Friday, December 19, 2014

Taking your infant out into this Non sterile world

When is it okay to take a newborn baby out into the germy world?

This is one of those questions that gets a lot of strong and differing opinions from anyone you ask. The only opinion that counts in the end is that of you and your partner. All the well meaning friends, family and healthcare professionals can only advise. It is up to you to pick a path that feels right for you.

The discussion with new parents about when it is safe to take the baby out and about and risk exposure to crowds comes up quite a bit. It is an especially popular question this time of year with holiday celebrations and gatherings.  I don't always have the same answer each time.

It is often not a black and white case and we end up trying to identify all the considerations specific to your situation. There is a vast difference between a single parent taking the baby with them to get some food, and the choice to take a newborn out to a crowded concert. Sadly, I recently had to tell the parents of a 3 day old that I thought taking them to one of the World Series games was a VERY bad idea (they heeded my advice, and no I didn't get the tickets.)

Travel questions come up a lot. I would rather avoid having a super young baby on a full airplane flight but some travel is worth the risk. I would likely say "go for it"  to a baby going to see aging great-grandparents, or to a once in a lifetime family event like a wedding. I would say "are you absolutely nuts???" to a family taking an infant to a beach vacation in Mexico.

These of course are my opinions. Parents get to make their own choices.
What time of year is it? Are there any active viruses circulating? We are just coming into the winter cold and flu season. I am going to be stricter in my recommendations this month. RSV is actively going around. I want my newborns safe.

Here are some factors to consider.

Babies are the most vulnerable the first 6-8 weeks of life. If one of these young babies gets a fever, it is going to be taken very seriously by any doctor that they encounter. In an emergency room, a fever in a young baby will most likely trigger diagnostic testing such as blood work, urine catheter, x-ray and even a spinal tap.
If in fact that baby has a serious infection, early intervention can be life saving, so the doctors aren't kidding around. No one wants to put their baby through that.
I have a very different standard when dispensing advice about the under two month crowd. Any fever gets my attention. That two month old check up and first set of vaccines is a significant milestone.

I know that many new parents get cabin fever, but whenever possible, keep your newborn away from any circumstance that may expose them to anyone who is sick. In general crowds should be avoided. If someone is coming to the house to visit make sure they are healthy before they come in. If they feel like they may be coming down with something, they are not doing you any favors. If you have family staying with you, ideally they have gotten the TDaP and Flu vaccines already. Unfortunately the Flu vaccine this year may have missed the mark and an early look at the Flu cases so far indicates that even if you have had the shot you may not be as protected as we would hope.
In any case, it does take a week or so for immunity to take effect. Better late than never. I prefer that anyone who is planning on spending time with your baby to be vaccinated. Send them over to Walgreen's for the shots as soon as possible if they haven't gotten around to it. As long as visitors appear healthy and are more help than hindrance, don't hesitate to take advantage of your support network even if they haven't gotten the shots yet. Good hand washing is essential.

First time parents have the luxury of protecting and isolating the baby and should take advantage. That being said, in my opinion, a walk outside on a lovely day is usually perfectly fine for even the most conservative family

Second kids are a different story by necessity.  They are often born into the situation where they have a loving, snotty nosed older sibling that wants to kiss and handle them from the start. These babies generally get exposed to things much earlier. Anyone who has multiple kids can tell you that it is really sad watching the young babies struggling with their first illness.

When making these types of decisions what are your actual options? Sometimes they are limited, in which case you simply do the best you can.
Use your best judgement!

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