Dear Pediatrician: How Can I Protect My Baby From Coronavirus?

Yes. While most studies of the novel coronavirus, also called COVID-19, are focused on older adults, doctors do know children, including babies, can get infected. Fortunately, most infants younger than 1 year experience asymptomatic or mild disease, meaning they have mild or no symptoms. However, babies with chronic medical conditions and premature infants are at an increased risk of hospitalization if infected with the virus.

Respiratory Infections in Infants

Even though most babies don’t experience serious illness from coronavirus, respiratory diseases—from the common cold to COVID-19—are dangerous in infants because:

• Infants have small airways. Simply due to their smaller physical size, infants are more susceptible to the effects of respiratory infections. Mucus and inflammation block infant airways, leading to increased work of breathing, difficulty breathing and sometimes dangerously low oxygen levels.
• Babies dehydrate quickly. Rapid breathing, fever and gastrointestinal symptoms associated with respiratory illnesses contribute to dehydration. Dehydration affects all body systems and can lead to organ damage if not medically managed.
• A baby’s immature immune system can’t fight illness well. Although infants are born with some innate immunity, infants are unable to mount a robust immune response to new infections. This immature immune response makes them more susceptible to complications of infections.

As the pandemic has evolved, so has the coronavirus itself. New viral variants have physical properties that make them more contagious and deadly to all humans, including children.

Doctors expect to see more infections and hospitalizations in infants within communities that have high rates of infectious variants. This increase has already been seen in areas with high variant spread. For example, from February 2021 to April 2021, Michigan reported a 237% increase in childhood admissions for COVID-19. While that resulted in 42 children hospitalized, a relatively small number of total COVID-19 hospital admissions statewide, the trend is troubling.

Maintaining vigilant public health measures remains necessary to protect children from coronavirus infection. Meanwhile, testing infants with symptoms suspicious for COVID-19 is a key step in providing proper medical care.

Coronavirus Symptoms in Babies

The symptoms of coronavirus in babies are similar to those of an adult. However, it’s nearly impossible to determine if an infant’s symptoms are actually due to coronavirus without testing. If your baby develops any of the following, call your pediatrician’s office to discuss next steps.

The symptoms of COVID-19 in infants include:

• Cough
• Fever
• Runny nose
• Rapid breathing
• Wheezing
• Fatigue
• Poor feeding
• Vomiting
• Diarrhea
• Headache
• Increased work of breathing

Until infants are able to be directly protected from coronavirus through vaccination, there are ways to protect your baby from COVID-19:

• Get vaccinated with any available COVID vaccine as soon as possible. By vaccinating adults who care for infants, the risk for children in the home declines.
• Limit outings with your baby, especially if your community infection rates are high. Utilize delivery services and carryout whenever available.
• Limit visitors to your home. Any unvaccinated individuals invited into your home should wear a mask while inside and while holding your infant.
• Breastfeed or provide human milk, if you’re able. 
• Keep sick people away from your baby. This includes siblings and other care providers.
• Continue routine pediatric in-person well visits. Pediatric offices across the country have taken steps to ensure their office environment is safe for patients and their families. At infant well visits, physicians can identify and treat growth and development issues, as well as ensure routine infant vaccinations are administered on time.

As always, follow the guidance of national medical experts, your local health department and your physician.

Researchers have found antibodies to COVID-19 in the human milk of vaccinated people. However, it’s unclear whether these antibodies provide direct protection to infants after consumption.

Human milk contains all sorts of living cells and proteins to help protect babies from illness. When an infant breastfeeds or consumes human milk, protective antibodies and other antimicrobial agents coat the lining of the infant’s respiratory and gastrointestinal tract, neutralizing micro-organisms of all types and defending against illness. Adding coronavirus selective antibodies in the breast milk may provide more advanced protection against COVID-19 in infants, but current research has not confirmed this hypothesis.

It’s important to understand that human milk doesn’t provide the same type or strength of immune protection as a vaccination. Immunity from human milk is “passive”—it requires no effort by the infant’s immune system to protect. Passive immunity doesn’t trigger the same long-term protection that results from vaccination or natural infection. That being said, infants who consume human milk will need to be vaccinated against coronavirus once leading experts determine infant vaccinations are safe and effective.

For parents who are unable to breastfeed or choose not to offer human milk, getting adult caretakers vaccinated still provides protection for infants. Like many other infectious diseases, COVID-19 infections primarily spread in the home from adult to child—as more adults are protected from infection, infection rates in children of all ages will drop.

With adequate support and guidance from your personal doctor, it’s safe to care for and feed your baby while infected with coronavirus.

Researchers have closely followed parent-infant pairs throughout the pandemic. Although it’s possible for an infant to be born infected with coronavirus if the mother has active infection, this seems to be exceedingly rare. More commonly, researchers are finding babies born to infected mothers are born healthy and with protective coronavirus antibodies in their blood.

Although research is ongoing, current evidence suggests the breastmilk of COVID-19 infected mothers is not a significant risk to infants. Due to the overwhelming benefits of breastfeeding, continuing to nurse or offer expressed human milk during maternal illness is recommended.

Tips for Caring for Your Baby if You Have Coronavirus

If you’re positive for COVID-19, take special care of yourself and your infant.

• Talk with your personal physician about the risks of caring for your infant while infected.
• Wear a mask at home and while caring for your infant.
• Do not place a mask or face shield on your infant.
• Wash your hands frequently, especially just before breastfeeding.
• Routinely clean commonly touched surfaces.
• As you are able, maintain a distance from your infant while not providing direct care or feeding, until your isolation period is complete.
• Continue to offer human milk, if able.

Keep in mind, people infected with coronavirus require ample time for rest and recovery that may not be possible if caring for an infant. It’s okay to ask for help and lean on trusted friends and family during this time. Prioritizing your personal health is part of being a successful parent.

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“Dear Pediatrician” is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your child’s pediatrician or other qualified health provider with any questions about a medical condition. By submitting your letter, you’re agreeing to let Forbes Health use it in part or in whole, and we may edit the letter for length and clarity.

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