Dr. Hugh Gilgoff, pediatrician and voice of experience, answers all our worrywart questions.
Who’s Allowed Near the Baby?
The birth of your baby is a time of utter joy and celebration. Friends, family, and even complete strangers on the street want to see and even touch your beautiful little one. The problem is that your baby does not yet have a developed immune system. Even if you breastfeed your baby and pass some of your immunity on, there are a plethora of illnesses that are just too easy to catch.
Germs are spread either by touch or by respiratory droplets. With this recent H1N1 swine flu epidemic, we are all aware of the need to wash hands thoroughly and frequently. But even if you have clean hands, you can still spread a virus or bacteria by coughing, sneezing or even breathing on a baby.
You will hear slightly different advice from different doctors (and different grandmas), but I think the happy medium would include having a high threshold for visitors during the first 2 to 3 months. If you have adult family or close friends who want to visit, take a quick medical history first. Are they sick, or even starting to feel sick? Do they have a family member, especially a child at home who is now sick? If an adult is definitely healthy, and promises to wash their hands often and not necessarily kiss the baby near the mouth, then it is “okay” in my book to have them visit.
I really would not want any little ones near your newborn. Toddlers are rarely without a runny nose. They are also notoriously putting their hands in their mouth or noses, so hand washing becomes “a wash” itself after a minute! Now if there is another baby who comes, that is okay – because they won’t touch your baby. As for those older kids, perhaps 7 or 8 years old, they can usually be trusted to wash their hands and look at the baby, but not necessarily handle him or her.
Now some of you are saying, “C’mon Dr. G – you sound a bit over-protective. You know everyone wants to see my new baby now!” So let me explain where I am coming from. First of all, it is just not worth seeing your newborn catch even a little cold if you can avoid it. They won’t eat well, and often gag or even throw up when they are congested. They will sleep even worse and cry even more, and they can suffer for 3-7 days from even a common cold.
Furthermore, and perhaps more importantly, your newborn will have very little clinical or behavioral cues to allow us doctors to NOT worry when they are sick. Whereas an older child is more like an adult – and can verbalize and localize their pains – a newborn is going to just act very irritable and even lethargic. On top of that, they respond with a fever quite easily, and any fever in a newborn is an emergency until proven otherwise.
What if a Baby Gets a Fever?
Each and every pediatrician will treat the newborn with a fever (or even one without a fever, but with lethargy or other signs of serious illness) the same way. We must assume the worst, and search for signs of infection, especially dangerous bacteria, in the blood, urine and even spinal fluid. Then we must actually admit the baby into the hospital for 2 to 3 days and administer antibiotics through an IV until the cultures prove whether there is a bacterial infection or not.
The reason for doctors being so aggressive in our approach to newborns who are sick is in the statistics. Babies who have high fevers can get sick very quickly. Whereas, with an adult with a serious infection, you often have many days to catch and treat an illness. There have been too many cases (and I have unfortunately seen this) where a baby is critically ill, or even dead in hours as a result of an overwhelming bacterial infection.
So, while the vast majority of fevers are going to be viral colds in origin, and the majority of colds are actually going to pass in a few days even in a newborn, it just isn’t a good thing to have your little one catch a fever. If you are concerned, measure your baby’s temperature using the most accurate method – rectally. You don’t have to check it daily, or really ever – but check it any time they feel warm or are acting sick. Any fever over 100.4, (or 38.0 Celsius) is an immediate trip to emergency room. Call us while you are on the way or when you are there so we can help. Certainly, don’t give Tylenol and wait until the morning.
After two to three months of age things start to change, and we don’t have to be as aggressive. At that point, the immune system is improving and hopefully the first vaccines are on board. Perhaps more importantly, there are now clinical cues that appear in the baby such as: how interactive they are, how well they are eating, smiling, sleeping, and even playing.
Can I Take my Baby Outside?
In the old days, the above concerns sometimes led to parents waiting inside for a month or two with their newborn. After all, since there are indeed tons of germs outside, that might seem a valid option. But I think, once again, we need to balance fear with reality (and mom’s sanity) and find that middle road.
Although there are germs and sick people outside, the only way your newborn is going to catch those germs is if people cough on or touch your baby. So as long as you are quick with a stiff arm and strong glance (or loud shout, perhaps even with a bull horn), you should be okay taking your baby for a quick walk after a few days of life (weather permitting, of course). Indeed, we want to see all newborns for a full physical exam on day 3, 4 or 5 at the doctor’s office, so all babies will come out at least once that first week. But, it also should be okay to take a quick walk (weather permitting) down the promenade, in the park, or even to get a coffee (decaf please!).
When your neighbor, best friend, or absolute random, well-meaning Brooklynite approaches the stroller you need to explain and prevent anyone coming within five feet. You can blame the pediatrician. It’s okay for them to look for a moment from far away, but they really shouldn’t come close or touch your baby.
As your child gets older, you will likely relax a bit about germs. You will still wash their hands often, but the truth is that kids at the playground will share their puffs, goldfish and their germs. You choose your battles and do the best you can. But with those newborns, it’s always best to be over-protective, and to err on the side of caution.
Other articles by Dr. Gilgoff:
- Vaccines- Thoughts from Dr. Gilgoff
- Colic and Nutrition for your baby
- Fever, Jaundice, Rash, Spit Up and More
- Fever- A Discussion by Brooklyn Pediatrician
- When can a baby sleep through the night?
- How to deal with constipation in children
- Does your child have allergies?
- What does asthma look like?
- Starting Solids
Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans. To see his listing information and read parents’ reviews, check the blog here under “Recommended Pediatricians”. Dr. Gilgoff also has his own website now too: www.drgilgoff.com