Going Public with Your Newborn, How and When! (Pedcast)

Doc Smo here. Thanks for joining me today. One of the most frequently asked questions that I get in the newborn nursery is, “When can I take my newborn to church, when can I take my baby to the mall, and when can I have my friends over?” Well you will find varying opinions on this subject and the truth is that there is no science behind any of this. I don’t believe that there is a right answer to this question. Different cultures have developed different norms. For instance in traditional Greek society, I am told that babies are isolated from public exposure for the first 60 days of life and in traditional Japanese culture, the isolation period is one year. To my knowledge, the Academy of Pediatrics does not have policy regarding this subject so I thought we would take a little time to explore the subject of when should newborns venture into public places.

 

So let’s define what we are talking about. Let’s distinguish between simply going outside, and going into a public place and letting people hold and touch your newborn baby. First going outside. There are many medical experts who feel that many American babies are Vitamin D deficient because they are not getting enough natural sunlight to stimulate Vitamin D production in their skin. Studies do seem to bear this out. Vitamin D levels, when measured, are indeed low. Infants, and that includes newborns, need a minimum of 30 minutes of shaded sunlight daily, to produce enough of their own Vitamin D. Light coming through glass such as in front of a window–that won’t do. It needs to be real unfiltered light. Not light on a glassed in porch or light that comes through the windows of the car. That simply won’t work. So you can see, going outside is good for babies, maybe even vital to their good health. But going into public places—wow cowgirl—that’s a whole different rodeo. Touch, especially by children—yuck! That’s nasty. Just watch the fingers of a child less than 5 years of age and you will quickly see why you don’t want them touching your newborn. You don’t want their viruses going viral in your spanking new bundle of joy. Remember the swine flu. Despite the public health officials vigorous attempts to isolate and contain that virus, it was able to spread to every continent on earth within a few months. Incredible. Going outside for shady sunlight is good for baby and mom but having your neighbors and friends hold and touch your newborns, I just think that is foolish.

 

How does a baby’s immune system work?

How does an infant defend himself or herself from germs? What’s the big deal about a fever in a young infant? Well, it actually is a big deal and to answer that question we are going to take a little detour down what I call, “Science Lane”. There are a number of defenses that babies use to fend off viruses and bacteria that they can be invaded by. Fever is one of the most primitive. Let’s speed up the defense by making it happen faster at a higher temperature. If you warm up the body, you make chemical reactions and immune reactions occur much faster. Try making a cup of tea with cold water and then try it with hot water and you will see exactly what I am talking about. Babies also have targeted proteins called antibodies that stick to the invading germs and allow these microbes to be eaten and destroyed by cells that are called phagocytes. Now for the first 4-6 months of life, a baby’s antibodies are gotten from, you know who, good old mom through the placenta, before birth. They are not very good at making their own antibodies and they can’t turn on an antibody response real quickly to new germs. They also have cells that are called “Killer cells” which direct a process called cell mediated immunity. These killer cells direct the whole immune system when a baby is attacked by germs. Now one of the most important defenses to keep bad germs on the outside is good barriers, healthy barriers; dry unbroken skin, a dry cord, healthy lungs, gut and urinary tract. Now remember, that your baby has mucous, gastric secretions, and urine flowing through them at all times. If a germ does end up the wrong place, these flows normally quickly wash them out. But if you don’t have good flow and good barriers, germs love that environment.

 

What happens when a baby gets a fever?

 

So now you have completed immunology 101 for babies. And you have some idea of how a baby defends itself from serious infections. And now, hopefully, you can now see why infants younger than 3 months of age are so susceptible to serious overwhelming infections. So let’s go through the reasons. First of all they have had almost no immunizations and they are naïve to most germs. They also have had no experience with germs so they have no immune memory…that cell mediated stuff we talked about. And for some reason it is particularly difficult for very young infants under a month to even generate a fever so they have trouble speeding up this whole process. They also can’t tell their parents how sick they are. They have very poor communication skills. And finally, they frequently have compromised barriers such as a damp cord, or poor bladder emptying. Germs can easily overwhelm them. So here is the big take home point; It is very difficult for pediatricians to tell which febrile fussy infant has a life threatening illness and which have a benign, self limited illness that is not needing treatment.

 

So current practice is to hospitalize most infants, less than 3 months of age who have a fever to the hospital for a full septic workup. Now a full septic workup is a spinal tap, blood cultures, urine culture collected with a catheter, and IV antibiotics. This is an unpleasant day for you and your baby. And usually means at least two days in the hospital. Probably about $20,000 of your insurance company’s money as well. For those babies with serious infections, this process is life saving but most of the time this happens because of benign viral illness. So, do you see where I am going with all this? You can see why going into public and having a lot of people touch your baby is probably not such a great idea until they are at least 3 months old.

 

When you own the blog, you can publish your opinion so here is mine:

I think you should get outside with your baby, weather permitting, as soon as you get home. Babies do well in hot and cold weather unless it is very extreme. They are very good at controlling their body temperature once they leave the hospital. Touch by non-family members should be deferred for as long as possible. I recommend at least 3 months of isolation. You thought pregnancy and delivery were stressful, try having an infant, under three months of age, with a fever, likely in the hospital for 2 days, not to mention a hospital bill of $20,000. That’s stress. So when your friends go for the early touch, just say “No, no, no, I’m blaming Doc Smo.”

 

Summary

 

So let’s sum it all up. Going outside with your newborn is a good thing. The weather does not make your child sick and natural sunlight in small quantities is really healthy for babies, and essential actually. But going into public, where folks will be touching your infant and you as the parent will be touching dirty surfaces and them your baby, I think should not occur until the infant is at least 3 months of age. Young infants are relatively immune-deficient compared to older children so limiting touch to only family members is what I recommend. You’ve got enough on your plate with a new baby in the house; let’s not take a chance of having a sick newborn.

 

Well, again, thanks for letting me help you sharpen your parenting IQ. It’s been fun. If you have any questions about any aspect of your child’s health, please don’t hesitate to talk to that wonderful person you call your child’s pediatrician. Until next time.

 

*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

 

All Rights Reserved.

 

SmoNotes:

 

  1.  Hirsch, Larissa When to Take My New Born Out in Public? Kids Health, May 2002. Web. July 2010 <http://kidshealth.org/parent/question/infants/newborn_out.html>.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

All Rights Reserved.

4 Comments

  1. Doc Smo says:

    Christy,

    Touch is the main means of spread of infection. I recommend that you keep touch to a minimum by people other than your family. Looking is fine. Have fun

    Doc Smo

  2. DocSmo says:

    Charlotte says- “We’ve been avoiding peak hours and keeping strangers at a distance but total isolation for 3 months would be hard, especially if you have other kids. I think I would go mad.”

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