Last reviewed October 23, 2012
|By Robert H. Shmerling, M.D.|
Beth Israel Deaconess Medical Center
During the first few weeks of our newborn daughter's life, we took her out often to the grocery, to restaurants, on errands. It was easy because she slept a lot, but we did get a mixed reaction from strangers. Some ogled over her, but others looked at us suspiciously, expressing concern that we would be taking such a young child out of the house. "Aren't you worried taking her out at such a young age?" they asked.
Although we had not received specific advice from our pediatrician at the time (and had not asked for any), we've since heard it suggested by friends and family that a newborn should stay inside for the first few weeks or even months. In fact, some friends with a new baby at home have taken their infant out only to go to the pediatrician for routine care.
Is there harm in taking a newborn out of the house when they are so young? The answer has more to do with exposure to people (and their germs) than to actually being outdoors.
The Newborn's Immune System
A newborn's immune system is remarkably competent, though not as strong as that of older infants and children. A fetus receives antibodies (proteins produced by the immune system that protect against infection) from the mother while still in the uterus (womb). However, these antibodies are not completely protective and wane during the first few months of life. In addition, the mother can only pass along antibodies against germs for which she has built up immunity.
Finally, a newborn's B cells, the immune cells most active in producing antibodies, do not respond to infection as well as they do later in life, making young infants particularly susceptible to certain types of infections.
Breastfeeding further boosts a newborn's immune system, as human milk contains antibodies for additional protection against infections.
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Protecting Infants From Infection
Although a newborn's immune system is immature, it does function fairly well and can defend the newborn against many infections. However, just as in healthy adults, it can't defend against all infections; for example, newborns can and do catch colds. For most adults and even older children, the common cold is simply an annoying illness, but for newborns, it can cause significant problems, such as difficulty feeding, dehydration, poor sleep, difficulty breathing and complications such as ear infections. Caring for a sick newborn can present stressful times for parents.
Since infections can cause serious problems in newborns, it's natural to worry about protecting your infant. However, the confusing advice offered by well-meaning friends and relatives could be a bit much to handle and difficult to understand. So what should a parent do? First of all, ask your pediatrician for his or her professional opinion. In addition, here are some well-established ways to reduce a healthy infant's risk of infection:
- Vaccinations Reliable and safe for the vast majority of babies, vaccinations prevent several infectious illnesses, including pertussis (whooping cough), tetanus, hepatitis, certain strains of pneumonia, some types of meningitis, and polio. Vaccinations are recommended for all healthy infants (as well as older children and adults). Experts recommend that newborns receive their first dose of the hepatitis vaccine before discharge from the hospital nursery, but no later than 2 months of age. Other routine vaccinations begin at 2 months and so are not protective during the newborn period.
- Limit exposure If another child or adult has an illness that clearly has the potential to spread to others for example, a child with diarrhea in a day care center, or a family member with a runny nose it is best to limit their exposure to your infant as much as is reasonable. Particularly for the first month, it may be wise to limit all unnecessary exposure, especially to people who may be sick or have not washed their hands.
- Hand washing Ask people to wash their hands before touching or holding your newborn. Anyone taking care of an infant should be sure to wash hands frequently; it will reduce the chance that germs will spread in either direction.
What about my friends' advice to keep a newborn in the house for the first month of life? While that may have been recommended years ago, today most pediatricians simply caution people to avoid exposing their newborns to people who are known to be sick or to any large group of people.
Germs, such as those that cause the common cold, respiratory syncytial virus (RSV), or pertussis (whooping cough), are widespread in the community and easily spread from person to person. Large groups of people, as may be found in shopping malls or movie theaters, increase the risk of exposure to a sick person. Because the risk is also increased on airplanes due to recirculated air, most pediatricians also advise avoiding unnecessary air travel during the first one to three months of life.
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There are times when it is best to keep your newborn away from others. For example, if your child is premature, has any condition associated with impaired immune function (such as HIV), or has a medical problem that would make it difficult to recover from an infection (such as congenital heart disease or cystic fibrosis), it may be important to keep your child away from potential sources of infection. Of course, the isolation need not be prolonged if the medical problems are temporary. If your child has any medical problems, ask your doctor for specific recommendations about going out in public.
Another reason that pediatricians advise new parents to limit their infants' exposure to sick people has to do with the standard medical evaluation for young infants with a moderate or high fever. To make sure that an infant with a fever is not one of the few with a serious illness, doctors typically perform extensive testing, including blood tests, urine tests and a lumbar puncture. The lumbar puncture is helpful to exclude meningitis or encephalitis, dangerous infections of the brain or the fluid surrounding it.
Anything you can do to keep your infant healthy during the first three months of life, and especially during the first month, will reduce the chances of having to go through the trauma of that evaluation. This has contributed to the recommendations to avoid being touched by or near people who are sick, and to limit time spent near crowds or breathing recirculated air (as on an airplane). These recommendations are based more on common sense and medical reasoning than scientific evidence, since careful studies to prove they are worthwhile have not been done (and would be difficult to perform).
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The Bottom Line
The potential problems with taking your young infant out during the first few months are not related so much to being outdoors as to the contact with others who might harbor a contagious infection. It is usually safe to take your newborn outside as long as he or she is appropriately dressed for the weather and extremes of temperature are avoided.
As for exposures to other people, some precautions are reasonable and may reduce the risk of infection. Whether inside the house or outside, young infants should not be exposed to people who have symptoms of an infection. Anyone touching an infant, especially during the first few weeks, should wash his or her hands well beforehand. Exposure to crowds during the first month or so should be avoided if possible, especially where ventilation is poor or air is recirculated. Routine vaccinations can reduce the risk further and are strongly recommended.
The notion that an infant must stay totally indoors for a certain number of days or weeks after birth is a myth. With the precautions mentioned above, you can safely take your baby outside, starting with your ride home from the hospital. In fact, some pediatricians say newborns should be taken outside for fresh air everyday! Fresh air is good for you and your baby, and getting out of the house may do wonders for your outlook.
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.