Keeping newborns well

About making tough decisions

Happy Thanksgiving! Thank you all for following my newsletter. I hope you find it helpful, and I’d love it if you commented to let me know what you’d like me to talk about next.

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In my pandemic book, I had a chapter about newborns that I’ve been thinking about it recently as I have helped many friends through tough decisions about protecting hteir baby at home. It sounds easy to always keep sick people away from a newborn, but in real life it’s rarely straightforward. Decisions are often much more complicated.

• When mom or dad is sick the week of thanksgiving and the baby has already been exposed, are you really going fully quarantine apart?

• What about when the the older sibling is sick and keeping them separate feels impossible?

• Sometimes a friend or family member was recently sick - even if they are now better they still have a bit of a sniffle or cough. Should they come?

Tiny babies are obviously vulnerable. They depend on us for everything and they even have a soft spot on their head where you can feel their brain directly through their skin. As a pediatrician, I have seen ill babies cope remarkably well until they use up their limited reserve of energy and suddenly deteriorate. Because of the unpredictable nature of their response, we have precautions in place to take any illness seriously in babies under 2 months of age. Fever should be treated like an emergency and a doctor involved if your child is sick.

The magnitude of the risk from coronavirus seems similar to other viruses that circulate in our community every year. It may even be that the risk to babies from coronavirus is slightly lower than influenza and RSV (while the risk of coronavirus for adults is much higher than these circulating viruses). For newborns, the risk of complications and hospitalizations from influenza and RSV is significant and matters. Many parents prior to the pandemic may have underestimated the impact of these viruses, but now this concern is front and center on everyone’s mind. So I’d like to share a story where a baby got sick, and one where I took a calculated risk.

When my dear friend had her second baby, she wanted to travel by plane to spend time with her parents during maternity leave. Prior, her baby hadn’t been out much, as he was only six weeks. Likely en route he caught a virus, while at the grandparents’ house he developed fever and required hospitalization. He had blood draws and a spinal tap, a needle inserted into his spinal column that showed a common virus — enterovirus — had caused a viral meningitis - an infection that spread to his brain. He remained well, other than signs of a cold and fever, and was discharged after a couple of days. He’s now 11 and a smart, charming and athletic boy, but the illness caused a major stress. But this story is relatively common, we know that everyday viruses can cause more serious infections.

So you might think with after watching my friend go through this, I put my own children in a bubble, but no. When my son was born, Thanksgiving was 10 days later and 5 days after being discharged from the NICU. We had to decide whether to see family. I was worried that someone would get my little one sick. But my husband wanted to see his family and show off his new baby, and I was feeling ready to get out of the house. A few people were attending Thanksgiving who might not have been able to join the following year and it was important to my husband. So we decided to mitigate the risk as best we could.

For us, this meant asking everyone to have gotten the flu vaccine prior to Thanksgiving. While the baby was too young to be vaccinated, the flu vaccine decreased the likelihood of attendees exposing the baby to flu. (This was before the COVID vaccines were out but the concept is the same, the risk is decreased even if it’s not eliminated). We made sure that no one came sick or “sort of sick.” And we asked people to wash their hands on arrival and before holding the baby. When people were holding the baby, I would ask them to use a blanket over their clothing. This would protect their clothing from any baby spills and my baby from any fomites on their clothing. I’ve heard from many parents — particularly new parents — that navigating these conversations with friends and families can be difficult. I got a LOT of eye rolls. Your loved ones may disagree with the plan, but setting limits that you feel comfortable with is a normal part of parenting.

Keep in mind that individuals with influenza are typically contagious for 5-7 days and with RSV the average is 4 days though there is a wide range as shown in this chart.

Both viruses can be spread by respiratory means AND by contact (touching infectious particles). You can decrease baby’s exposure to respiratory droplets by using masks, air purifiers or keeping windows open. And as a pediatrician who often sees germs, I change clothes before I hug my kids at the end of the day. I also recommend wiping down phones and high touch surfaces to protect against infection.

Still at the end of the day, you make the best decisions you can with the information at hand. Despite best efforts sometimes babies will get sick. Have you had to make tough decisions this holiday? Or maybe you’ve been struggling with sick kids?

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My book Advanced Parenting has loads of content about approaching difficult decisions and is available for presale! If you’re going on a shopping spree throw it in the cart!