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Challenges With Pediatric Mass Care Feeding
Research and Practical Application
This page is a constant work-in-progress. Please re-check back here again frequently, for more details and material. Current timeline or milestone status is at the end of this page. Thank you for viewing, learning more and hopefully joining our advocacy efforts. Big news - as of 1/6/25 Public Assistance on Declared Disasters now supports breast feeding / chest feeding in congregate care shelters under PA Category B - Emergency Protective Measures!
See our blog post on this, as a starting point and subscribe for updates.
Our Published Articles:
Prasad, M, Russell, JH. Challenges with pediatric mass care feeding. Dom Prep. 2023;19(5):27–31. https://www.domesticpreparedness.com/journals/may-2023
Russell, J. H., Haushalter, A., & Rhoads, S. J. (2025). Supporting Breastfeeding Women Amid Natural Disasters in the US: A Scoping Review. Disaster Medicine and Public Health Preparedness, 19, e24. doi:https://doi.org/10.1017/dmp.2024.323
Our Published Book Chapter:
Issues for Infant and Toddler Feeding at Disaster Mass Care Sites: Paradigm Shifts for Strategic and Operational Planning - in Current and Emerging Trends in the Management of International Disasters (2024)
IRB Research Approval at the end of this page.
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Disasters can disrupt daily life, affecting various facets of society, including food security and nutrition. The prevalence of food allergies is increasing. While there has been a general focus on improving infant and young child nutrition during disasters, the specific challenges faced by children with food allergies are often neglected in disaster preparedness and response. (Adeoya, A. A. (2024). Enhancing the Nutritional Well-Being of Children With Food Allergies During Disaster. Disaster Medicine and Public Health Preparedness, 18, e47. doi:10.1017/dmp.2024.37) https://pubmed.ncbi.nlm.nih.gov/35173109/
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The National Academies in 2025 produced a consensus report which noted:
Breastfeeding is the safest way to feed infants in emergency situations, but few resources are in place to provide skilled breastfeeding support to address breastfeeding challenges in emergencies, nor to mitigate the substantial risks associated with using commercial milk formula in emergencies. Federal agencies as well as state, tribal, and local emergency management plans can reduce disruption by incorporating well-coordinated infant and young child feeding emergency planning into emergency preparedness. Coordination with community organizations and coalitions is needed to ensure that breastfeeding resources, peer support, and emergency access to breastfeeding supplies and donor human milk are possible during disasters and emergencies. These practical and structural protections are necessary to ensure that historically and currently underserved communities are better supported during emergencies.
Conclusion 4-4: Over the last decade, humanitarian emergencies, disasters, and supply chain disruptions have exposed vulnerabilities in the current landscape of infant feeding; these events can make it difficult for parents and caregivers to access the information and support they need to safely and appropriately feed their infants and young children. Improving emergency planning and preparedness for infant and young child feeding in emergencies would help ensure that all families receive the support they need to safely feed their children, minimize risk, and maximize infant and child health.
Recommendation 4-4: The Federal Emergency Management Agency, state and local emergency management agencies, and nonprofit organizations such as the Red Cross should incorporate infant and young child feeding in emergencies into their emergency preparedness and response guidance and plans. They should share this guidance with states, tribes, territories, and local health jurisdictions and fund efforts that address infant and young child feeding needs during natural disasters and public health emergencies. These actors should collaborate with breastfeeding support organizations in this process, including state, tribal, and community coalitions, as well as offices providing access to the Special Supplemental Nutrition Program for Women, Infants, and Children.
- Source: https://nap.nationalacademies.org/read/29118/chapter/6?term=4.4#138
Our work has directly supported these conclusions and recommendations with tangible results in policies and procedures.
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U.S. National Mass Care Strategy Items - See Downloads below
- NEWLY ADDED! Infant/Toddler Feeding Support Statement, as of May 2, 2024
- Our Recommendations, what we want added to the NMCS website (see below):
- Infant/Toddler Feeding Exercise Series - Exercise Facilitator Handbook EXPLAN
- 'Before' (Preparedness/Prevention/Protection) - Sample Table Top Exercise (TTX)
- 'During' (Response/Interim Recovery) - Sample TTX
- 'After' (Long-Term Recovery/Mitigation) - Sample TTX
- Logistics and Supply-Chain Management/Security - Sample TTX - TBD
- Durable Medical Equipment (DME)
- Consumable Medical Supplies (CMS)
- Baby Bottle Nipple Compatibility Info (from The Glass Baby Bottle*)
- Breast Pump Baby Bottle Compatibility Info (from The Glass Baby Bottle*)
- Accessible Sites: Inclusive and Equitable Access to Emergency Sites - by Samantha Clements (includes references for support of breastfeeding in shelters)
U.S. National Mass Care Exercise - NMCE (2024)
- Pediatric Feeding in Mass Care Webinar 2024-01-29 - State of Pennsylvania
- Commonwealth's Media Release on the exercise
- 2024 NMCE After-Action Report / Improvement Plan - State of Pennsylvania
- Barton Dunant's comments on the 2024 NYCE which were not included
- See below for downloads of potential exercise MSEL Injects and EEGs
US HHS: ASPR/ACF/CDC
- Infant Feeding During Disasters
- Infant and Young Child Feeding in Emergencies Toolkit
- Pediatric Disaster Care Centers of Excellence (ASPR)
American Red Cross and other Disaster Shelter Operators (i.e., general population evacuation shelters, serving people with disabilities and access/functional needs)
- Working with their national leadership for updating/revising mass care feeding plans, organization, equipment, training, and exercises associated with pediatric mass care feeding
- This work is aligned to FEMA/DOJ guidelines for mass care shelter operators issued in 2010, which includes the need to support disabilities, access & functional needs within general population shelters (i.e., eliminating the segregation and separation of 'special needs' sheltering).
- Support is need for nursing mothers with Durable Medical Equipment (DME), including high-quality breast pumps and medical refrigeration, Consumable Medical Supplies (CMS) (including pads and human milk storage containers, bottles, etc.), and Personal Assistance Services (PAS) (including lactation counseling).
- Work should be performed with a continuous improvement perspective, and one which includes a feedback loop from the shelter clients (i.e., the nursing mothers) themselves.
- Exercises should be designed along a stair-stepped approach and follow the HSEEP process.
US FEMA
- Public Assistance Program and Policy Guide v5 (now includes congregate care support for breast feeding / chest feeding, on p. 143)
US FDA
International Association of Emergency Managers (IAEM)
- TBD
Academy of Breastfeeding Medicine (ABM)
U.S. Breast Feeding Committee (USBC)
- Breastfeeding References and Links
- Infant and young child feeding in emergencies (IYCF-E)
- Alimentación Segura en Emergencia (en español)
U.S. National Association of County and City Health Officials (NACCHO)
U.S. National Academies (NIH)
- Challenges in Supply, Market Competition, and Regulation of Infant Formula in the United States (2024)
- Barton Dunant Commentary
U.S. North Carolina
Australia
World Health Organization (WHO)
Sphere
- Sphere Interactive Handbook (2018) English Version, see Vector Control Standard 4.2, p. 124
- Minimum Standards (EN) for child protection in humanitarian action (CPMS-2013), Standard 22, p. 190
Jefferson County, Colorado, US
Academic Journal Articles (may require access)
- Dyck, S., R. J. Fraser, S. E. DeYoung, S. Leahy, and E. Pumo. “Including the Maternal and Infant Needs in Preparedness and Sheltering: A Case Study Emphasizing Hurricanes Ida and Ian”. Journal of Emergency Management, vol. 23, no. 2, Mar. 2024, pp. 341-50, doi:10.5055/jem.0907.
* non-governmental sites (commercial and non-profit) have not been fully researched, and may contain unverified and/or biased information. There may also be financial incentives towards specific products and/or services at those sites. Barton Dunant has no financial interest or connection, and makes no warranties for use.
