COVID-19: Advice for Parents at home

Updated – 20th March 2020

Consultants and Senior Nurses on the RVI Neonatal Unit have put together a guide to help address some of the concerns and questions that Neonatal Parents may have in these understandably worrying times. We want you all to feel supported during this time so we will do our best to work with the Neonatologists and Senior Staff to respond to general questions, but please be aware we cannot answer specific questions about individual babies.

Please see below. You can also download a PDF version of this information here.

COVID19 - babies off the Unit

The consultant neonatologists and senior nurses have put together a short list of responses to questions we have been asked over the last few days. We cannot answer questions about individual babies via the web. We will do our best to update and provide more information over the next few days. If your baby is on the Neonatal Unit at present, we have provided a short leaflet with “Ten top tips” you can access here.

My child is still under outpatient follow up and I have a specific question, or concern relating to my child’s treatment or medicines

Please contact the neonatal secretaries directly using the number and/or email at the top of your most recent clinic letter.

My child has an outpatient appointment in next few weeks – what should I do?

We will try and provide outpatient advice and support by telephone where this is appropriate. For example, your child may be stable, and it might be possible to discuss current progress and plans by telephone. We are still working out the most effective way of doing this and will provide updates soon. We may still need to see some children in clinic to assess their progress.

My child has Chronic Lung Disease and/or is on home oxygen. What should I do?

Most children who get COVID19 do not develop serious disease, and many only have mild or no symptoms. However, children with Chronic Lung Disease (CLD) may be more affected and we therefore consider them to be in an ‘at-risk’ group. For this reason, we think it is very important to follow government advice on ‘social distancing’. This means limiting or avoiding any visitors to your house and avoiding taking your child into situations or environments where contact with others is likely. Even if no one in the family is unwell, it is sensible to practice regular handwashing. If your baby’s oxygen is being ‘weaned’ then continue to follow the advice from the community nursing team.

My child does not have Chronic Lung Disease but is regularly admitted with chest infections, or often requires antibiotics, or is being investigated for problems with their immune system. What should I do?

In these types of situations, we think it is sensible to follow the same advice as for children with CLD and consider them to be in an ‘at-risk’ group.

My child was premature but is otherwise well and does not have any other specific medical problems. Are they still at risk?

Most children who were born premature will have normal immune systems when they are discharged. There is no current evidence to suggest they are at higher risk than other children. However, we think it is sensible to consider any very premature baby (born at less than 32 weeks) to be in an ‘at-risk’ group until they are 2 years old. Most prematurely born children older than 2 years of age appear to withstand coughs, cold and flu the same as term-born children. There may be exceptions however, for those who required prolonged home oxygen e.g. for more than 6-9 months after discharge.

At what age do you grow out of Chronic Lung Disease (CLD)?

Most babies who develop CLD will have lungs that function fairly normally by the time they are 2 years old. A small number of children may have longer term problems, but these will mainly still be under paediatric follow up. Therefore, if your child is now over 2 years old AND did not require prolonged oxygen after discharge AND is otherwise generally well then you should follow standard NHS advice about protecting your family. The risk to most children from COVID19 is generally very low.

I can’t get hold of hand sanitizer (or alcohol gel), what should I do?

Washing hands with soap and water for at least 20 seconds is just as good as using sanitizers. If you have sanitizer then it can be useful if you are travelling or where you cannot wash your hands. However, in the house soap and water is effective.

Is it OK to use paracetamol or ibuprofen?

The current advice is that paracetamol (calpol) is the first choice for both children and adults who want symptomatic relief, unless you have been advised not to use paracetamol. There is no strong evidence that using ibuprofen is riskier despite media reports circulating. However, the guidance on this may change.

Is it OK to still have immunisations?

It is very important that infants (and children) continue to receive their routine immunisations. There is no reason to avoid or delay them as that would only increase the risk of other infectious diseases.

I have symptoms (mother), should I keep on breastfeeding?

The current advice is that babies benefit from being breastfed even if the mother has symptoms or is known to be COVID19 +. There is currently no clinical evidence to suggest that the virus can be transmitted through breastmilk. Infection can be spread to the baby in the same way as to anyone in close contact with you. The benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk or by being in close contact with your child, however, this will be an individual decision and can be discussed with your midwife, health visitor or GP by telephone. If you wish to breastfeed, take precautions to limit the potential spread of COVID19 to the baby by:

  • washing your hands before touching the baby, breast pump or bottles
  • avoiding coughing or sneezing on the baby while feeding at the breast
  • cleaning any breast pump as recommended by the manufacturer after each use
  • considering asking someone who is well to feed your expressed breastmilk to the baby
  • If you are feeding with formula or expressed milk, sterilize the equipment carefully before each use. You should not share bottles or a breast pump with someone else

I cannot get hold of my usual baby milk formula, what should I do?

Despite what many people think, or what advertising suggests, there is no evidence of any important health difference between any of the commercially available infant milk formula after hospital discharge in the UK. The cheapest formula available (often supermarket own brand) is just as healthy and good for growth as any more expensive brand and always contains the recommended amount of nutrition.

  • If you are using a stage 1 milk and cannot get your usual brand it is best to switch to another brand. Stage 2 milks and/or so called ‘follow-on’ milks contain the same amount of protein and vitamins as stage 1 milks and are not necessary.
  • If you baby has been prescribed a post-discharge formula (e.g. Nutriprem 2, SMA Gold Prem 2 etc.) and you run out, then any stage 1 infant formula can be used until you are able to discuss with the neonatal team.
  • If you are using follow on formula for a baby older than 6 months and cannot access this, then use Stage 1 (first) infant formula.
  • If you are using other milks such as anti-reflux milk, comfort milk, etc. and can’t access these, then use a stage 1 infant formula.
  • Always make up infant formula as per manufacturers guidance – do not be tempted to add more water to make it last longer as diluting the milk could endanger your baby’s health.

 

 

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