What parents need to know

If you have a baby at home, or are expecting one in the next few months, you could be on edge for all kinds of reasons, but mostly because of COVID-19. The delta variant of the coronavirus has made almost every community across the country a bright red hotspot of viral infection. Babies cannot yet be vaccinated against COVID-19 – and the youngest age included in current clinical vaccine studies is six months.

In fact, the rate of new cases of COVID-19 in babies and children under 4 in the United States recently exceeded the rate of new cases in adults over 65, according to the Centers for Disease Control. and Prevention (although the number of deaths among children remains very low).

“People were like ‘Oh kids don’t get COVID’ – that’s really not true,” says Dr. Jennifer Shu, a pediatrician in suburban Atlanta. “They get it at the same rates we would expect, based on their [portion of the] population.”

Shu says she is worried: “Because they are not disproportionately vaccinated, we will see above. [case] numbers of children, as variants like delta take advantage of vulnerable people. “

Here’s a guide to the latest scientific knowledge – and some practical advice – on how to protect a new baby from all variants of the coronavirus.

There are many reasons why obstetricians-gynecologists, midwives and infectious disease experts encourage anyone who is pregnant to get the coronavirus vaccine, the first of which is: COVID-19 can make pregnant women particularly sick. .

Then there is this bonus of vaccinating a pregnant person, explains Dr Flor Muñoz, a pediatric infectious disease specialist at Texas Children’s Hospital and Baylor College of Medicine: the fetuses receive a share of the antibodies generated – via the placenta. .

“The paradigm of vaccinating a pregnant woman so that her newborn and young child are protected from disease is a long-standing one,” notes Dr. Karen Puopolo, who heads the neonatal medicine section at Pennsylvania Hospital in Philadelphia and conducts research. research on neonatal infectious diseases. . For example, pregnant women have long been encouraged to get the pertussis vaccine so that their bodies generate antibodies that pass to the fetus and protect the baby after birth.

There isn’t a particularly recommended time to know when to get the COVID-19 vaccine during pregnancy, Muñoz says. But because of the timing required with Moderna and Pfizer for two injections several weeks apart, if you get vaccinated “around the second trimester, you will be protected during the period of highest sensitivity, which is the third trimester”. .

In fact, explains Puopolo, “at the end of the third trimester, there is an active process for your body to make your baby have more antibodies – in terms of concentration – than there is. there is in you “.

Muñoz is currently leading a large NIH-funded study called MOMI-VAX to collect extensive data on mothers and infants and immunization, including measuring the concentration of SARS-CoV-2 antibodies in the mother versus baby at birth. He will also look at how long these antibodies last and how well they protect the baby from infection. (The study began recruiting volunteers in early July, with plans to follow individuals and their infants for a year after giving birth.)

It is likely, Muñoz says, that the antibodies borrowed from pregnancy decline in the first two months of a child’s life.

Mothers who have been vaccinated or have had coronavirus infections in the past can also pass antibodies to their babies through breast milk, which acts as a temporary shield inside the mouth, nose and stomach. , explains Muñoz.

“It’s mostly a surface coating, if you will,” she says. This coating is useful because “this is where these respiratory infections enter – from the baby’s nose or mouth.” Details on the operation and operation of this mode of protection are part of his MOMI-VAX study.

To be clear, however, she adds, “in relation to the [the quantity of]antibodies that babies get through the placenta – therefore directly into the blood – the contribution of antibodies from breast milk is less. “

This is why Shu in Atlanta is concerned. She says that even in her highly vaccinated community, she sees many pregnant women who do not get vaccinated.

“I see too many people who choose to wait for the postpartum vaccine,” Shu says, “and they really rely on some immunity through breast milk to protect their babies.” Nationally, only about 1 in 4 pregnant people had at least one dose of a coronavirus vaccine at the end of August, according to the CDC.

“Because the delta variant is as transmissible as it is, I would really like moms to get vaccinated before they become pregnant or during pregnancy,” Shu said.

Beyond providing antibodies, which can help babies fight infection if exposed to the virus, parents can use other strategies to prevent babies from being exposed in the first place.

Many of these tips have been proven to work against other germs – babies have always been vulnerable to viruses and other pathogens, especially early on. “The first month of a baby’s life is really tricky,” says Shu. “During this month, if they do get an infection, it can get serious much faster than in older babies.”

So while the pandemic is a particularly stressful time to protect the health of a newborn baby, “the actions I would tell a family to take today are not shocking to what I would have told them ago. 10 years, ”says Puopolo.

In summary, when it comes to those around your baby: “Do your best to keep them in good health, ”advises Puopolo.

In the era of COVID-19, she says, that means “making sure that everyone – depending on their age – is vaccinated. Parents must be vaccinated; if you have grandparents or a nanny or someone who is at home to help babysit, they are vaccinated. “Siblings who qualify for vaccines should also get vaccinated, she says. .

Immunizing everyone around the baby acts like a force field. These people are less likely to be infected, which means they are less likely to bring the virus home.

“For the most part, what we have learned is that when an infant becomes ill with a respiratory illness, such as the flu, COVID or whooping cough, it is because he has been in contact with someone. ‘one in the house [who’s sick]”, explains Muñoz.

Of course, vaccines are not a perfect shield, so it makes sense to use several different methods to fight COVID-19, including making parents, caregivers, and siblings wear masks when they are. in public. Keep the house well ventilated and wash your hands frequently. And, if your baby is in daycare, Puopolo suggests talking with the staff to see if they are taking the same steps to minimize the risks.

If anyone at home with the baby is sick (with any illness, but especially COVID-19), keep them as far away from the baby as possible. “We strongly recommend that sick people are not near babies – they don’t kiss babies, they don’t have very close face-to-face contact,” Muñoz said.

If the parent or any direct caregiver becomes ill or thinks they might have something and are the only one looking after the infant, Muñoz recommends that they put on a mask when around the baby, especially if they are around the baby. they are symptomatic. “In some cases it has even been recommended to completely separate the sick person – even if it is the mother from the baby – when there is a high risk of transmission,” she adds.

Life with a newborn baby is often a mixture of heartbreak and fun – and during a pandemic there is certainly added stress. Go for a walk with your baby, Shu said, but don’t take the baby to large gatherings.

“You don’t want them in large groups of people,” she says. “If you want to see guests, you can show them around outside your home rather than inside. Anyone who wants to hold the baby should be healthy, wash their hands and – these days – wear probably a mask. “

In other words, “stay away from places where your baby can catch something,” Puopolo advises, especially during baby’s first few months.

So far, even though the delta variant is much more transmissible than the original variant of the coronavirus, researchers are still trying to determine whether it causes more serious illness in children and babies.

“Fortunately, in my practice, newborns and young infants that I have seen who have had COVID have done well – they tend to have cold symptoms and recover,” says Shu. “Having said that, I have seen other infants with fever for several days due to COVID [and] we sometimes see breathing problems that may require a trip to the hospital. “

Especially for anyone in the first few months of life, fevers are a red flag, says Puopolo. “You should always call your pediatrician or seek emergency care if a baby has a fever over 100.4 ° Fahrenheit,” she says. “Besides the fever, you worry about how the baby is feeding, how the baby is sleeping.” Since sick infants tend not to eat well, they can also become dehydrated, she says.

“So signs of a cold, signs of fever, restlessness that cannot be resolved, poor nutrition – these are, COVID or no COVID, always reasons why you should see a doctor for your infant,” explains Puopolo.

Again, “the risk is small, but it is not zero,” says Shu, that babies will develop serious complications from COVID-19.

The clinical trials of COVID-19 vaccines currently underway do not go down until around the age of six months. But reduced doses of the vaccine might – at some point – be available to younger people, Muñoz says.

“If you look at some of the FDA guidelines from the onset of the pandemic, children under six months are not excluded,” she stresses. “So they can be included, it’s just that at this time, to my knowledge, there aren’t any studies evaluating vaccines from zero to six months.”

Vaccines are evaluated in stages by age, she explains. “We started with adults, then adolescents and now we are working on pediatric age groups,” says Muñoz. “It will take some time, as we need to establish safety and effectiveness in the older age groups before we can move on to newborns and younger babies.”

“So it is something that is not [realm] possibilities, “she said.” But that will also take time. ”

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