Kids, Infants & Long Term Impacts

Emily Oster

8 min Read Emily Oster

Emily Oster

Kids, Infants & Long Term Impacts

Emily Oster

8 min Read

I wanted to start this post with a note of optimism. At times the last few weeks have seemed like nothing but bad news — vaccine roll-out is slow, variants are arriving and mutating, vaccines might not work perfectly, kids will not have vaccines until much later, and on and on.

But: I want to pause for a moment of optimism. Despite the slowdown, we actually ARE vaccinating a lot of people. Around 8% of the US has gotten at least one vaccine, and these are largely high risk people. We are seeing dramatically dropping COVID rates in nursing homes. Overall COVID case rates and hospitalization rates are dropping.

And while it’s true that vaccines do not seem to be as effective against some new variants, it’s not as if they provide no protection. There was a time when a 66% effective vaccine (this is the Johnson & Johnson vaccine performance against the South African variant) would have been embraced unequivocally. Yes, 95% is better and, yes, numbers like this likely mean we’ll need boosters going forward. But it is not nothing.

All this is to say that while there is lots to be worried about, and we cannot stop working to vaccinate faster and test more, there should be optimism too.

Now to the Content!

I wanted to address some of the many questions I’ve gotten on how to think about risk in kids. At this point, it’s been said many times that risks to kids are low. They’re low. Very low. Kids do not get very sick from COVID-19, and asymptomatic infection is common. This idea — that COVID is very rarely serious in children — underlies a lot of the possible return to normalcy. It will be a long time before kids are vaccinated, and if we want to do things like have normal school in the fall, or travel in the summer, we should expect to do it with unvaccinated kids.

But: When we report this out, people come back with (mostly) three questions. So I wanted to address them here.

  1. What do you mean low?
  2. What about infants?
  3. What about possible long term effects of even asymptomatic infection?

What do you mean “Low”?

As with all other groups, identifying case rates in children is a challenge. COVID-19 cases detected in kids tend to be rare, but this is in part due to relatively limited testing in this population (especially early in the pandemic). For this reason, I want to completely side step case rates and look at serious disease risk and mortality.

I’m aware that hospitalization and death rates are not by any means the only things we care about. But they provide a source of reliable data and they do proxy for less serious cases.

Let’s look first at COVID-19 itself. For a child between the ages of 1 and 17, the risk of death from COVID-19 is about 1 in 700,000 over this last year. The hospitalization risk is in the range of 1 in 50,000. For children under 1, the risks are slightly higher. A bit more context on this is below, but these numbers are still really small. COVID-19 accounts for only 0.2% of deaths among children under 1 year.

Numbers in this range are so small it can be hard to think about what they mean. Which is why comparisons are useful. The second two sets of columns look at two other sources of illness and death : RSV (respiratory syncytial virus, a common childhood respiratory virus) and drowning. For children under 1, the death rate from RSV in a typical year is three times higher than the death risk from COVID. The hospitalization rate is about 200 times as high. Put simply: in a typical year a child under 1 is 200 times as likely to be hospitalized for RSV than they were for COVID last year.

RSV is less common in older children; drowning is much more so. The death rate from unintentional drowning for children aged 1 to 4 is 20 times higher than from COVID-19; it’s about 7 times higher for older children. Hospitalization rates are similarly elevated.

I put this information up not to minimize COVID-19 (to be clear: the risk of death from COVID in the last year for someone over 85 is 1 in 50, which is extremely high). But the fact is that, for kids, serious illness risk is extremely low, far lower than risks associated with other common childhood diseases and injury causes. And at the same time I’m not trying to make you afraid of pools (although you should be very careful around them). Life entails some risk, whether acknowledged or not, and making good choices requires understanding this and, yes, accepting it.

What About Infants?

In the table above, you can see that infants (under the age of 1) are higher risk than older children. This is a little bit misleading, though, since they are generally higher risk for everything. In fact, COVID-19 accounts for a much smaller share of deaths in this group than in older children, even with the higher numbers. Put differently, illness risks are higher in babies than older kids so more caution is generally warranted, but not necessarily relatively more so with COVID-19.

A notable fact in the hospitalization data is that the rates seem to be highest in the very youngest infants (see here). Or, rather, infants under 2 months account for about 20% of total hospitalizations among children 0 to 17 (versus only 8% for infants 2 to 11 months). This could suggest higher risk in this group, or possibly that fever in very young infants often prompts hospitalization even without COVID to check for bacterial infection.

My read of this all together is that infants up to 2 months probably deserve even more caution than usual, and the excess risk of COVID-19 to older infants is similar to the excess risk to older kids. Which is to say, “low”.

(Read: maybe limit visits to young infants to people who are vaccinated.)

Long Term Effects

Expressions of this fear seem to come in two parts. The first is a fear that if your child does get sick from COVID-19, they may take a very long time to recover. The second is that even if they do not get sick, there are some hidden long term consequences that we will only learn about later.

To address the first. A small number of children do seem have persistent COVID symptoms, and we have seen cases of what is called MIS-C, basically serious post-COVID illness. The latter is rare, and the former is difficult to study. One recent paper reports on a cohort of 129 children in Italy, and suggests that 42% of them have persistent COVID symptoms even four months later. However: many many of these symptoms are non-specific and, more importantly, there is no control group. Runny nose and diarrhea are common even absent COVID. The data on fatigue shows 10.9% of kids report more fatigue after COVID-19, but 13.2% report less, suggesting this is likely just variation over time.

Based on what we know, it does seem likely that some children (like some adults) take a long time to recover from COVID-19. This is also true of other illnesses like the flu.

This is a known risk. I think more scary is the unknown risk that, somehow, even if your child doesn’t have symptoms of COVID, they will be harboring some kind of ticking time bomb that will cause serious issues later. This is not helped by articles like this one that 1000 people sent me on blood vessels. That article shows elevation of a particular biomarker in 50 hospitalized children who had COVID-19. The clinical significance of this is unclear, never mind the long term impacts.

This WSJ article does a good job, I think, making the scare case. To paraphrase: We know that in (for example) lung scans we see some evidence of infection even in asymptomatic people. We don’t know what it means, but it could be bad. Or not. But it could be bad. In kids, we do not have much evidence other than this blood marker study, but they could also have bad consequences. We really cannot know. Could be bad. Or not.

This evidence, especially in kids, is necessarily limited by what we simply cannot see. Eventually, we will have big studies which follow kids who had COVID and see if they have health problems. But this requires recruitment, testing, analysis and money. And, even with these, it’s going to be a long time before results. Like, literally, it could be decades depending on the outcomes you are worried about. Until then, uncertainty is basically our only option.

One possible conclusion is that you shouldn’t do anything until you can be 100% sure no one will get COVID-19. This is not, in fact, possible. Maybe you could wait until children vaccinated. But this ignores the possible costs of continued isolation on kids (and adults). These risks may also be long term.

My bottom line here is that this what-if-ism can go too far. We are always living with unknown risks. We should worry about the risks of COVID that we can see, just like we should think carefully about all the risks we face, and our kids face. But it’s not productive to get caught up in every fear about what could happen.

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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
...

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
...

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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