When can you take your baby out into this germy world ( 2016)

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. This is one of those questions that gets a lot of differing opinions from anyone you ask. The only opinion that really matters 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.  It is an especially popular question this time of year with the holiday season looming. Many folks have celebrations and gatherings ahead. Lots of folks are considering traveling.

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 provisions, and the choice to take a newborn out to a crowded concert.

Travel questions come up a lot. I would rather avoid having a very young baby on a full airplane 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.

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 posted about it a few weeks ago and since that post we have had positive tests in the office. I want my newborns safe.

I have a very different standard when dispensing advice about the under two month crowd. That two month old check up and first set of vaccines is a significant milestone. If you know that you have upcoming travel, bring that up at your early doctor appointments. In our office we can accelerate some of the first vaccinations.

Any fever in a young infant gets my attention. 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, a urine catheter, x-rays 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 their baby to have to  go through that.

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 by exposing you and your newborn. If you have family staying with you I prefer that anyone who is planning on spending time with your baby be vaccinated.  Ideally they have gotten the TDaP and Flu vaccines already. It takes a week or so for immunity to take effect. Plan ahead and make sure that family members get the shot now if they haven’t yet. Send them over to a pharmacy 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. We haven’t started seeing true influenza, but it is coming.

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. As I mentioned in my sibling post, tell your older child or any children who will be in close contact with the baby, that they are in charge of the “germ patrol.” It is their job to make sure that anyone who is going to touch the baby washes their hands first or uses a hand sanitizer. Good hand washing is essential but quarantining your kids from each other is not reasonable. Common sense also dictates that kids are likely contagious before you realized they were getting sick, and by the time you realize that something is up, it is already too late.

When making decisions about how much contact your infant is going to have with the outside world, it is nice to have choices. Unfortunately situations will come up when it’s not so simple. When faced with these types of decisions, recognize that things are usually not clear cut so explore your options. Sometimes they are limited so do the best you can and use your best judgement!

Antibiotic considerations

Fortunately  the majority of my patients understand that antibiotics need to be used with care. Antibiotic resistance is a reality and it is essential that we don’t exacerbate the problem by giving these important medications unless they are really needed. Antibiotics should not be given for viral illness. Of course, sometimes a viral syndrome does morph into something bacterial. Fluid in the sinus cavities, ears, or lungs can become infected. To be certain that we are dealing with a bacterial infection, the best practice would be to do a culture prior to starting treatment. Reality sets in and considerations such as cost and invasive testing are complicating factors. In our office the doctors use their best clinical judgement when deciding whether or not antibiotic treatment is appropriate. If a bacterial infection is suspected and treatment is started, here are some factors to consider: UNDERSTAND THE DOSE Many antibiotics come in different concentrations. Some conditions will warrant higher dosing and longer courses. Some doctors also will also have individual dosing habits and practices. Dr Schwanke has his own favorite way of using Zithromax. When he first started ordering it his way, it was routine for me to get calls from the pharmacies saying ??????     Parents, please don’t hesitate to check with your doctor/nurse if you have any question about the dosage. Read the directions on the bottle to see if refrigeration is necessary. I suggest keeping a checklist with the bottle. Check off each dose when you give it. This will help you keep track of the doses. It is not unusual for me to get  calls about double dosing when both parents realize that they had each given the scheduled dose. (Usually not a big deal, aside from possible GI upset, but keeping track is a worthwhile habit.) Some antibiotics like Septra can make you more sensitive to the sun. It is a good idea to be especially cautious about exposure if you or your child is on any medication. Antibiotics usually are better absorbed on an empty stomach, but medications like Augmentin can be tough on the tummy and taking them with food helps make them easier to tolerate. Ask the pharmacist if there are any food interactions to pay attention to. Some antibiotics don’t interact well with very acidic foods such as grapefruit juice. Some naturopathic doctors suggest that green tea is a positive thing to drink when taking medications. Warning to women on birth control pills - while this is not universal, some antibiotics do interact with, and minimize the effectiveness of, the pill. Unplanned pregnancies have happened. Sometimes parents report a miraculous improvement after the first dose, but that isn’t typical. Although folks are considered to no longer be contagious after 24 hours of treatment, It can take several days before the patient starts feeling better. If 3 or 4 days has passed with no change, it is worth checking in with your doctor to make sure you are on the right medication. DON’T PARTIALLY TREAT The goal of the treatment is to knock out the bacteria. Stopping the medicine mid course may allow the hardier bacteria to develop resistance to future treatment. http://www.cdc.gov/getsmart/community/about/antibiotic-resistance-faqs.html If you start the treatment and can’t complete the course, confirm with the doctor that the infection you are treating has cleared up prior to stopping. PROBIOTICS The job of the antibiotic is to kill bacteria. Our body has a host of necessary good bacteria that might be caught in the crossfire. If this balance gets out of whack, issues like indigestion and yeast can occur. I think that taking a good probiotic while taking antibiotics is a good move. Do not take them at the same time as the antibiotic, but space them out.  If the antibiotic is twice daily, give the probiotic mid day. BRUSH TEETH Most antibiotic liquids are loaded with sweetener to make them more palatable (I wish that the sweetness was magic, many are still pretty nasty.) You can also ask the pharmacy to add a flavoring to help with compliance. It is essential to brush teeth after every dose. I have seen teeth get discolored when this isn’t done. ALLERGIC REACTIONS As my favorite allergist says, “not all drug rashes are created equal.” Anything that seems drug related and involves blisters should be seen immediately. These can indicators of serious complications. If the patient gets hives, that is a sign  of a classic drug allergy. With hives or blisters no further doses of that medication should be given. Less serious rashes are more common, but are still worthy of attention. Some patients develop a rash once they have been on the medication for several days (8 seems to be the magic number for some reasonand Amoxicilin seems like a frequent culprit for this.) This might be a T-cell mediated hypersensitivity. Some physicians feel comfortable completing the treatment as long as the patient seems comfortable, but anytime a patient develops a rash when they are on medication it is worth having them seen. Remember, they were on medications for a reason. We don’t want to simply stop a partially treated infection.The doctor can make the decision if the condition still needs treatment, in which case we will likely swap to a different medication. If you child has any type of rash, their chart should be flagged with an allergy alert. If this was a hive reaction, that medication should not be given again. If it was a non hive rash, it is possible that it can be tried again cautiously in the future. There does seem to be some family tendencies toward allergies but no firm rules.  It is important that parents keep track of allergies, and don’t count on a notation in their child's records. With multiple children in the family, many parents actually have a hard time keeping track of who is allergic to what. If you are traveling, you should know what your child should not be treated with. The travel doctor most likely won’t have access to your child’s history.