What parents need to know about babies, the delta variant and COVID

Alaska Public Media | By Selena Simmons-Duffin - NPR

Published September 10, 2021 at 7:56 AM AKDT

Getting vaccinated during pregnancy is one of the best ways to make sure your vulnerable newborn benefits from your antibodies to the coronavirus, doctors say. (©fitopardo/Getty Images)

If you have a baby at home or are expecting one in the next few months, you might be on edge for all sorts of reasons, but particularly because of COVID-19. The delta variant of the coronavirus has turned nearly every community in the country into a bright red hot spot of viral infection. Babies can't get vaccinated against COVID-19 yet — and the youngest age included in current vaccine clinical studies is 6 months old.In fact, the rate of new cases of COVID-19 among babies and children younger than 4 years old in the U.S. recently surpassed the rate of new cases among adults older than 65, according to the Centers for Disease Control and Prevention (although the number of deaths among the children remains very low)."People were saying 'Oh, kids don't get COVID' — that's really not true," says Dr. Jennifer Shu, a pediatrician in suburban Atlanta. "They are getting it at the same rates as we would expect, based on their population."Shu says she's concerned: "Because they are disproportionately unvaccinated, we are going to see higher numbers from children, as variants like delta take advantage of people who are vulnerable."Here's a guide to the latest science — and some practical advice — on how to protect a new baby from all variants of the coronavirus.

1. How to pass along some coronavirus antibodies during pregnancy

There are lots of reasons why OB-GYNs, midwives and infectious disease experts encourage anyone who's pregnant to get vaccinated against the coronavirus, the first reason being this: COVID-19 can make pregnant people especially sick.Then there's this bonus from a pregnant individual's vaccination, says Dr. Flor Muñoz, a pediatric infectious diseases specialist at Texas Children's Hospital and Baylor College of Medicine: Fetuses get a share of the antibodies generated via the placenta."The paradigm of immunizing a pregnant woman so that her newborn and young infant is protected from a disease is an old one," notes Dr. Karen Puopolo, who heads the newborn medicine section at Pennsylvania Hospital in Philadelphia and conducts neonatal infectious disease research. For example, pregnant people have long been encouraged to get vaccinated against whooping cough so that their bodies generate antibodies that pass to the fetus and protect the baby after birth.There's no particular recommended timing for when to get the COVID-19 vaccine during pregnancy, Muñoz says. But because of the timing required with Moderna and Pfizer, with two shots several weeks apart, if you get vaccinated "around the second trimester, you will be protected in the highest period of susceptibility, which is the third trimester."In fact, Puopolo explains, "late in the third trimester, there is an active process so that essentially your body makes it so that there is more antibody in your baby — in terms of the concentration — than there is in you."Muñoz is leading a large study funded by the National Institutes of Health called MOMI-VAX to gather lots of data about mothers and infants and vaccination, including measuring the concentration of SARS-CoV-2 antibodies in the mother versus the baby at birth. It will also look into how long these antibodies last and how well they protect the baby from infection. (The study began enrolling volunteers in early July, with plans to follow individuals and their infants for one year after delivery.)It's likely, Muñoz says, that the borrowed antibodies from pregnancy decline over the first couple of months of a child's life.

2. Breastfeeding can help, too, if you've been vaccinated or already had COVID-19

Mothers who have been vaccinated or had prior infections with the coronavirus can also pass along antibodies to their babies through breast milk, which acts like a temporary shield inside the mouth and nose and stomach, Muñoz explains."It's mostly a surface coating, if you will," she says. That coating is helpful since "this is where these respiratory infections go in — from the nose or the mouth of the baby." The details of how and how well that mode of protection works is part of her MOMI-VAX study.To be clear, though, she adds, "compared to the antibody that babies get through the placenta — so directly into the blood — the contribution of breast milk antibodies is less."That's why Shu in Atlanta is concerned. She says even in her highly vaccinated community, she's seeing many pregnant women who aren't getting vaccinated."I'm seeing too many people who are choosing to wait to get the vaccine until after they've delivered," Shu says, "and they're really relying on some immunity going through the breast milk to protect their baby." Nationally, only about 1 in 4 pregnant people had at least one dose of a coronavirus vaccine as of the end of August, according to the CDC."With the delta variant being as transmissible as it is, I would really like to see that the moms get the vaccine either before they become pregnant or during their pregnancy," Shu says.

3. Try to create a caregiver force field

Beyond supplying antibodies, which can help babies fight off infection if they get exposed to the virus, parents can avail themselves of other strategies to keep babies from getting exposed in the first place.Many of these tricks have been proven to work against other germs — babies have always been vulnerable to picking up viruses and other pathogens, especially early on. "The first month of a baby's life is really delicate," Shu explains. "In that month, if they get an infection, it can turn serious a lot faster than in older babies."So, although the pandemic is a particularly stressful time to be guarding a newborn's health, "the steps that I would tell a family to take today are not shockingly different than I would have told them 10 years ago," Puopolo says.Bottom line, in regards to the people who are around your baby: "Make every effort to keep them healthy," Puopolo advises.In the era of COVID-19, she says, that means "ensuring that anybody — age appropriate — is vaccinated. The parents should be vaccinated; if you have grandparents or a nanny or someone who's in your home helping with child care, make sure they're vaccinated." Siblings who qualify for the shots should get vaccinated, too, she says.Having all of the people around the baby vaccinated acts like a force field. Those people are less likely to get infected, which means they're less likely to bring the virus home."For the most part, what we have learned is that when an infant becomes ill with a respiratory illness, such as flu, COVID or pertussis, it's because they've been in contact with someone in the house ," explains Muñoz.Of course, the vaccines are not a perfect shield, so it's smart to use several methods to fight off COVID-19, including having parents, caregivers and siblings wear masks when they're out in public. Keep the home well-ventilated, and frequently wash your hands. And, if your baby is at day care, Puopolo suggests having conversations with staff about whether they're taking those same steps to minimize risks.If someone home with the baby is sick (with any illness, but especially COVID-19), keep them away from the baby as much as possible. "We highly recommend that people who are sick are not around babies — they don't kiss the babies, they don't have very close contact face to face," Muñoz says.If the parent or any direct caregiver gets sick or feels they might be coming down with something and is the only one to care for the infant, Muñoz recommends that they put on a mask when around the baby, especially if they're symptomatic. "In some cases, it's even been recommended to completely separate the person who's ill — even if it's the mother from the baby — when there is a high risk of transmission," she adds.

4. Where to (not) go and who to (not) see

Life with a newborn is often a mix of harrowing and delightful — and during a pandemic, there's definitely extra stress. Do go for walks with your baby, Shu says, but don't take the baby to big gatherings."You don't want them in large groups of people," she says. "If you want to see guests, you might have them visit outside your house instead of inside. Anyone who wants to hold the baby needs to be healthy, wash their hands and — in this day and age — probably wear a mask."In other words, "stay away from settings where your baby can catch something," Puopolo advises, especially in the baby's first few months.

5. Watch for these red-flag signs of COVID-19 in your infant

So far, even though the delta variant is much more transmissible than the original coronavirus variant, researchers are still trying to figure out if it causes illness in children and babies that is any more severe."Fortunately, in my practice, the newborns and young infants I've seen who have had COVID have done well — they tend to have cold symptoms and recover," says Shu. "That said, I've seen other infants with a fever lasting for many days from COVID we sometimes see some breathing problems that may require a trip to the hospital."Especially for anyone in the first few months of life, fevers are a red flag, says Puopolo. "You should always call your pediatrician or seek emergency care if a baby has a fever greater than 100.4° Fahrenheit," she says. "In addition to fever, you are worried about how the baby's feeding, how the baby's sleeping." Since infants who are sick don't tend to feed well, they can also get dehydrated, she says."So signs of a cold, signs of a fever, fussiness that can't be resolved, poor feeding — these are, COVID or no COVID, always reasons why you should seek medical care for your infant," says Puopolo.Again, "the risk is low, but it's not zero," Shu says, that babies will develop severe complications from COVID-19.

So, when will babies be eligible for vaccination against this virus?

The clinical trials of COVID-19 vaccines currently underway only dip down in age as young as 6 months. But reduced doses of the vaccine might — at some point — be available for younger ages, says Muñoz."If you look at some of the guidance from the FDA from very early on in the pandemic, children under 6 months are not excluded," she points out. "So they can be included, it's just that at this time, to my knowledge, there are no studies evaluating vaccines at zero to 6 months of age."Vaccines are evaluated in a stepwise process by age, she explains. "We have been starting with adults and then adolescents and now working on the pediatric age groups," Muñoz says. "It will take some time, because we have to establish safety and efficacy in older groups before we can go down to the newborns and the youngest babies.""So this is something that is not out of the