Infants & Newborns in Emergency

Essential guidance for keeping infants and newborns safe during emergencies — covering feeding, warmth, medical needs, evacuation, and illness recognition.

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Infants and newborns are among the most vulnerable people in any emergency. They cannot communicate distress except through crying. They cannot regulate their own body temperature. They depend entirely on a caregiver for every survival need — feeding, hydration, warmth, and safety. A caregiver who has not planned specifically for an infant in an emergency is not prepared.

This guide covers the specific considerations for infants from birth to approximately twelve months in emergency and disaster situations. The needs of this age group are significantly different from older children, and they demand specific preparation.

The First Priority: Feeding

Feeding is the most urgent ongoing concern with an infant during an emergency. Nutritional deprivation, dehydration, or feeding with contaminated materials can become life-threatening within hours to days.

Breastfeeding in Emergencies

Breastfeeding is the single safest feeding method during any emergency or disaster. Breast milk requires no water, no fuel, no equipment, no hygiene infrastructure, and adapts to the infant's needs in real time. Breastfeeding mothers should:

  • Continue breastfeeding through stress and disruption — milk production may temporarily decrease due to stress but will not stop entirely with continued feeding
  • Stay hydrated — a breastfeeding mother needs at minimum two litres of water per day; carry extra
  • Know that physical stress, relocation, and sleep disruption are temporary challenges, not reasons to stop

If a mother was not previously breastfeeding and loses access to formula, relactation (restarting milk production) is possible but slow. Do not depend on this as an emergency strategy.

Formula Feeding in Emergencies

Formula feeding requires significant resources that emergencies may cut off:

  • Clean water for mixing (many formula types require boiled or purified water)
  • Fuel to boil water
  • Sterilised bottles and teats
  • A continuous supply of formula

⚠️ Never dilute infant formula to extend supply. Under-diluted formula causes severe electrolyte imbalances and can be fatal in newborns and young infants. Use the correct ratio exactly as specified, always.

Formula-feeding caregivers should store a minimum 2-week supply of formula (rotating stock) and have a safe, stored water supply for mixing. Pre-mixed liquid formula is safer in emergencies as it requires no water preparation, though it is heavier and more expensive.

Infant Water Needs

Infants under six months should not receive plain water. Their kidneys cannot process it and they can develop dangerous hyponatraemia (low sodium). All hydration should come through breast milk or correctly prepared formula. Infants over six months beginning solids may have small amounts of cooled boiled water, but breastmilk or formula remains the primary source.

Nappy and Sanitation Supplies

A newborn uses approximately 8–12 nappies per day. A 3-month-old uses 6–8. For a two-week emergency supply, calculate:

AgeDaily Nappies2-Week Minimum
0–1 month10–12140–168
1–3 months8–10112–140
3–6 months6–884–112
6–12 months5–770–98

Include in your infant emergency supplies:

  • Nappies (sized appropriately — check sizing regularly as infant grows)
  • Nappy rash cream (barrier cream prevents skin breakdown, which can become infected)
  • Wet wipes or clean cloths
  • Nappy bags for waste disposal
  • Spare clothing (at minimum three complete outfits)

In a true shortage, cloth nappies or towelling squares can be improvised, but require safe water for washing. Skin hygiene becomes critical to prevent infection.

Keeping Infants Warm

Newborns and young infants cannot regulate their own body temperature. Hypothermia can develop quickly in a cold environment, and overheating is equally dangerous. Normal infant body temperature is 36.5–37.5°C (97.7–99.5°F).

Signs of an infant who is too cold:

  • Cool or cold skin, especially the chest and abdomen
  • Pale or mottled (blotchy) skin
  • Weak crying, lethargy, poor feeding
  • Shivering (rare in newborns — absence doesn't mean they are warm enough)

Warming an infant who is too cold:

  1. Remove them from the cold environment
  2. Skin-to-skin contact with a caregiver inside clothing is the fastest warming method
  3. Wrap in dry blankets
  4. Feed (breastmilk or formula) to provide caloric warmth
  5. Monitor temperature

Layering is the correct approach for infant warmth — thin layers trap air and insulate. A sleeping bag or swaddle in a cool environment is often sufficient.

Infant Medical Kit

An infant-specific medical kit should include:

ItemPurpose
Digital rectal or forehead thermometerAccurate temperature measurement
Oral rehydration salts (infant-safe formula)Dehydration management
Paracetamol infant drops (age-appropriate)Fever management
Nappy rash creamSkin barrier protection
Saline nasal dropsNasal congestion relief
Alcohol-free antiseptic wipesWound cleaning
Sterile gauze padsWound dressing
Scissors with rounded tipsSafe cutting
Bulb syringeNasal/mouth clearance
Vaccination record (copy)Medical history at any facility

Keep all medications clearly labelled. Check expiry dates. Replace all expired items.

Recognising Illness in Infants

Infants cannot describe symptoms. Caregivers must watch for signs. The following symptoms in an infant under 3 months require urgent medical attention. In an emergency setting without medical access, these are high-priority situations requiring the most intense response available:

  • Temperature above 38°C (100.4°F) in infants under 3 months — always urgent
  • Persistent weak or high-pitched crying
  • Refusing to feed (several consecutive missed feeds)
  • Dry mouth, no wet nappies for 6+ hours — indicates dehydration
  • Sunken fontanelle (soft spot on top of head)
  • Difficulty breathing: rapid rate, nostril flaring, visible ribs during breathing
  • Rash that does not fade when pressed (glass test)
  • Unusual limpness or unresponsiveness
  • Pale, blue, or ashen skin

⚠️ In an emergency without medical access, a sick infant under 3 months is always a priority evacuation concern. Do not wait. Seek the nearest medical facility regardless of the circumstances. Infant illness can deteriorate to life-threatening within hours.

Evacuation with an Infant

Carrying an infant during evacuation requires hands-free options when safe passage is uncertain:

Baby carrier (sling/structured carrier): Keeps hands free, maintains skin-to-skin warmth, keeps infant's airway accessible. Check infant's face is always visible and chin is off the chest (the TICKS checklist). Best for foot evacuation.

Pram/stroller: Faster on smooth surfaces but impractical on rubble, stairs, through smoke, or in crowds. Have a carrier available as a backup whenever a pram is your primary option.

Car seat: Appropriate for vehicle evacuation. Every infant should have a car seat in the evacuation vehicle. Never place an infant seat on a car seat that has been in a crash — replace it.

Things to carry for infant evacuation:

  1. At least 48 hours of formula or confirm breastfeeding
  2. 24 hours of nappies
  3. Warm wrap and change of clothing
  4. Medical kit and vaccination record
  5. Comfort object (reduces distress)

Special Considerations for Premature Babies

Premature infants have additional vulnerabilities:

  • Temperature regulation: Premature infants are especially prone to heat loss. Extra layers, close body contact, and enclosed environments are critical.
  • Immune compromise: Pre-term infants have immature immune systems. Avoid exposing them to crowds, communal shelters, or sick individuals if possible.
  • Feeding complexity: Many premature infants have specific feeding protocols. Carry written instructions from their medical team.
  • Medical equipment: If a premature infant is home on oxygen, apnoea monitor, or other equipment, register with local emergency services pre-event (many jurisdictions offer medical priority registration). Have a plan for power loss.
  • Specialist records: Carry complete NICU discharge documents, specialist contacts, and a summary of the infant's medical history.

Vaccination Records

A copy of the infant's vaccination record should be in your emergency bag. In a shelter or emergency medical setting, this prevents unnecessary vaccinations and alerts staff to any scheduled vaccinations the infant may be due for. Laminate a copy or store a photograph on your phone with a cloud backup.

Quick Reference

SituationAction
No formula availableContact Red Cross, aid station, or shelter. Never dilute existing formula.
Infant appears too coldSkin-to-skin warming inside clothing, wrap in dry blankets, feed
Infant has not had wet nappy for 6+ hoursDehydration risk — increase feeds, seek medical attention
Infant has fever above 38°C (under 3 months)Urgent — seek medical care immediately
Evacuation on footUse structured baby carrier, hands free
No clean water available for formula mixingUse pre-mixed liquid formula or seek water supply before preparing
Power outage with premature infant on equipmentActivate backup power plan, contact emergency services, move toward medical facility
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