Caring for a newborn during the coronavirus outbreak
We spoke to a paediatrician and obstetrician-gynecologist to get some advice on navigating this uncertain time.
Bringing a new baby home can be stressful for any new parent. Throw a global pandemic into the mix and the parents' stress levels can go off the charts. We are in uncharted territory right now with the COVID-19 outbreak, and navigating bringing home a newborn is a unique circumstance that may not come with a lot of guidance. In our new normal, new rules have been implemented that may change how babies are typically cared for, says Dr Prashant Nagpal, a Mumbai-based paediatrician. Visitors and extra help may be limited due to social distancing measures, and in-person doctor's visits may be held as teleconsultations — communication with the patient through information technology platforms, including voice, audio, text, and digital data exchange, which allows doctors to prescribe medicine — instead. We spoke to a paediatrician and obstetrician-gynecologist to get some advice on navigating this uncertain time.
What do new parents need to be aware of once they bring their baby home during COVID-19?
Newborns are expected to have multiple paediatric visits post-birth to monitor weight and height trends, administer vaccines if applicable, and address any concerns. "Paediatricians track growth and development during these visits, and can spot underlying issues to address," says Dr Nagpal. These exams are particularly important for newborns, as doctors are also looking out for signs of jaundice, congenital diseases, and weight loss — issues that could be much more dangerous than the coronavirus at this point, he explains.
Dr Nagpal says that for in-person visits after discharge from the hospital, walk-ins may be discouraged, so parents should call the paediatrician's chamber before they make the effort of travelling, and leaving their home. He recommends the fewer people attending the appointment, the better. "Only one parent should come in, with no siblings, if possible." Dr Nagpal shares that many paediatricians are only seeing newborns or young infants if unavoidable, thereby limiting as much exposure as possible to respiratory or infectious illnesses. "To support social distancing efforts, and to reduce the risk of potential exposure to COVID-19, some doctors are performing checkups in a parent's car, limiting the number of appointments permitted at a time in their chamber, and only allowing 'sick' visits at designated times of the day," he says.
Parents are encouraged to wear a mask when entering the paediatrician's chamber (or going out anywhere for that matter); however, babies under the age of two should avoid covering their faces to avoid risk of suffocation, says Dr Nagpal. He explains that if an emergency situation arises, like a fever, trouble breathing, or dehydration with no urine output for 6-10 hours, a physical doctor's visit may be required. However, situations like an unexpected rash or excessive spit-up could likely be addressed via a telephone call or a video-chat, says Dr Nagpal.
How should new parents navigate teleconsultations with a newborn?
Teleconsultations may be a new concept for some families. While it might not allow families to receive the same quality of care that they receive during face-to-face appointments, there are some unique aspects to this mode of care that parents should be mindful of. "It allows you to communicate with your doctor in real time remotely. Utilizing it for non-emergency doctor's visits allows for more social distancing, and less risk for spreading COVID-19," says Dr Nagpal. He assures that doctors are able to assess common concerns, like rashes or unusual diaper discharge (poop), effectively via online teleconsultations.
No infant visit to the paediatrician is complete without a weight check, says Dr Nagpal. When a family is unable to go for face-to-face appointments, he suggests that they ensure they have a scale at home to monitor weight trends. He also suggests that parents make sure that they maintain a record of the doctor's prescription, and online consultation. Parents should also try and time their appointment, so it is not during the baby's naptime, according to Dr Nagpal. Your baby's doctor will likely want to see your child during the appointment, and avoiding a cranky little one is preferred to allow for a thorough exam, he says. He also recommends that the parents have a pharmacy phone number handy in case a prescription needs to be called in.
"I remind my newborn families that even though we are in the middle of a global pandemic, don't let this rob you of this amazing time for your new family," says Dr Nagpal. "Never hesitate to call your paediatrician for advice. Your paediatrician is an excellent resource, and expects you to have questions and to call us."
Should you delay your child's vaccines?
Dr Nagpal says parents are cancelling their children's routine check-ups and vaccination appointments because they worry about a more imminent concern — having their child get infected with the coronavirus at the paediatrician's chamber. He says, "Some parents have even delayed the first-time vaccines for their infants for fear of COVID-19 contraction. For them, it's a logical concern: why put my otherwise healthy baby in harm's way?". However, to Dr Nagpal, this is just solving one short-term problem by creating another, much larger crisis down the road. "To be blunt, in the long run, delaying vaccines is inviting disaster for everyone. Now is not the time to let our guard down, and allow another disease epidemic to strike." Dr Nagpal says that's because delaying immunizations during this pandemic could lead to an outbreak of vaccine-preventable illnesses, like tetanus, a serious bacterial infection that affects the nervous system, and pertussis, a respiratory infection that Dr Nagpal noted, would "be a nightmare" in this current climate.
"Even though our attention has been on COVID-19, there are many other infections still out there. They haven't gone away just because we're preoccupied with a new infection. In fact, measles is still present all over the world, and more contagious than COVID-19," says Dr Nagpal. Although social distancing has decreased the spread of all bacterial and viral illnesses, vaccine-preventable illnesses are slippery and tricky, just like the novel coronavirus, he explains. "Being late means you've left children vulnerable, and allowed time for them to be able to spread infections to other people. That's especially dangerous when our hospitals and healthcare workers are already strained." If any family member is still gathering groceries, running to the chemist, or continuing essential work, vaccine-preventable illnesses will continue to spread within family units, he adds.
So what are concerned parents, desperate to keep their young ones safe and healthy, to do? Dr Nagpal urges parents to consider those beyond their child, as the success of vaccines is dependent on community protection rates. "It is advised that babies and young children should still be brought in for vaccines amid the coronavirus outbreak, while you do your best to protect yourself and others by keeping your children socially distanced. However, parents with children at least two years of age — or older kids in need of a booster shot — could put off those appointments temporarily," he says.
What advice should new parents follow during COVID-19?
The first thing parents can do is manage their stress as best as they can during this time, according to Dr Ratnabali Dasgupta, a gynaecologist and obstetrician. Babies feed off of parents' emotions, so keeping a calm environment is key, though in some cases that's easier said than done. Dr Dasgupta explains that a large concern is preventing the parents from getting sick during these uncertain times. "If parents get sick, they may require being separated from the baby, and getting additional support will be a challenge. Parents need to take the precautions set forth by the government and other health agencies seriously, which includes frequent handwashing, and social distancing," she says.
Parents can also keep themselves healthy by getting good sleep, eating well, and exercising, while still complying with the coronavirus guidelines, advises Dr Dasgupta. Keeping healthy may also include some specific supplements. In addition to eating a healthy diet, Dr Dasgupta suggests considering supplementation of nutrients like zinc, selenium, and vitamin C to support immune health. Dr Dasgupta offers additional tips, like getting baby on a schedule despite being inside the house for the majority of the day, to breastfeed, if possible, to provide baby with passive immunity, and to establish a relationship with a lactation consultant before the baby is born to have support available, if needed.