Considerations for the upcoming school year during the COVID-19 pandemic.
The information provided is current to the time this post was written. MPI is continuing to closely follow all relevant information, scientific studies, and recommendations to help provide you with accurate, up-to-date information on the COVID-19 pandemic.
My Personal Experience
As a pediatrician, I was nervous to have a baby during the annual flu and RSV season. Imagine the sense of irony I felt having a baby during a global pandemic. As the unprecedented lockdowns commenced in the spring, I was entering my 3rd trimester. The hard part about this virus is that it is new. The scientific community is studying it and providing recommendations in real time. At that time, we did not know if the virus could cross the placenta. If it did, we also did not know exactly what that meant for the baby. When the AAP announced their initial recommendations of separation of the mother baby dyad if the Mother was found to be COVID positive at the time of delivery, I was terrified. I could not fathom not physically being with my baby immediately after birth. It was also recommended that the Mother’s household contacts should also not directly care for the baby. I started brainstorming who I would entrust my baby with those first few critical weeks if I contracted this virus. Of course, I could refuse separation. But with the ever shifting terrain of knowledge about Covid-19, the one thing that is constant is that there is so much that we still have to learn. Although it seems as though young children seem to be somewhat unscathed by this novel disease, this was not an absolute certainty. If he was infected with the virus as a newborn it is not known if he would suffer any long term health consequences. Thankful this was a decision that I did not need to make. My heart breaks for the other parents who were faced with this difficult situation.
The birth process I experienced during the age of COVID-19 was oddly quiet. The hospital halls were empty and people were sequestered to their room. Hospital staff, nurses, and doctors coordinated and limited their visits. There was no fanfare and excited family members and friends bringing flowers and well wishes. I found my baby’s first evening strangely serene. There was time to focus and be present in the moment. I made an effort to take a few selfies to document the time. His baby book will look vastly different than his older brothers. The following weeks he met his extended family member via picture share drives and video calls. We settled into the new normal and the familiar happy haze of days and nights blending together.
AAP Guidance on Newborn Care for Mothers Who Test Positive for COVID-19 ( SARS-CoV-2)
The initial neonatal guidance from the AAP was provided on April 2, 2020. Since that time there has been two revisions, the most recent on July 22, 2020. The revisions reflect the most recent published evidence as well as data from the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection. Initial AAP guidance recommended temporary separation of newborns from infected mothers. This guidance was provided because the risk of perinatal and postnatal acquired newborn infection was unknown. Early in the pandemic the only data available came from China where the universal approach was immediate separation and isolation for 14 days of the newborn and infected Mother. After months of reviewing national and international experience with newborns born to mothers who tested positive for COVID-19, the risk of an infant testing positive was no greater if the infant was physical separated from the mother compared to if they roomed in together with proper infection control measures. As of September 10, 2020, the AAP recommended that affected Mothers and newborns may room in according to usual center practices. If a Mother is acutely ill with COVID-19, they may not be able to safely care for their newborn and the baby should be cared for by a noninfected caregiver. Additionally, more conservative measures may need to be employed for neonates at high risk for severe illness such as preterm infants and those with underlying medical conditions. Current data suggests that approximately 2% of infants born to Mothers who tested positive for COVID-19 near the time of delivery tested positive in the first 24-96 hours of birth. It is not yet known what number of infants tested positive outside of that timeframe.
AAP Guidance on Breastfeeding for Mothers Who Test Positive for COVID-19 ( SARS-CoV-2)
The AAP strongly supports breastfeeding and recognizes its numerous health benefits. Breastfeeding protects infants from infection and contain natural bioactive factors, antibodies, and targeted immunologic mediators. Although it is not yet known if protective antibodies for SARS-CoV-2 is found in breastmilk, it is known that breastfeeding can provide protection against other viruses. Several published studies have detected SARS-CoV-2 nucleic acid in breastmilk. However, no viable infectious particles have been detected in breastmilk. There are still some uncertainties but given current findings direct breast feeding for Mothers who are positive for COVID-19 is not contraindicated. Mothers should practice good hygiene and infection control methods including hand washing and wearing a mask during breastfeeding. Mothers may also choose to pump and the expressed breastmilk may be fed to the baby by a noninfected caregiver.
When to Allow Non Household Members to Interact with You and Your Baby during the COVID-19 Pandemic
Another critical decision is deciding when to allow non household members to interact with your baby. There is a risk of SARS-CoV-2 transmission to the neonate via contact with infected caregivers including just prior to when the individual develops symptoms. There are published reports of infants requiring hospitalization due to severe COVID-19 infections. This is in line with the observation that infants less than 1 year of age seem to be at higher risk for severe disease. Additionally, fever is a common clinical symptom of COVID-19. Any time a child less than two months of age develops a fever, an evaluation for serious bacterial illnesses is warranted. This typically entails a combination of lab tests that include blood tests, a test of the urine, and potential the test of the spinal fluid. Depending on your child’s age and preliminary test results they may require hospitalization.
The most conservative approach is to limit your child’s exposure to only household contacts for at least the first 2 months of life. This will decrease their risk of exposure and subsequent risk of infection. We understand that this may be difficult and may be impossible for some families. We recognize the importance of family/friend support during the newborn period and the impact isolation may have on the new parent’s mental and physical health. If you determine that it is necessary to have non household contact care for your baby in the newborn period, we recommend that they not have any ill symptoms and follow infection control measures. These measures include good hand hygiene, wearing a mask, and staying 6 feet away from you and the baby whenever possible. It is also important to consider what activities they are participating in outside of your home. These factors will help mitigate the risk but it will not eliminate it. We are happy to educate you regarding the risks and provide information based on the most update knowledge on COVID-19.
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