It can be scary to be a parent and be responsible for a baby’s health, safety, and well-being, especially during a global pandemic. Weighing your baby’s risks of exposer to COVID-19 against the benefits of social interaction can be challenging. You may decide the best course of action is to be isolated right now. Or you could decide that you need to be surrounded by friends and family. Let’s examine the risks of COVID-19 for newborns so you can better determine what level of precautions you want to take.
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Making Decisions Based on Evidence, Not Fear
It can be scary to be a parent and be responsible for the health, safety, and well-being of a baby, especially during a global pandemic. There are still a lot of unknowns around COVID-19. This is a novel disease and we are still trying to fully understand exactly what the risks are, not just short term, but long term. When you become a parent you will find yourself worrying about all kinds of threats, real or imagined, to your baby. Please make your decisions based on evidence and not based on fear.
Weighing Benefits and Risks
Many of the decisions you will make as a parent will be based on weighing risks and benefits. You could decide that the risk of your baby getting COVID-19 is high. You could choose to limit your interactions with others. To stay in your home and not get outside where you could encounter other people. That calculation will look different for everyone. Let’s examine some of the evidence-based risks of COVID-19 and your baby.
The Evidence on Newborns and COVID-19
The CDC states that most newborns who tested positive for the virus that causes COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness. Children under two are at a higher risk for a serious case of COVID-19, as well as children born prematurely.
There have been some cases of pediatric multisystem inflammatory syndrome showing up in children who have SARS-CoV-2. This is rare, but can be very serious and involves inflammation of the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. This is something doctors are still working to understand. Since the CDC started tracking this in mid-May 2020, there have been 1,163 total confirmed cases up until 10/31/20. There have been 20 deaths, but I was unable to locate data on the ages of the children who died. Less than 4% of the total cases were in babies under age one.
A systematic review looked at community-onset SARS-CoV-2 in infants under three months. The review included studies as well as individual case reports. These were infants that contracted SARS-CoV-2 at home or outside of the setting where they were born. In total there were 63 cases included in this review. 58 of those were hospitalized, 13 in the ICU, and 2 required mechanical ventilation. No deaths were reported.
A study in the U.K. During a two month period in March and April of 2020 identified 66 babies with a SARS-CoV-2 infection. Of these, 42% has a severe neonatal SARS-CoV-2 infection. It should be noted that 24% of these babies were born preterm. As of July 28, 2020, 88% of the babies were discharged and went home, seven remained in the hospital, and one baby passed away due to causes unrelated to SARS-CoV-2. This was also in the peak of infections in the UK and the overall instance was one in 1,785 births.
The takeaway from these studies is that most babies were mildly affected, and cases of severe illness are rare. Overall children are showing more mild symptoms, than adults. But, children under two are thought to be at the highest risk. For this reason, you should be observant for any signs of COVID-19 and contact your pediatrician right away if you notice any symptoms or have any concerns. Even with low risk, if your baby does get COVID-19, the sooner you catch it, the better.
Symptoms of COVID-19 in Babies
The most common signs of COVID-19 in babies are fever, poor feeding, and vomiting. Other symptoms include shortness of breath and being lethargic. A fever in a newborn is serious and if your baby does have a fever you should contact your pediatrician. Ask your pediatrician what temperature constitutes a fever, when to call them, and when you should be taking a newborn to the emergency room. Make sure you have contact phone numbers for the office and how to get in touch with someone if it is outside of normal office hours. Also, make sure you know how to take your baby’s temperature correctly.
We covered a lot of evidence on the risks of COVID-19 in babies. Unless you live alone on a remote island with no contact with the outside world, you cannot reduce your risk to zero. Everyone who comes into contact with other people is exposed to some amount of risk of getting COVID-19. Even if you live in a highly populated city there are a lot of things you can do to mitigate your risk and the risk to your baby.
Wearing a Mask and Washing Hands
We have heard over and over that you should be washing your hands frequently, and this is still one of the best ways to stay healthy. You can also wear a mask when you are around other people. Depending on where you live, masks may be required in public or inside businesses. Masks are only recommended for ages 2 and older. Putting anything over your baby’s face could increase the risk for SIDS (Sudden Infant Death Syndrome), suffocation, or strangulation. Please do not ever put a face mask on your baby.
You can keep your baby in a carrier or sling so they are close to you, and facing your chest, rather than facing outward. If you take your baby somewhere in a car seat carrier or a stroller you can put the canopy up or drape a light blanket over it. This is going to give your baby some protection, plus strangers are less likely to approach your baby and get close to them if your baby is covered up.
Breastfeeding and Your Baby’s Immunity
One of the most significant benefits of breastfeeding is the immune-boosting properties of breastmilk. Babies who get breast milk are better protected to fight off illnesses, and they have stronger immune systems. You are directly passing antibodies to your baby through your breastmilk. If you are unable to breastfeed your baby directly, the next best thing is pumping milk. After that, if you have access to donor milk, that could also be an option. While exclusive breastfeeding is ideal, it is not an all or nothing. If your baby drinks formula, you can still breastfeed and give them the benefits of breastmilk, even if they are not drinking breastmilk at every feeding.
There are ongoing studies, like one at the University of California San Diego that is investigating whether the virus is transmitted through breastfeeding and if human milk can protect infants from COVID-19. The latest research shows that breast milk is not likely to be a source of infection for babies. They also took samples and added SARS-CoV-2 and when it was pasteurized SARS-CoV-2 was not detectable. This means that if you are considering milk from a milk bank, SARS-CoV-2 should not be a concern.
Some of the most prominent health organizations including the American College of Obstetricians and Gynecologists, the World Health Organization, and La Leche League all recommend breastfeeding, even if you have COVID-19. Breastfeeding will make your baby’s immune system stronger.
Risks to Your Mental Health
Humans are social and we did not develop to start families and raise children in isolation. It can be a huge adjustment to becoming a parent. Trying to do everything alone can be daunting, lonely, and frustrating. Prior to COVID-19 new parents commonly had lots of visitors after a baby was born. The family would visit. Friends would stop by with food. Now with everyone social distancing, some new parents are finding themselves completely isolated. You can have a Zoom coffee date or a phone call with a friend but that will not replace in-person interaction. You may do well relatively on your own, or you may be struggling with social distancing.
Your mental health should be at the top of your priority list. If your mental health is suffering it will make every aspect of parenting, breastfeeding, and taking care of yourself more difficult. The baby blues or postpartum depression are very common in new mothers. After you have a baby your hormones change significantly, you are lacking sleep, you are trying to navigate breastfeeding, and you are suddenly in charge of raising a human. This is not easy and humans were not meant to do this alone. You need help. What form of help and what level of risks you comfortable taking will be unique to you. The good news is that there is a lot you can do to mitigate the risks of COVID-19 to you and your baby and still get some social interaction.
Virtual contact is not the same thing as seeing someone face to face. Still, it can be helpful to have a group text chat going with friends, hop on Facetime with family who live far away, or catch up with a friend over the phone. Many people will want to give you some space after having a baby and may not reach out to you because they think that is the right thing to do.
If you would enjoy catching up with someone you may need to reach out first. That can be as easy as sending a text saying, “Hi, I would love to catch up, is there a good time next week for call?” You can also ask friends or family to periodically check in on you. The next time you talk to a friend let them know it is so nice to talk to someone. It is so easy to get wrapped up in taking care of a baby. Let your friends and family know you want periodic calls or texts.
Weighing Risks of Who You See in Person
If you have a friend who works in a hospital, that is a different risk than someone who is working from home. You can find out pretty quickly whether someone is being cautious by asking how they are handling this whole pandemic. You will likely get a response like, “I am over it and I don’t even care any more” or “I am still being careful”. Deciding to see someone in person does not mean you have to extend that invitation to everyone you know. You can pick and choose who you see based on the level of risk you are comfortable with.
If you are seeing people face to face there is a lot you can do to lower your risks of COVID-19. Weather permitting, try to get together outside. Put your baby in a stroller and go for a walk. Meet up for a picnic in the park or have a meal in your backyard. If you are concerned about other people putting you at risk for COVID-19 you can always ask some simple questions to assess your risk or make some requests ahead of time. Some examples are:
- I would love to get together for a short visit. I am being careful because of the new baby and I just want to make sure you and everyone in your house has been healthy. Has anyone had any symptoms of a cold or other illness recently?
- We are being extra cautious right now, have you been socially distancing or working from home?
- It would be wonderful to see you. Just a heads up, we are being careful per our pediatrician’s instructions and we are not letting anyone hold the baby.
- If you are comfortable doing a socially distanced visit outside, it would be great to see you.
Forming a Pod
Many families have been forming pandemic pods. This is essentially a group of people or families who have decided that they are all on the same page with how careful they are being and are comfortable getting together. You can set ground rules for things like, if anyone travels then they quarantine for a certain amount of time. Everyone should be relatively taking the same precautions and limiting their interactions with people outside of the pod. This tactic can be a lifesaver for your mental health. In theory, limiting your interaction to a select group, should limit your risks. This is assuming everyone is following the agreed upon rules. Then, you have a group of people you can see in person, or who can help with your baby.
This doesn’t have to be rigid group with written out guidelines and rules. You can decide that you have some friends or family members that you are comfortable being around. Like any interaction, this increases your risk at some level, but it is a calculated risk.Remember, if you are struggling with being isolated you need to take into account the benefits of social interaction on your mental health.
Avoiding Unnecessary Exposure
Even though social distancing rules vary depending on where you live most big events are not taking place. The most prudent move would be to avoid any place with large crowds. This would include weddings, large get togethers of people, houses of worship. Each of these events has benefits, but they also come with risks. It will be up to you to decide whether you want to attend, and whether you will keep some distance or wear a mask when you go. You may decide not to bring your baby and have a family member or friend watch them to minimize their risk at a large event. If you are not comfortable attending an event you have been invited to you should be able to tell the host that you want to be careful with the new baby and look forward to resuming visits in the future.
Shopping, Grocery Stores, and Errands
Even in the middle of a pandemic we still need things. It is great that we have so many options for delivery services and shipping, but that sometimes comes with additional costs. If you are going to a grocery store or running errands there are several things you can do to lower your risk of exposure to SARS-CoV-2. The first would be to not go and get a delivery, or ask your partner or a friend to go for you. If you do need to go you can wear a mask, be mindful about touching your face, wash your hands, and leave your baby with your partner or someone else at home.
Not everyone has the luxury of having a partner who is available and you may need to run errands with your baby in tow. If you do you can put your baby in a carrier, sling, or keep them in an infant car seat or stroller. Be mindful about touching your baby or their face until you have had an opportunity to wash your hands.
Choose Your News Sources Wisely
How up to date you want to stay on the COVID-19 pandemic is a personal choice. If you are spending a lot of time reading or watching the news, a good question to ask is, “How is this information informing my decisions?” If you alter your behavior or the precautions you are taking as a result of how many cases are in your area, then you are doing something useful with that information. If the news changing nothing in your life and it is giving you anxiety, turn it off. You can also choose sources that are less likely to use fear-inducing headlines or sensationalize the news.
Talk to Your Pediatrician
Continue to check in with local resources for your city, county, or state for instructions that will apply to you. Please discuss this topic with your doctor or midwife during your pregnancy for their thoughts and recommendations. They are your trusted partner during your pregnancy and birth and can help you navigate this.
If you already know who your pediatrician will be reach out and talk to them about COVID-19 and your baby. Get their recommendations for what you should be doing and ask what signs to keep an eye out for. If you do not have a pediatrician yet, finding out how they answer your questions on COVID-19 should give you a good idea of what kind of doctor they will be. Are they understanding of your concerns and thoughtful about their recommendations? Do they brush off your questions and refer you to CDC recommendations? Ideally, you have a pediatrician you can have a dialogue with and who understands the need to balance your needs with your baby’s to keep you both healthy, physically, and mentally.
Dealing With Other People’s Opinions
The other side of what risk you’re willing to assume is how your friends or family feel about COVID-19. You may have someone who does not want to meet up because you were just in a hospital having a baby. You may have parents who think you are overreacting and COVID-19 is just like the flu, or vice-versa. Your pediatrician is also a great excuse for getting out of any in-person encounters. If you don’t want your aunt coming over to meet the baby, tell her you would love her to meet the baby but your pediatrician said it is best to hold off on introducing your baby to new people right now.
This pandemic has been hard on everyone in different ways. As an expecting or new mother, you have been through the unique challenge of growing a human during this time. You will get through this. Be confident in your decisions, don’t let other people talk you out of what you want. This is what being a parent is. It is making tough choices because they are in the best interest of your family. That may mean that you are really isolated right now. That may mean that you need to be surrounded by friends and family during this time in your life. Yes, you need to take care of your baby, but if you don’t also take care of yourself, being a mother is exponentially more difficult. There is no one right answer and I truly hope you can be confident in whatever you choose.
Thank you to the amazing companies that have supported this episode.
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