Babies, Germ Exposure, and COVID

Emily Oster

8 min Read Emily Oster

Emily Oster

Babies, Germ Exposure, and COVID

Emily Oster

8 min Read

First off: hats off to all of you who are new parents during this pandemic. I whine a lot about home school and not being able to be in my office, but at least my kids sleep through(ish) the night. Having a new baby is hard and isolating in the best of circumstances. So, good job new parents: you may not feel it, but you are doing great.

From these new pandemic parents, I’ve been getting a lot of emails about babies, germs and some combination of travel or visiting.

When is is it okay to fly?

Can other people hold the baby? When?

My partner’s family wants to rent a beach house together and our baby is three weeks and I cannot imagine anything I’d less like to do and can you please give me an excuse to say no? Thanks so much.

People are asking this in the context of COVID, but as usual I think it is helpful to step back and give the problem some scaffolding. That is: let’s start by asking about this question in general, and then we can add on the COVID circumstances.

Stepping even further back, we can note that these questions are basically all the same question: how concerned should I be about germ exposure?

I wrote about this in Cribsheet, so I’m going to excerpt that below, and then return to the COVID situation.

The Non-COVID Answer

Virtually all doctors will suggest you try to avoid exposure to illness in the baby’s first couple of months. One reason for this is simply that the smaller the child, the more vulnerable they are to serious complications. But a second reason is that for very young infants—especially those younger than twenty-eight days—medical protocols suggest much more aggressive interventions in response to illness.

What does this mean? Basically, if your otherwise well-seeming six-month-old gets a fever—even a pretty high one—and you go to the doctor, they’ll probably look them over, tell you they have a cold or a virus, and send you home with instructions to give them Tylenol and fluids. In fact, many doctors’ offices will tell you not to bring this child in at all unless you are very concerned.

In contrast, if your two-week-old has even a low fever, you’ll need to take them to the hospital, where they’ll be subjected to lab tests—likely including a lumbar puncture (spinal tap)—given antibiotics, and admitted as an inpatient. With very young babies, doctors have a harder time distinguishing between high- and low-risk fevers. Babies in this group are somewhat more susceptible to bacterial infections, including meningitis, which is extremely serious. Somewhere between 3 and 20 percent of infants under a month old who come to the doctor with a fever have a bacterial infection. These are mostly urinary tract infections, but they must be treated, and reasonably quickly.

The combination of this higher risk of and difficulty detecting infection means that aggressive intervention is an appropriate approach, but most babies with fevers are actually fine.

When a slightly older infant—between twenty-eight days and two or three months—presents with a fever, there is more ambiguity about treatment. Some doctors will still preform a routine spinal tap, although there is less evidence that this is beneficial. The procedure for managing infants in this age range (and younger) is many-stepped and varied.

Two of the key points here are whether the baby appears sick (this sounds crazy—of course they appear sick, they have a fever—but if you are a pediatrician, this distinction apparently makes sense) and whether there is an obvious viral exposure. If you come in with a forty-five-day-old baby who has a cold and a low-grade fever but seems otherwise fine and bring along the baby’s two-year-old sibling, who has a cold from day care, the doctor is likely to react differently than if you come in with the same baby, with no sibling, and the baby is listless.

How does this all relate to the question of germ exposure?

The big downside of being exposed to germs—or specifically, to sick kids—during these early weeks is the possibility of setting off this chain of interventions, including the spinal tap. If your infant does get sick, these procedures make sense, but if they just caught a cold from being pawed by a germy two-year-old, you’ll be doing a lot of interventions for no reason. It’s therefore better to keep the germy two-year-old away from the newborn, if at all possible.

Once your baby is over three months, and especially after they’ve had a first set of vaccines, treatment of a fever is closer to what you’d expect with an older child—basically, give them some Tylenol, keep them hydrated, and wait for it to go away. At this point, the downside of germ exposure is simply a sick kid, not a cascade of invasive testing.

Adding COVID

How does COVID-19 change the calculus? Many of the considerations are the same. At the core, especially in kids, COVID-19 is a respiratory virus like a cold or a flu. If your infant has a fever — whether it is COVID-19 or not — the medical reaction considerations above apply.

What is different about COVID? The first thing is the risk to you. When you think about visiting or flying or any of the rest of it, you’re now factoring in your own illness risk in a way you wouldn’t do normally. If you do not feel it is safe for you to visit someone — or for them to visit you — then adding the baby isn’t going to improve safety.

Imagining, though, that you are comfortable with whatever the activity is if ther were no baby in the picture. Then, the key questions that we add to the above in the era of COVID are: (1) whether the presence of the virus means a much elevated disease risk for infants relative to the status quo and (2) if your infant does contract COVID-19, how worried should you be?

The answers to both of these questions, as I’ve said before, are mostly reassuring. Most affected infants have mild or asymptomatic cases of COVID-19. They also seem seem fairly unlikely to contract it, even from a COVID-positive mother. For a good and recently updated summary, you can check out either COVID-Explained or Don’t Forget the Bubbles.

Having said this, there is reason to think more people have COVID-19 than the flu. So if you asked about the random chance of someone who interacts with the baby having an illness, it’s going to be higher right now than otherwise. Also, COVID-19 is more likely to be asymptomatic. You may be able to more easily avoid someone with the flu because they seem sick.

The combination of these things leaves you, I would say, with some easier answers and some less easy ones.

  • Easier: Even in non-pandemic times, my argument is that it is good to avoid unnecessary infant germ exposure before the first shots, so around 8 weeks. This includes, probably, limiting random visitors or limiting their holding of the baby and, ideally, not flying. If you have to, you have to. But if you can avoid it, do. Your friend thinks it is selfish for you to miss his destination wedding in Aruba? Too bad.
  • Also Fairly Easy: From the baby perspective, some limited exposure to close family (grandparents, for example) shouldn’t be very different than normal times. The fact is, that although COIVD greatly changes the disease risk environment for older people, this is simply less true for babies. You should always be careful to have grandparents wash their hands before holding the baby. This was true before, and it’s true now. (The greater worry is transmission to, rather than from the grandparents, so this is something to keep in mind).
  • Less Obvious: So, your baby is now three months old and you want to fly to (say) see some family further afield. This is more complicated. In a normal time, you’d do it for sure. I’d send you back to my post on grandparents and day care for this one: frame the choice, mitigate and evaluate risks, think about benefits and decide.You can limit the risk by washing hands carefully on the flights, wearing masks, etc. The airplane itself is actually fairly low risk, due to the extensive air processing. But, still, an airport is riskier than your house. So it really comes down to the benefits. If this is the chance to see the grandparents, that’s different than the destination wedding.
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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
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Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
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When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
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There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
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Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
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What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven
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