Read on for information on visitors, taking them outdoors, and fevers in newborns
Check out the PedsDocTalk YouTube Video: Newborns, Visitors, Taking Them Outdoors & Fevers in Newborns for more details on when a newborn’s immune system is “ready to go,” travel and other outing recommendations, older siblings and infection risk, reducing infection risk, and rules with visitors.
All about newborns!
First of all, congratulations, I’m sure you’re so excited to welcome that new baby into the world! Have you bought the New Mom’s Survival Guide yet?! We have way more for you inside this course and community, so join us if you are a new mom. All moms of older kids and newborns welcome!
We all know that socialization is really important and that we want everyone to see our newborn.
But we want to do it in the safest way possible. Read on for my tips!
A newborn is any baby under two months of age. Why do we care so much about babies who are under two months of age in regards to infection? In babies under two months, their immune system is immature as they have not been exposed to the pathogens and the microbes like an older child yet. We don’t want them to get sick with really bad illnesses. It has a lot to do also with the blood-brain barrier. This is a barrier that helps keep things in the blood or in the body away from the brain.
In little babies under one month of age, if they get a fever, we’ll do a workup to make sure it’s nothing serious.
In the USA, if your baby under one month of age has a fever, over 100.4 taken rectally, you’re going to need to go to the ER. If your child is not feeding well, your baby is super fussy, feels warm, too sweaty, etc. I want you to take a temperature rectally. Rectally is the most accurate way to take a temperature. If you take a temp and it’s 100.2, I want you to check that temperature again in 20-30 minutes. If it’s over 100.4 and your child is under 30 days old, you need to take that child in to be evaluated immediately.
Evaluation can look like a CBC, which checks for infection. It can look like a urinalysis, which checks for a urinary infection. It can look like blood cultures to make sure there’s no infection in the blood. And it can also look like a lumbar puncture, which is a procedure that takes spinal fluid to make sure that there’s no infection in the brain. Babies this young are going to have to be observed for at least 48 hours until all those cultures and workups are normal.
If your child is between 30 and 60 days old, and has a fever over 100.4 taken rectally, it’s important to let your child’s clinician know. They’re going to probably do a limited workup of a physical exam and bloodwork. Based on that, they may decide to check a lumbar puncture. They’ll probably check a blood culture depending on how the child’s looking.
My personal opinion is that if your child is under one month of age, and has a fever that’s confirmed rectally, you need to go to the ER.
Between one and two months, you can call your child’s clinician.
If for any reason they’re not answering, if they’re closed, then I would recommend evaluation in the ER. Between two months and three months, the recommendation is that if this is your first fever, run it by your child’s clinician.
It doesn’t mean an automatic infection. It just means hey, a lot of people getting together can put someone at risk, not even just newborns, but adults, too. I don’t want your newborns getting sick if we can avoid it. Obviously, you can’t control everything, but we’re trying to reduce risk as much as possible. And part of that risk reduction is avoiding a lot of people, crowds of people, etc. The other reason is that if your newborn does get sick with a fever, that’s going to require a workup as mentioned above.
Well, similar to COVID, the idea here is risk reduction – we want to look at doing activities with the lowest risk possible if we’re going to be with other people. Obviously, not seeing anyone at all is going to be the best in terms of risk reduction during a pandemic.
But if you want to have people over or if you want to see other people or take your baby out, what is the best way to do this? Or is it even worth it at all?
To illustrate an example, let’s discuss travel. This is a common question I get asked, and more particularly airline travel. I recommend waiting until two months of age for all the reasons I mentioned above. I want them to be a little bit older so that we don’t have to do the big if they get a fever. This is about risk reduction: more points of contact in crowded airports and travel can mean more chance of getting viral illnesses.
Of course, it doesn’t mean that you go on a plane and all of a sudden you get sick. But there are more points of contact right? Through the airport, you’re running into other people, you have to go through baggage claim, you’re on an airplane, and also on your destination, you’re going to see a lot of other human beings that can transmit illnesses.
In the end, if you MUST travel. You travel. This is about weighing benefit and risk. I have many families who have adopted a child and have to fly under the two month mark: AWESOME! This is something that needs to happen.
You are absolutely okay to go on walks as soon as you’re comfortable doing it. A walk is a very low-risk activity for me. Obviously, if you’re in a crowded New York City street, then maybe that’s a lot of exposure. But going for a walk is important for the parent, the caregiver, and also for a baby to just get outside during the day hours.
You’ll leave your newborn at home if you have an option to leave your newborn at home. To be honest, not everyone does. And I don’t want us to judge parents who do not have that option. If you need to drop off your older sibling to daycare, you have to take your newborn with you, where are they going to stay? They can’t stay at home without anyone. So they’re coming with you. So this is really important that we understand that we are doing the best we can with the information and resources we have. But if we have to take our newborn, we take our newborn. This is again about risk reduction. And if we have to take our newborn out, we take them out. We have to drop off our older sibling to the daycare, that’s fine. We have to go to the grocery store, that’s fine.
My first rule with visitors is you need to talk to your partner, if you have one, on what you want with visitors and what your rules are. Some parents don’t want visitors and that should be okay. You need to decide who you want to visit. And if you want them to visit at all – this is really important. I find sometimes that parents become overwhelmed and they are afraid to say no because they don’t want people to feel bad. You have to set the rules that are important for you! You want to have the ability to just be comfortable and not have to entertain guests – you need to decide what’s most comfortable. I like to prioritize visitors who are helpful to you or helpful to the baby. You need to heal if you’ve just had a baby.
It really comes down to your style. Some people are going to be more direct – don’t touch my baby. Some people are not that confrontational. This is for strangers that you may see outside at the grocery store or at any store. You can say directly, “Please don’t touch him or her.” That’s it, done. You don’t need to say why, you just say direct, “Please don’t touch him.” And they can decide how they feel about that. Another tip is putting a sign on your stroller. This is something that can say, “I’m a little baby or I’m a newborn, please look but don’t touch.” This is a good idea if you’re going to be going into a place of worship, for example, or to a wedding where people are going to be coming up to newborns.
The last thing, (which is a method that I talk to my families a lot about) is you can blame the doctor! If you have trouble setting boundaries with a family member, or you don’t want a visitor, you can say, “Hey, my child’s clinician is not comfortable with having visitors or my child’s clinician said that this is not the right time.” It’s okay to do that.
As a mom myself, remember that your desires may change. Before I had Ryaan, I said I would not want a lot of visitors. And then after I was like, “Yes, please, everyone come!” This was before the pandemic. It’s really important to recognize that things may change and your boundaries may change, but remember what you want before going into it.