Can COVID-19 Affect New Born Babies?

Dr Sridhar Kalyanasundaram, a consultant Pediatrician and Neonatologist and Head of Neonatology Department at Zulekha hospital, shares his first-hand experience on the effect of Coronavirus to new born babies. He also addresses main concerns of parents with toddlers such as vaccination, growth issues, and increased screen time during COVID-19.

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Dr. Sridhar Kalyanasundaram

Pediatrician/Neonatologist
Al Zahra Hospital, Al Barsha

How is COVID-19 affecting new-born baby care?

We have been seeing some mothers with COVID positive coming in. But luckily the newborns have not been significantly affected, even if they are born to a COVID positive mother. And very few babies have any symptoms at all. We don't do anything different compared to normal babies, except for wearing PPE (personal protective equipment) and taking the precautions. The parents understand the situation, and they are not overly alarmed or anything. So it's been helping us as well.

But as time goes on, I think this (the crisis) will continue for some more time and we will see more cases. Possibly we might start seeing babies presenting with the viral chest infection and similar. to the RSV infection causing bronchiolitis, we might possibly see infection similar to that with COVID as well. So time will tell but obviously as far as babies and children are concerned, there is nothing to be overly concerned (with the current knowledge).

Recently you might be reading in the press about the inflammatory syndrome in children related to COVID-19. We have a condition called Kawasaki disease which presents with multiple system involvement and  affected children may even have coronary artery dilatation in the heart and we give them immunoglobulin therapy to reduce the severity of the problem. There are reports that the COVID-19 infection may produce such a condition as the above. But that is more in the older kids, not in the babies.

What are main concerns of parents during Coronavirus pandemic?

The main concern that parents have is regarding vaccination: whether the routine vaccines should be given as scheduled? Now that we are past the lock down stage, it's not advisable to keep delaying your routine vaccinations. Obviously you can discuss the individual situation with your doctor if it is okay to wait a couple of weeks or more. But there are important vaccines in the first year of life. For example, at the one year stage, we have the MMR vaccine (mumps, measles, rubella), and measles is a serious infection as well. So you have to make sure that we are not delaying these too much.

Other common concerns that they have is whether the growth of the child is going normally. That is a concern we commonly address when they come to the clinic but now that they are not coming to the clinic,  they should remember that healthy children have a differing growth pattern. Each child is different, so you cannot exactly say my child has to be in this weight range or they should be chubby. There are lots of factors: there may be genetic factors, or it may be related to low birth weight. If your baby was premature or was growth restricted, they may not grow at the normal rate. They may have a lower potential. Your family may have smaller people and genetically your baby may have taken that aspect. And obviously if the baby had any other issues which may affect growth, you should be aware of that.

We do have growth charts and now we have good apps to monitor growth. We just have to plot the babies' growth in the WHO growth chart in the first two years, and after that, you can use the CDC charts. The WHO charts are designed for breast feeding babies and if you go by the age of the baby. If you have earlier weights, you can record them and plot them as well, so that they will give you a percentile distribution for your baby's growth, i.e., where your baby's growth falls in relation to 100 children of their age.

Suppose your baby is a six months old boy and the child's weight is 8 kg. That's likely to fall in the average, which is close to 50th percentile. But as pediatricians, we take anywhere from the 10th percentile to the 90th percent as normal. We don't need to be bang on in the middle, because you have a range. Once your child falls on a certain centile, we expect it to be maintained-but if it is dropping rapidly, then there may be some factors to explore. You would have to discuss with your doctor but don't be overly concerned.

If the child's weight is going excessively, nowadays with more TV time and games on the TV and things like that, obesity is  a risk as well. We should watch the trend and hold the reins when you can avoid unnecessary eating. Avoid junk food. It's not just poor growth they are concerned about. If at all you have started any high energy milk, it is for a short period of time to boost the growth, so try to avoid continuing it, especially if the your child growth suggest that they grow too rapidly. So in terms of growth concerns my advice would be that individualize your child's growth pattern, know where your child is on the growth chart and follow that trend. So in terms of growth concerns my advice would be that individualize your child's growth pattern, know where your child is on the growth chart and follow that trend.

How can we control kid's screen time while social distancing?

Reducing activity leads to more screen time. So both for reducing screen time which is harmful for the child's development and to avoid obesity and keep general level of fitness, you do need to focus on activity. And children do look at their parents as role models so we have to give them the example, we have to stop screen time ourselves as much as we can. Do your essential stuff, but don't let it interfere with interaction with your child.

As for physical activity, try to do it with your child. Go out to the park with the child, run around with them, kick the ball. Go biking, take your child  along with you. Nowadays we are not encouraging adventurous activities. When we were kids, we used to jump up and down, parents didn't stop us. But now we are worried about injury, probably rightly so to an extent. But we are curbing their adventurer spirit and the freedom that they feel. Playing with other children nowadays maybe a little difficult with social distancing, but we have to find a balance. Don't go to open play areas where there are play gyms and things like that where you might come in contact with many other children, touching things etc. But if you are in an open space kicking a ball it's a perfectly safe. The swimming pools may take some time to open because there is a risk from there, but the normal activities, walking, cycling, kicking a ball, running, these things should be okay. 

If you don't have any elderly person in your family, the risk to your own family is not very high. But if you have some elders, you have to be extra cautious. The children are not a high risk group. Healthy adults are not a high risk group. But if you have obese individuals, if you have people at high risk in your family, you have to be extra careful.

*Disclaimer: Please consider the information in this video/article most recent as per date and medical recommendations towards COVID-19 may change as the situation evolves.