COVID-19 and RSV have captured the attention of new parents as cases for both were on the rise over the summer, but there are other respiratory illnesses in our community that are resulting in the hospitalization of newborns in Tampa Bay.
Dr. Christina Canody, BayCare Pediatric Service Line Medical Director is hoping to raise awareness and also educate parents on things they can do to protect their babies during those critical first couple of months of life.
Since it is a pandemic, we met with Dr. Canody via Zoom to learn more about what’s going around and how to keep baby safe.
We’ve talked a lot about COVID-19 and RSV–when did you first start to see a rise in cases locally?
Dr. Canody: One of the things that—and this is an effect of the pandemic—our respiratory viral season is completely mixed up. We went the whole winter season last year with very little anything. No flu, no RSV and then what happened was the world started to emerge–I would say after spring break. March/April is when everybody started to get a little bit more mobile, going on vacations, starting with spring break in Florida. Families started to put their kids back in daycare…we started seeing the emergence of all these viral illnesses that usually have a seasonal approach, but they all just went whoom. RSV being one of the main ones.
In our region, we’ve seen everything. We’ve seen parainfluenza which is the croup, we’ve seen rhino enterovirus which has been causing a lot of these colds in kids. We’ve seen regular coronaviruses, we’ve also seen adenovirus, and starting to see human metapneumovirus which some people compare to a walking pneumonia—all of these which can cause croup-like wheezing symptoms, but they’re all at unprecedented rates this summer.
What ended up happening was we saw all these respiratory viruses coming up, we saw all these little babies with fevers.
As you know, babies under two months, if they get a fever, they’re automatically being worked up to make sure they don’t have sepsis or a bacterial infection of the bloodstream or the brain…meningitis and bacteremia being the two biggest things we worry about.
Why is it 2 months for babies?
Dr. Canody: In general, everyone says it’s until you get your two-month vaccines, when truly it has more to do with the blood-brain barrier and in newborns, it has just one layer to begin with and then that layer becomes thicker as they get past two months of age.
What’s the best way to take a newborn’s temperature?
Dr. Canody: I don’t recommend ears for young infants because the ear thermometer actually has to look at the ear drum and after years and years of experience, seeing the ear drum comes naturally but it’s one of the most difficult skills for medical students and residents to learn, so pointing an ear thermometer on kids is hard for parents. Usually, you’re just getting the temperature of the ear wax.
I actually recommend using a digital thermometer and using it axillary in the armpit. If you are getting anything in the high 99s or low 100, it’s best to check it rectally.
The temporal artery thermometers are pretty good, but they’re not great for babies because they lose a lot of heat from their skin.
The other thing is to make sure they’re not over bundled. Some families tend to put too many layers on, so keep them cool, unbundle them and see where their temperature is going because sometimes it’s just that they’re really warm.
We don’t recommend giving Tylenol or any kind of medicine to babies under two months of age.
Any time in that first two months of life, it’s critical if they get a fever over 100.4 they call the pediatrician and be seen immediately.
What steps can families take to protect their newborns from a respiratory infection?
Dr. Canody: A couple of things you can do—number one, anything a new parent should do…make sure they are practicing healthy habits. You don’t have to go in public crowds for any reason and avoid taking your toddler to Disney for their birthday. Second thing, make sure you are getting plenty of rest. New parents tend to not to get enough sleep. I’d say sleep when the baby is sleeping and take advantage of that naptime.
It’s the basic things you do when you bring a newborn home. Just like we tell you all of the time, in the first two months, if they get a fever, chances are they are going to require hospitalization, blood tests and possibly a spinal tap and we want to avoid that if at all possible.
So take precaution. Moms -pregnant moms-it’s been encouraged that they get vaccinated for COVID. Parents who are expecting, we recommend they get tetanus boosters which includes the pertussis vaccine, that should be true of any caregivers taking care of young infants.
Make sure that your other children are up to date on their vaccinations as well.
It’s flu season now, we don’t know what the season is going to bring so we do recommend that all children ages 6 months and up get their flu vaccine and that’s also going to protect those younger siblings coming into the home.
What should a family do if a young child or other household member is sick?
Dr. Canody: If kids are sick and you’re about to have the baby, make sure they are seeing a physician to see what they have.
Try to arrange alternative care and separate the household. You may not be able to quarantine the toddler, but you can quarantine the newborn. Keeping them in mom or dad’s room or in the nursery and keeping the other kids out. I have some parents that will divide and conquer and some parents that will change their clothes and put on another sweater or jacket when they’re around the other kids.
Make sure that you’re cleaning and sanitizing the surfaces in your home.
Also, moms that are breastfeeding, that is definitely beneficial for the baby.
Make sure if they are going out of the house, especially during COVID, make sure they are wearing masks. And if children in the house are coughing a lot, you can actually have them wear a mask in the home.
What if no one is sick at home? What are some other best practices?
Dr. Canody: In general, even if nobody is sick, when you bring a new baby home, we usually recommend keeping toddlers out of their face. Number one for safety issues, but number two—those little hands have lots of germs on them. So we encourage them to kiss the baby’s feet and help the parent by bringing over a diaper.
After school, have them change their clothes, wash their hands. I had a friend who used to say, ‘we wash the day away’, we wash everything that happened earlier in the day and it’s a clean start so we can have a nice evening as a family.
We’re coming up on a busy holiday season of events. Should new parents risk it?
Dr. Canody: It’s hard to always tell parents no. They want to have fun and want to do cool things with their family, but maybe choose a time that’s not quite so busy. Earlier in the morning as opposed to the height of the day or picking an off day.
We do say avoid eating out because that’s the time when everybody is unmasked and you’re around other people. But, it’s a short time frame, it passes really quickly in a newborn’s life, but the benefits of taking precaution definitely outweigh the risk.
Nobody wants to have a newborn admitted and a lot of these viruses put newborns are risk for apnea, things like RSV can put them at increased risk for wheezing or associated respiratory problems for up to 2-5 years of their life.
We haven’t heard of a lot of these illnesses –let’s talk more about them.
Dr. Canody: Parainfluenza –we actually saw that double the rates we normally see this time of year. That usually causes the croup.
One that’s been really high and persistent and has been higher than it has been in the past five ears much like RSV, we refer to as human rhino-enterovirus and it’s a group of viruses that show up on PCR testing and it causes a lot of cold symptoms-fever, cough, congestion.
Not only that, but the parents are also getting sick -and it’s the sickest the parents have ever been. I’ve seen more parents this year with high fevers because of RSV than in my entire practice.
The other is other coronaviruses -so just cold viruses. They’re called corona because they look sort of like a crown under the microscope.
And the other one is adenoviruses -that’s another common cold virus.
And the last is called human metapneumovirus. It can cause a pretty severe cough that lasts for awhile.
Why do you think these respiratory illnesses are on the rise again?
Dr. Canody: One wonders where the reserves have been, but they stayed at pretty low levels in the population. I guess it shows the resilience of when it’s given the opportunity, it’s going to take advantage of it. The other thing is our immune system, we gradually develop a small amount of immunity to these kinds of viruses and when you don’t see them for quite some time, our bodies just don’t have the long-term immunity to them and that’s why you get colds and viruses throughout different seasons.
Photo courtesy of iStock by Getty Images by mmpile
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