Non-Puerperal Adoptive Breastfeeding as Lactational Rescue in the Rohingya Refugee Camp: 2 Case Studies

Abstract

Introduction: Non-puerperal adoptive lactation sometimes requires long preparation and substantial expense for pharmacological intervention to be successful, which are not feasible in refugee camps. Here we report two case studies of non-puerperal adoptive breastfeeding of two infants in the Rohingya Refugee Camp of Cox’s Bazar, Bangladesh. Main Issue: Two non-pregnant, non-breastfeeding caregivers with previous experience of breastfeeding brought two adopted infants—one a 12-day-old female with severe acute malnutrition, and the other a 2-day-old male with normal anthropometric measurements—to a nutritional stabilization center for feeding. After counseling, both families opted for adoptive lactation. Management: Both infants were treated with a modified Action Against Hunger protocol of in-patient management of severe acute malnutrition using the supplementary suckling technique, a procedure to feed the baby with supplementary feed. Diluted F100 was used as the supplementary feed; the energy and protein gained from it were just enough to maintain body physiology and were not responsible for any weight gain. When the infants gained weight, indicating that the caregivers were producing milk, we reduced the supplementary feed as per protocol guidelines. The caregivers were prescribed domperidone and counseled on their ability to breastfeed the infants. The cases required 35 days and 20 days, respectively, for the full establishment of breastfeeding. Conclusion: This is the first report of successful adoptive breastfeeding in a refugee camp. With proper counseling and motivation of the caregiver, induced lactation can be started without a preparatory period and with very low-cost intervention.