Keeping my newborn healthy with a toddler in the house

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When a parent raises the question “How do I protect my newborn from the germs my toddler brings home from school?” it touches a very sensitive cord in me. My son was just over 2 years old when we brought our premature, 1,8kg baby home from ICU.

My wife’s cousin came to visit with his three kids, each of them sporting a nasty chest and snotty noses. My son then picked up Coxsackie and so our journey of learning to dodge the landmines of illness began. It was agonising to watch this little newborn struggle, when my son, who had been an only child up until this point, had his first anti-biotic at the age of two.

We decided to put some basic rules in place that ensured our little girl was protected and our stress levels halved. Many of the rules were probably considered a little over the top then. What COVID-19, however, has taught everyone is that handwashing, the wearing of facemasks and keeping ill people away from those who are vulnerable, are highly effective ways of keeping our little ones healthy.

In general, parenting a newborn is challenging and tiring. Short of being perceived as completely OCD and unreasonable, parents need to find ways of keeping their baby healthy. This will entail measures that ensure that well-meaning family, friends and our toddlers keep their germs to themselves.

Why is this important?

Your baby’s immune system doesn’t mature until your baby is two to three months old. This means that a baby of 3 months old has a much better chance of fighting off viruses or bacteria than a baby of two weeks.

While it is true that babies develop immunity by being exposed to viruses and bacteria, they have underdeveloped immune systems so a common cold can quickly escalate into serious illnesses like croup and pneumonia. Both of these illnesses would require urgent medical intervention and are scary for parents to deal with. RS virus is another nasty virus for your newborn. Any of these illnesses may affect your baby’s breathing as their airways are also not fully developed. Congestion, fever and other cold and flu symptoms affect a baby’s ability to feed and will add to the stress of caring for these little ones.

Ongoing exposure to viruses doesn’t allow time for your baby to develop anti-bodies and build up resistance. Their immune systems become compromised. What we now call “crèche syndrome” is a state where a baby or toddler constantly has a runny nose, slight cough and sometimes a low-grade fever. We see this kind of scenario setting in with babies from around nine months of age but very often it has its beginnings back when the baby first came home and was exposed to unnecessary infections.

Ideally, we should be protecting babies from germs in the first three months and if possible, the first six months. There are enough germs in the general environment to stimulate your child’s immune system without having an inconsiderate adult coughing or sneezing all over your newborn. More difficult to control are the germs which your toddler may spread to your newborn simply because they share the same space.

But how do we protect our newborns?

Shared immunity

From the very beginning, a mother shares her immunity with her baby through the placenta immediately after birth. These antibodies continue to protect the baby for some time.

Colostrum

Colostrum is the first form of breastmilk that a mother produces. Colostrum is produced straight after birth and then for the next two to four days. It is very high in antibodies and antioxidants which build your new-borns immunity. Even if a mother finds breastfeeding difficult these first few drops of colostrum play a vital role in immunity.

Skin-to-skin

Immediately after birth, a baby is usually placed on the mother’s bare chest. This skin to skin contact is very important for a healthy skin flora which protects the baby from harmful organisms. What I love about this is that dads can get involved in stimulating the baby’s immune system from the very beginning by having skin to skin contact with their baby as well. Over and above this, Dad’s skin increases the baby’s skin hydration. A well-hydrated skin forms a protective barrier from harmful bacteria entering the baby via its delicate skin.

Breastmilk

Breastmilk contains a large number of antibodies. These antibodies provide the baby with immunity to infections which the mother may have had in the past as well as those she may get throughout her time of breastfeeding. The white blood cells, proteins, fats and sugars contained in breastmilk have a significant effect on gut health. We are learning more and more each day how vital gut health is for a person’s general health from birth and throughout their lives.

Taking baby home to an overzealous toddler and well-meaning visitors

Your toddler will no doubt be very excited about the arrival of the new baby that has been growing in mommy’s tummy for the longest time. The toddler wants to do everything for the new addition including smothering the baby with kisses and plugging that little mouth with the dummy. My advice is to teach your toddler that a baby only likes foot kisses. Use a doll or some other toy to teach this before the baby even arrives.

Your toddler will be able to express all the affection he or she wants while you limit the number of germs being close to the baby’s airways. A quick wipe of the kissed foot is an easy way to prevent the spread of germs. You don’t want to hurt your toddler’s feelings by telling him or her not to kiss the baby, so instituting the feet kissing rule for all who come into contact with your newborn, is a very good idea.

Good hygienic practices for everyone in the house

Encourage everyone in the house to wash their hands before touching the baby. You can make it your toddler’s job to show all visitors how and where it is done. This will ensure your toddler’s involvement, give them a sense of responsibility and ensure that those little hands receive regular washing as well.

Vaccinations

Since your newborn will only receive his or her first vaccinations at 6 weeks, your toddler must be up-to-date with all the scheduled vaccinations before the baby arrives. This will certainly help protect the baby as your toddler will have immunity to a lot of the illnesses which could cause serious disease.

I would also strongly recommend that all adults and children over the age of six months receive their flu injection before the baby arrives. A pregnant woman can receive the flu vaccination in the last few weeks of pregnancy and this immunity will carry through to the newborn. The COVID-19 vaccine will protect the mother during pregnancy from the serious side effects of COVID-19 and will also protect your newborn up to six months of age.

Although not standard practice in South Africa yet, it is advisable that anyone who is going to be caring for the baby be vaccinated against pertussis (whooping cough). Pertussis is very dangerous for babies in the first few months of life. The simple 4-in-one injection can be given to those living and working in your home to help protect the baby. This process is called cocooning your baby against pertussis.

Vaccines against RSV infection (a serious respiratory illness in newborns) are in the advanced stages of development. These vaccines will be administered to a mother before the end of her pregnancy. This is such an important development in the protection of our little ones. The immunity that the mother receives will be passed to the baby in utero and protect them in the first vulnerable months.

The use of probiotics

There is a lot of data suggesting that a good probiotic is effective for the managing and prevention of certain paediatric conditions. I would suggest discussing this option with your paediatrician, especially if your toddler is at pre-school where tummy bugs often do the rounds.

There are some other points which do seem like common sense when talking about protecting your baby but they are worth mentioning here:

Disposable tissues- get your toddler to use disposable tissue each time he or she blows his or her nose rather than wiping with those little hands. These can be thrown away and lessen the risk of infection being spread. Be sure to wash those little hands and face after blowing.
Use a baby-safe anti-bacterial surface cleaner for surfaces and toys. Remember that some germs can live on surfaces for up to 48 hours so getting rid of them is a good idea.
Smoke from tobacco sticks to hair, clothing and furniture. This means that a smoker doesn’t have to be holding the baby or smoking in the baby’s room for there to be a significant effect on the baby’s health. Exposure to cigarette smoke is known to worsen many of the symptoms of illness in young babies. Premature babies and those with fragile lungs are at even higher risk for complications as a result of exposure to cigarette smoke.

Conclusion

There is a lot to think about when you are bringing a newborn home. This is true for any baby but it is especially stressful when you are bringing home a baby during flu season or when you have other children at home. Pre-schoolers are renowned for bringing home colds and flu which can then be passed onto your vulnerable newborn. Don’t be afraid to check the protocols at the school for ill children. You want to be sure that your toddler isn’t going into an environment where there aren’t rules about ill children at school.

Once home ensure that all people wanting to visit, understand the need for being completely well before visiting your baby. Grannies, grandpas and friends may take exception to your rules for hand-washing and NO kisses on the face, but in the end, you will be the one left holding the ill newborn.

If you find this difficult, I always encourage my patients to blame me. Telling visitors that your strict paediatrician has insisted on these protocols takes the spotlight off you and provides you with some solid backup for your decisions.

Be sure that you know how to deal with an ill infant. Make sure you have a thermometer at hand to check for fever. Most important is that you seek medical help if your baby does develop a fever, cough, difficulty with breathing or gastroenteritis. Your healthcare provider will be the best person to guide you through the illness.

In the end, you can’t avoid all germs and it certainly isn’t your fault if your newborn does get ill. What we are striving for is to limit exposure to unnecessary infection before your baby has developed immunity of his or her own.

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