diapers.  If you do not have cloth diapers already, it would be good to have at least 6 to 8 as a backup, in case you run out of disposable and can't re-supply. In a pinch, any absorbent material would work, fastened with some safety pins or other fastener and covered with some plastic pants. Store some extra detergent for washing.
  
  
  
  
  
  
  Basic Washing Method: Scrape all solid matter into the toilet or wherever you are handling your own waste.  Then save the diaper until you have enough for a load of wash.  (No need to soak.)  If heavily soiled, rinse diapers in cold water cycle (or hand wash); then run in a regular cycle (or hand) with warm or hot water and some bleach.  Dry in the dryer or hang to dry.
  


• Potty use. In an  extended emergency with uncertain utilities and supplies, it might make sense to potty train the child (if old enough).  For infants, there is a method used in traditional cultures that may be of interest.  Watch the infant carefully for cues he is about to “go” (usually a grimace, squirm, or cry) and, while carefully supporting neck and torso, hold the infant over a bowl, toilet or other container to “catch” the waste in the bowl.  This method takes some time and attention, but may be preferable to hand washing diapers if fuel and/or water are scarce.

Learn More: DiaperFreeBaby.org

Health and Safety

Why This Is Important

Many parents are accustomed to being able to contact their child's doctor at any time.  However, during a pandemic, healthcare services may be overwhelmed.  Parents may not wish to bring their children to a treatment center for minor illnesses or injuries, as doing so may expose their child to pandemic flu.  While healthcare services may be available for the critically ill or injured during a pandemic, parents may find themselves caring for minor illnesses and injuries at home.

Be Prepared

1. Household first aid kit.  Be sure it includes items specifically for infants:
   
   
   • infant thermometers (at least one that does not require batteries)
   • diaper rash cream
   • baby Tylenol
   • infant Motrin
   • infant Benadryl
   • hydrocortisone cream
   • baby ‘Oral Gel'
   • petroleum jelly
   • bulb syringe
   
   
2. Good reference books may help you diagnose and treat illness and injuries when other sources of advice are unavailable (for example, if the internet is down, phone service is unavailable, or doctors are absent).

Caring for Your Baby and Young Child Revised Edition: Birth to Age 5, by American Academy of Pediatricians or a similar reference is a good resource to have on hand; such books focus specifically on the needs of young children, but do assume access to regular health care services.
 
Where There is No Doctor, though meant for all ages, does not assume access to health care as it is for use in developing countries.

(Note:  For treatment of influenza – see 'Influenza Pandemic Preparation and Response – A Citizen's Guide' PDF.)

Prevent Illness, Infection and Injuries

1. Illness:  By taking social distancing steps in a pandemic, and keeping infants and children at home, you will reduce their exposure to many communicable diseases.



2. Infection:  Simple precautions can help greatly.  Pay attention to cleanliness.   Immediately attend to any blisters, diaper sores or cuts in the skin to prevent infection.   Clip nails to prevent scratches which can become infected.   Signs of infection include swelling, redness or discharge from the wound; consult available health care or your reference books for how to deal with these.



3. Injuries/Poisoning:
   
   WARNING: It only takes a moment for a child to become seriously injured or killed.  There will most likely not be medical care available.  Do not rely on barriers – these are easily climbed.  Children are invariably stronger and more agile than parents think.  Watch your children at ALL times.  DO NOT rely on older siblings to watch your child.  There is NO substitute for parental supervision of a child around dangerous items or situations.
   

• Be vigilant in making your home safe for an infant or young child.  You may need to use a crib or more often that in normal ti mes.
  
  
• Items like buckets of water or propane stoves, candles and such that you may be using in a power outage can cause injury or death if you are not extremely careful when children are around them.
  
  
• Move choking hazards and poisons OUT of reach.  Learn now to perform the Heimlich maneuver on an infant or  small child.
  
  
• Baby proof your home now more than ever, and stay alert to hazards when you are out of your usual routine. In a stressful emergency situation, be especially attentive to making your home safe from accidents, especially falls, suffocation or choking, poisoning, scalds and burns.
  
  
• Take Care! Review and be sure to follow the safety precautions listed in any baby book