Germ Warfare

How to keep your baby healthy this winter. Plus, the expert advice on making it through the flu season.

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Winter means holiday outings, celebrations with family and friends … and, for new parents, worries about their baby's health. From when it's safe to take a newborn out for the first time (especially in cold weather), to what to do if your child catches a cold or a more serious respiratory infection, here are answers to your most commonly asked questions.

When is it OK to take my new baby outside?

Keep a newborn home for the first few weeks and limit the number of visitors who handle the baby during this time. This is especially crucial during winter and early spring, which are prime times for contracting respiratory illnesses, including respiratory syncytial virus (RSV), colds and the flu. Particularly avoid taking a newborn to crowded places such as supermarkets, shopping malls and restaurants and on airplanes. "In the first month of life there's an advantage to keeping babies away from crowds," says Patricia Keener, M.D., professor of clinical pediatrics at Indiana University School of Medicine in Indianapolis.

How warmly should I dress my baby when we go out?

Follow this rule of thumb: If you feel cold, your baby is even colder, so bundle her up. And pay special attention to her head. "Infants lose about 50 percent of their body heat from their heads," says Ed Glasser, M.D., associate clinical professor of pediatrics at the University of Colorado School of Medicine in Denver. Cover her head with a thermal cap, and in wet weather layer a waterproof cap over that. In fact, layering makes sense for an infant in general during winter. Babies don't do well in excessive heat, either, so avoid overdressing them or wrapping them in too many blankets. It's a good idea to remove outer layers of your baby's clothing as soon as you come inside.

Winter's cold air, wetness and blustery winds are hard on an infant's soft, tender skin as well, so be sure to keep your baby's face protected if you do go out in these conditions. If the windchill factor is below zero, stay indoors.

What is RSV, and what should I do if my baby gets it?

Respiratory syncytial virus (RSV) is a very common but potentially serious infection that usually occurs from late fall to early spring. It can cause coldlike symptoms, such as low-grade fever, runny nose, coughing and sore throat. In fact, what appears to be a cold in an adult may actually be RSV. The infection is contagious and is most dangerous for premature infants and full-term babies younger than 6 weeks.

Because it is a virus, RSV doesn't respond to antibiotics; however, a number of treatments are available to relieve symptoms. According to the American Academy of Pediatrics, you should contact your pediatrician if you suspect your baby may have RSV, especially if she shows signs of more serious infection, including irritability and restlessness, poor appetite, difficult or rapid breathing or wheezing (put your ear to your baby's chest and listen for a raspy sound). Unless there are complications such as pneumonia, most full-term babies with RSV do not need hospitalization. For more information, visit www.rsvinfo.com.

How can I protect my baby from the flu? And what should I do if she does?

The best way to protect a baby younger than 3 months old is to keep her away from people who have colds. Frequent hand washing also is essential. An infant under 3 or 4 months old who has a fever should see the pediatrician, even if you think it's "just a cold." That's because a virus that causes a mild illness in an older child or adult can be serious for an infant.

If your baby is older than 3 or 4 months and has cold symptoms such as a runny nose and cough with low-grade fever (99°F to 100°F), you can take more of a wait-and-see approach. Call your doctor if you feel you must, says Santa Monica, Calif., pediatrician Jay Gordon, M.D., F.A.A.P. "But as long as your baby will nurse or take a bottle, smile and play a little, don't make an appointment." (The converse also is true, Gordon says: If you believe you need a doctor to look at your child, don't let anyone talk you out of it.)

Keeping her well-hydrated and using a cold-mist humidifier can help her feel more comfortable. If her nose is so stuffed up that she can't breathe or nurse comfortably, use a baby-size nasal syringe to clear it before each feeding: Never give your baby any kind of over-the-counter or herbal cold remedy without first checking with your pediatrician.

How can I protect my baby from the flu?

The influenza vaccine's effectiveness rates vary year by year, depending on what strain of the virus is dominant. However, the Centers for Disease Control and Prevention (CDC) for the first time is recommending that all healthy children from 6 months to 23 months old, as well as other household members and caretakers, receive the influenza vaccine. The current flu-vaccine shortage obviously affects availability, but you should still ask for a thimerosal-free vaccine; the U.S. Food and Drug Administration lists vaccines and how much of this mercury preservative they contain at www.fda.gov/cber/vaccine/thimerosal.htm.

Flu season generally starts in December. The vaccine should be received in October or November in order for it to be most effective, Bocchini says. A child under 9 years old who is getting immunized for the first time needs two doses spaced one month apart, so the first dose should be given as early as possible in order for the child to receive the second dose before flu season begins.

The CDC also recommends that women who will pregnant during flu season get the flu shot. However, they as well as children under 5 years old should not get the nasal-spray flu vaccine. For a full list of who should get the shot, go to www.cdc.gov/flu. Pregnant women should consult their doctors if they or their babies or toddlers begin to display flu symptoms, which can include fever, headache, extreme fatigue, dry cough, sore throat, runny or stuffy nose and muscle aches. Children also can have gastrointestinal symptoms, such as nausea, vomiting and diarrhea.

Should I continue to breastfeed my baby if I come down with the flu?

Yes; the virus isn't transmitted via breast milk. However, the CDC recommends that any mother who has the flu take the following steps before feeding and when handling her infant for seven days after the first symptoms appear. For more information on this topic, visit www.cdc.gov/flu/about/qa/breastfeeding.htm.

1. Put on a surgical mask (they're available in most drugstores).

2. Wash your hands thoroughly, then dry them with a clean towel or paper towels.

3. If you're breastfeeding, keep your breasts covered until you have followed the previous steps and are ready to nurse.

4. Do not remove your surgical mask until you have finished feeding and burping the baby and have put her down.

Additonal Resources

For more information on the seasonal flu and the 2009 H1N1 virus, including breaking news and updates, visit flu.gov.

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