The basics of RSV

RSV is most common during October to April, which coincides with flu season. This can make it tough to tell which illness your child has, and your pediatric provider can order a nasal swab to test for both. Commonly, kids will have:

• Runny nose
• Decreased appetite
• Cough
• Wheezing
• Fever
• Fast breathing
• Tiredness or fatigue

The biggest worry with RSV is that it can make it hard for people to breathe. This video shows what to look for when it comes to RSV and breathing. Call your pediatric provider or seek emergent care if you notice any of these symptoms – even one. Babies under age one, children born prematurely, and any child with a high-risk condition are at greatest risk for complications. Older people are also at higher risk of hospitalization and complications from RSV. Encourage the grandparents and other older adults in your life to get vaccinated to protect the whole family.

What now?

If your child has been diagnosed with RSV, or it’s strongly suspected, try not to panic. Most children recover well and only need rest, hydration and maybe medication for fever. Keep a close eye out for severe symptoms and breathing difficulties, and alert your pediatric provider if your child is high-risk or having trouble eating or drinking. 

For young children and babies, it can be hard to eat and drink while sick with RSV. Signs of dehydration can be found here, but try to offer lots of fluids or water-rich foods, like fruit or popsicles, often throughout the day. Babies under age one don’t need additional water, just breastmilk and/or formula. Breastfed babies may want to breastfeed all day or find it tough to stay latched – both are common experiences. On the other end, it can be helpful to track wet diapers again in the Ovia Parenting app – even if it’s been a while! 

Because RSV spreads so easily, your child should not go back to daycare or preschool until their symptoms have resolved. Your family may also want to consider limiting contact with other high-risk family members, like grandparents.

Preventing RSV

Preventing RSV is similar to preventing other respiratory illnesses like the flu or Covid-19. Hand washing, masking and avoiding large indoor groups during RSV season can all help. Preventative treatment is approved for babies entering their first RSV season or high-risk children entering their second RSV season. 

In addition, there are currently two ways to protect your baby from the risk of getting RSV that you may want to consider. 

Nirsevimab (Beyfortus) for infants

• The RSV antibody is available for babies and some young children to protect against severe RSV.
• Recommended for infants under eight months of age born during RSV season or about to enter RSV season, especially those who are at an increased risk, such as infants:
  • Children born prematurely
  • Those with a severely compromised immune system
  • Children with cystic fibrosis
  • American Indian and Alaska Native children
• If the birthing parent gives birth 14 or more days after being vaccinated against RSV, except in rare circumstances, most infants younger than 8 months of age do not need to receive the Nirsevimab vaccine.

RSV Vaccine (Pfizer ABRYSVO) for those who are pregnant and people over 60

• An RSV maternal vaccine for the pregnant parent to pass on protection to their babies. 
• Individuals in their third trimester, from September through January, should receive the vaccine, specifically during weeks 32-36 of pregnancy. 
• Taking the vaccine will pass on valuable antibodies to your newborn baby. 
• RSV Vaccine is also approved for people over 60. If you have close family members who may live with you or care for your children, discussing vaccination may be a good idea to help protect both the baby and family members.

It’s important to explore these options with your OB provider and family to determine what’s best for your baby. It’s a big step forward in protecting those most vulnerable to severe RSV infection and hospitalization.

Reviewed by the Ovia Health Clinical Team

Sources:

• Signs & Symptoms of RSV in Babies. American Academy of Pediatrics, AAP. Oct 26, 2022 https://www.youtube.com/watch?v=_2qh31Wndls
• Signs of Dehydration in Infants & Children, HealthyChildren.org. Healthy Children. Last Updated 9/24/2019 https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/dehydration.aspx
• RSV in Infants and Young Children, CDC, Center for Disease Control, Last sourced: July 17, 2024 https://www.cdc.gov/rsv/high-risk/infants-young-children.html
• RSV Immunizations to Protect Infants. CDC, Center for Disease Control, Last Reviewed: July 17, 2024 https://www.cdc.gov/rsv/vaccines/?CDC_AAref_Val=https://www.cdc.gov/rsv/about/prevention.html

These recent guidelines offer recommendations that include 0 to 2 year olds for the first time ever, including a key recommendation that parents should “introduce infants to allergenic foods.” Let’s break down these important new food allergy guidelines.

USDA guidelines on early introduction: 5 key takeaways for parents

1. Introduce Infants to Potentially Allergenic Foods

The new Dietary Guidelines recommend that parents introduce infants to allergenic foods like peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy. They note that, for example, introducing peanuts “reduces the risk that an infant will develop a food allergy to peanuts.” Parents should introduce these allergenic foods in baby’s first year of life along with other complementary foods.

2. There is no evidence that suggests parents should delay peanut introduction

It is important to introduce these foods early, in your baby’s first year of life.

3. Parents should introduce peanut-containing foods at 4-6 months for high risk infants

Babies at high risk for food allergies are those with severe eczema and/or egg allergy. For these babies, introducing peanuts at 4-6 months can “reduce the risk of developing peanut allergy.” Parents should consult with their healthcare provider before introducing peanuts to determine the safest way to introduce them.

4. Nuts and chunks of peanut butter can pose a choking risk

Parents should find appropriate forms of allergenic foods to introduce to their baby as nuts and peanut butter can be a choking hazard. Learn more about how to safely introduce peanuts from the NIAID Guidelines here.

5. Diversify your baby’s meals after six months

In addition to allergenic foods, it is strongly recommended to introduce a variety of foods across all food groups to help with your baby’s growth and development.

Reviewed by the Ovia Health Clinical Team

Content provided by Ready, Set, Food!. Ready, Set, Food! is a complete guided system that gently introduces your baby to the top 9 most common childhood food allergens, including peanut, egg, and milk. 

1. Fever over 105 F (40.5 C), or 100.4 F (38 C) for babies under 3 months
   Fevers normally have to be over 106 F (41.1 C) to pose a risk to the brain, but it’s best that you call the pediatrician for any fever over 100.4 F (38 C) in a baby less than 3 months old. If you do notice a high fever, you should also pay attention to any other symptoms your child might be displaying. You may also want to call for a lower fever if it lasts more than a few days, as this is probably a sign of illness.
2. Bloody stool
   If the poop is black, it might mean blood has been digested. This could just be a result of bleeding or cracked nipples while breastfeeding, but could also be a sign of something more serious. Call the doctor regardless, just to be safe. Poop that is mostly bright red with blood is of greater concern, and should lead to an immediate call to the doctor.
3. Intense abdominal pain
   Digestive problems are about as common in babies as trees are in a forest, but you should definitely call the pediatrician if your child is experiencing intense abdominal pain, or if the pain is concentrated in one area.
4. Severe vomiting, or vomiting that lasts longer than a day
   Like abdominal pain, a child is bound to vomit at some point in the early days, but very severe or frequent vomiting, or vomiting that lasts longer than a day deserves a call to the pediatrician.
5. Intense diarrhea or mild diarrhea that lasts for 10 or more days
   Diarrhea is pretty common in babies, but if your child has severe, dehydrating diarrhea, or mild diarrhea that lasts more than 10 days, you should call the doctor.
6. Dehydration
   Common signs of dehydration include a lack of tears when crying, fewer wet diapers than you previously noticed, or going 6 or more hours with a dry diaper.
7. Lethargy, or lack of interest in feeding
   This could be symptomatic of a number of different things, so it’s best to call the doctor if a baby seems more lethargic or less interested in eating than usual.
8. Constant or painful cough
   A small cough that goes away is no big deal, but a cough that is constant, or causes pain should definitely be reported.
9. Breathing problems
   If it seems like there’s some breathing trouble going on, you should call the pediatrician right away. This includes wheezing, or straining for breath.
10. Rash that doesn’t clear within a few days
    Lots of children get rashes, but most clear within a few days. If it doesn’t, it’s a good idea to make the call.
11. If you’re worried
    Last, but certainly not least, you should feel free to call the pediatrician whenever you’re worried. Now, we’re not saying to call about every sneeze and boo-boo, but if a call to the doctor would make you feel more comfortable, you shouldn’t hesitate to make it.

Sources

• Mayo Clinic Staff. “Diaper rash.” Mayo Clinic. Mayo Clinic. April 7, 2020. http://www.mayoclinic.org/diseases-conditions/diaper-rash/basics/treatment/con-20019220.

The American Academy of Pediatrics recommends that all healthy infants be put down to sleep on their backs, not their sides or stomachs.

Why should babies sleep on their backs?

This is the safest position to sleep for the first year of life, since it drastically reduces the chance of Sudden Infant Death Syndrome, often known as SIDS.

SIDS is one of the top 5 causes of death for babies under age one. However, the SIDS rate has declined by 50% since experts began recommending that parents place babies on their backs to sleep for every nap and overnight. While experts do not know exactly what causes SIDS, in addition to genetic predisposition, there may also be airway and awareness changes that make it harder for babies on their stomachs to get enough oxygen. 

Doctors used to believe that if babies slept on their backs, if they were to vomit it could cause dangerous blocked airways. Doctors later discovered that babies have little difficulty turning their heads while sick or spitting up, and leaving baby in a stomach down position is far more dangerous. If your newborn has a condition that forces them to remain on their stomachs, consult your pediatrician or family doctor about safe sleep positions. Infants who sleep on their backs are also less susceptible to ear infections, fevers, and stuffy noses.

Even if your newborn is sleeping on their back, it is important to avoid soft surfaces like pillows and comforters, stuffed toys, loose clothing, crib bumpers or any other potentially loose item (like mittens or hats) which can block the airway. A firm crib mattress covered by a tightly fitted sheet is the safest bedding for an infant, even if it seems empty in there! The AAP recommends that infants should be sleeping in their sleep space alone as well.

Parents and caregivers should place infants on their backs for every sleep. Once a baby can roll into their preferred sleep position, you do not need to reposition them as SIDS becomes far less of a risk. 

Reviewed by the Ovia Health Clinical Team 

Sources

• “Frequently Asked Questions (FAQs) About SIDS and Safe Infant Sleep.” National Institute of Child Health and Human Development. U.S. Department of Health and Human Services. Web.
• “Sleep Position: Why Back is Best.” HealthyChildren. American Academy of Pediatrics, November 21 2015. Web.
• “Sudden Infant Death Syndrome(SIDS).” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, October 3 2016. Web.

How to effectively burp your newborn

Burping is often helpful for both breastfed and bottle-fed babies, though many breastfed newborns need less burping than bottle-fed infants. There are four common positions that many parents use to burp, but every baby is different. Some may burp easily, while others almost never seem to give up a burp! See if a different approach improves burping or your baby’s overall comfort.

1) On the chest

This tried and true position begins by holding Baby against your chest so that their chin rests on your right shoulder while their body stays centered. As you support their head with one hand, rub or pat their back with the other hand. This position takes into consideration the unique shape of the stomach to help any air come up and out.

2) Sitting on your lap

Begin this position by sitting Baby on your lap facing to the side or away from you. Use one hand to gently support their chin while being careful not to strain their neck, and use the other hand to rub their back. Encourage Baby to lean forward while you pat their back until they burp. This may lead to some spit up, so be prepared!

3) Face down across your lap

One of the easiest burping positions involves laying Baby face down across your legs so that they is lying across your knees. Make sure to support their head and gently rub or pat their back to release the air bubble. You can also gently place your baby on their side on a firm surface after feeds to help them burp.

4) The wiggle

For newborns and smaller babies, a gentle rotation of their tush can sometimes release gas! Hold your baby by the shoulders and the hips, and gently rotate their hips in a circular position. 

Remember that every baby is unique. Burping can sometimes lead to more upset, especially when it’s done as Baby has already started to drift off. A full stomach of milk may feel uncomfortable if their position is changed suddenly and there is a lot of jostling and patting. It’s always okay to experiment with what works best for your baby. Although burping can commonly make babies feel more comfortable, it’s not a must-do for everyone!

Sources

• “Burping, Hiccups, and Spitting Up.” HealthyChildren. American Academy of Pediatrics. November 21 2015. Web.
• “You don’t need to burp babies.” McGill Office for Science and Society. March 29, 2019. Web. https://www.mcgill.ca/oss/article/did-you-know/did-you-know-you-dont-need-burp-babies

Traveling with your newborn

It’s true that Baby‘s immune system won’t be fully formed for a while yet, which makes the outside world little bit of a risk for them, but sometimes trips outdoors can’t be avoided. With the right precautions, though, stepping out with Baby can be safe, healthy, and fun for the whole family.

Make sure to pack these nine items for any outing, and go at your own pace — don’t let anyone else (except maybe the doctor) dictate what you can and can’t do with Baby.

1. Fully stocked diaper bag
   This should include key items such as diapers, rash cream, changing pad, wipes, a pacifier if Baby uses one, a blanket or two, and any other poop emergency necessities.
2. Feeding materials
   The obvious aspects of feeding may include formula, water to mix the formula with if it’s not already fully mixed, bottles, or a breastfeeding cover-up, depending on Baby‘s feeding routine.
3. Stroller and sling
   If you’re taking Baby for a short stroll, or even to a more crowded place, wheeling them around can be cumbersome — packing a sling for shorter or more crowded jaunts can give the two of you better ease of movement, and keep them close for comfort on these early trips. On the other hand, keeping the stroller on hand for longer outings can keep you both from getting tired out or uncomfortable to early on in your outing.
4. Water
   This is for you, not Baby, who shouldn’t start drinking water until they is around 6 months old. For you, though, it’s important to have some water handy to stay hydrated, especially if you’re breastfeeding, or going out soon after delivery.
5. Sunglasses and hat
   Baby shouldn’t be exposed to direct sunlight until they is at least 6 months old. Before 6 months, sunscreen is not recommended for babies. Making sure Baby is covered up with a hat and lightweight long sleeves is an important part of their sun-defenses. You can also bring an umbrella as a shade for Baby‘s stroller, carrier, or seat. Even after Baby hits that 6-month mark, and is old enough to squirm away as you try to get sunscreen to cover their face, baby sunglasses with UV protection can help to keep their eyes and face protected from harmful UV rays. This is especially important since even once Baby can wear sunscreen, it’s a good idea to be careful about putting it on the skin to near to their eyes.
6. Change of clothes
   This is mostly for Baby, but that doesn’t mean it isn’t a good idea to have a clean change of shirt for you around, too. You never know what sort of mess Baby could get themselves into, though, so you’ll want to pack a couple of extra pieces of clothing for them just in case of wet, cold, or mess.
7. Sense of humor
   Leaving home for the first time after giving birth can be a trying experience, so try to remain positive and laugh off any and all mistakes that are bound to happen. A great way to keep tension from getting too high on these early trips out into the world is to make sure to leave yourself plenty of time – maybe a full half hour just to leave the house, and then plenty of travel time in-between stops, if you’re planning a busy day.
8. Moral support
   Bringing your partner, a family member, or a friend along with you and Baby to keep an eye on them, or even hold onto them while you eat, use the restroom, or even just catch your breath a minute can be a great way to have a more relaxed outing.

What is an allergy?

Babies who haven’t been introduced to solids yet but are having some trouble with what they’re ingesting are much more likely to have an allergy than an intolerance (although a lactose intolerance is still possible, especially for babies with family histories of lactose intolerance), which means that rather than just having trouble digesting certain parts of what they’re eating, their bodies actually react negatively against certain proteins or compounds.

Signs of an allergy

Allergy symptoms include:

• Skin rash: Rashes that don’t go away on their own, especially around joints, in skin folds, or around the anus. Skin rashes that are part of allergic reactions can, but do not always, look like hives.
• Digestive issues: Diarrhea, vomiting, gas, and upset stomach that causes fussiness can all potentially be allergy symptoms. These symptoms can put babies in danger of other health issues – like dehydration, weight loss, and failure to thrive – if they occur regularly or arrive and don’t go away. It’s always a good idea to consult a doctor about such issues, whether they’re allergy-related or not.
• Eczema: The red, scaly, sometimes oozing skin patches created by eczema commonly overlap with allergies.
• Ear problems: Allergies can lead to fluid build-up in the ear, which can lead to hearing problems and ear infections. Ear problems during language development can cause problems with speech and comprehension delays. Babies experiencing ear pain may be fussy or upset and may tug on their earlobes to try to relieve the feeling of pressure.
• Swelling: Allergies that cause an immediate response can sometimes cause swelling of the face, mouth, and sometimes throat. Since this swelling can cause airway obstructions, parents who notice it should seek immediate medical attention.
• Respiratory problems: Babies with constant runny nose, congestion, or sniffles can also be suffering from allergies. These issues can cause problems with sleeping patterns too.

What might Baby be allergic to?

Most babies who experience allergic reactions while formula-feeding and before solids have been introduced are allergic to dairy. Unfortunately, an allergy to milk proteins, which is what most dairy allergies are, often overlaps with soy allergies. Babies who continue to have allergic reactions after both milk and soy proteins have been removed from their diets might also have an allergy to corn. The vast majority of formula brands use some corn products, though there are a few corn-free brands.

What should I do about a formula allergy?

If you suspect your child might be having an allergic reaction to their formula, it’s definitely time to talk to a pediatrician. Since allergy symptoms can seem like other health issues – particularly colic – it’s a good idea to take careful note of the timing and pattern of any symptoms you notice in the days leading up to an appointment. A pediatrician may recommend switching formulas, speaking to an allergist, or both.

Should I switch to soy?

Though soy-based formula is a good alternative to cow’s milk-based formula for many babies who have trouble digesting milk, it doesn’t work for all babies with allergies. Some of the proteins in soy are not too different from milk proteins, and so babies who can’t process milk proteins may also have trouble processing soy proteins. Formula-fed babies who have trouble with both milk and soy proteins are generally transitioned back to a milk-based formula, but one that is either hypoallergenic or amino acid-based.

Sensitive, hypoallergenic, or amino acid-based?

Formulas designed for sensitive stomachs generally aren’t different enough from regular formula to make a difference for babies with allergies or serious intolerances. Hypoallergenic formulas are much more likely to work, but in cases where they don’t, a pediatrician may prescribe an amino acid-based formula, which is not available over the counter.

After switching formulas, parents generally start to see results within 48 hours.

Sources

• Committee on Nutrition. “Hypoallergenic Infant Formulas.” Pediatrics. 12(1): 183. August 2000. Retrieved October 26 2017. https://pediatrics.aappublications.org/content/pediatrics/106/2/346.full.pdf.

• Larissa Hirsch. “Milk Allergy in Infants.” KidsHealth. The Nemours Foundation. September 2016. Retrieved October 26 2017. https://kidshealth.org/en/parents/milk-allergy.html.

• Rajesh Kumar, et al. “Early Life Eczema, Food Introduction, and Risk of Food Allergy in Children.” Pediatric Allergy, Immunology, and Pulmonology. 23(3): 175-182. September 2010. Retrieved October 26 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3281290/.

• “Could my fussy baby have allergies?” Minnesota Allergy & Asthma Clinic. Minnesota Allergy & Asthma Clinic, 2014. Retrieved October 26 2017. http://mnallergyclinic.com/education/could-my-fussy-baby-have-allergies/.

• “Food allergies and baby.” March of Dimes. March of Dimes. Retrieved October 26 2017. https://www.marchofdimes.org/baby/food-allergies-and-baby.aspx.

• “Preventing Allergies: What You Should Know About Your Baby’s Nutrition.” American Academy of Allergy, Asthma, & Immunology. American Academy of Allergy, Asthma, & Immunology, 2015. Retrieved October 26 2017. http://media.mycme.com/documents/87/aaaai_parent_allergy_preventio_21705.pdf.

Kate RodgerContributing writer

We rocked back and forth in the little green glider, the same glider I had rocked you in two months earlier, in the same room, at the same time of night. Except now everything was different.

As a new mother, I made a habit of using this 3 AM feeding as a time to practice being completely present with you, without the distractions of a busy day to pull my attention away from your sweet face, your smell, your little noises. But I couldn’t help imagining your future. I would look around your room, picturing how it would grow with you. Would I someday paint the walls blue? Buy airplane sheets and hang vehicle pictures on the wall? Or maybe jungle animals. I would, of course, choose what you liked best. Would you someday share the room with a sibling? When would you grow out of your crib?

I made a habit of using this 3 AM feeding as a time to practice being completely present with you, without the distractions of a busy day to pull my attention away from your sweet face, your smell, your little noises. But I couldn’t help imagining your future.

That was before we learned what Diamond Blackfan Anemia is. Before we knew that babies can have blood transfusions through an IV inserted in a vein at the top of their tiny head (your nurses called it a “party hat”). Before we knew what RPS19, hemoglobin, reticulocyte counts, and corticosteroids meant, and how much those new words would factor into our world. Before we knew you might need a bone marrow transplant, and before we knew your life expectancy had been cut by two-thirds.

Now while we rocked, instead of looking around your room and blissfully picturing your future, I cried. Most nights, I cried so hard the sadness violently shook my body, as I attempted to slow my breathing so I wouldn’t wake you again. Tears soaked your fuzzy little head each night, and no matter how much you grew, at three in the morning you always seemed impossibly tiny in my arms. The life I had pictured ahead of you had suddenly been flipped around and came rushing back at us in the dark, and I held you tighter to protect you from my fear.

During the day, I moved through our routines of caring for you, working, keeping house, and tracking your medications, nap schedule, and nutrition. These activities distracted me, and, knowing you would never lead a “normal” life, I committed myself to making sure your life was calm, full of love, and awash in quality time. Dad and I were a team, and he held me up so I could make a beautiful life for you.

But at night, during that once beautiful time we shared together when the rest of the world is asleep, pain and panic caught up with me. I switched to making mental lists of what to pack for extended hospital stays. Instead of picturing your future, I timed your pulse and counted your breaths. I turned on the light and checked your coloring, and watched your chest move up and down. Dreams of a future sibling were pushed out of my mind.  

Instead of wondering when you would grow out of your crib, I wondered how we would pay our bills. I had used up all my sick and personal days by the time you were 4 months old, and our savings was gone, spent on medical bills. I wondered how we could survive on a single income, since Dad would stay home to care for you. I wondered how to best keep track of your four rotating medications that needed filling at different times, and would try to remember if one needed filling the next day.  

I wondered how many milestones you would reach before we lost you.

It continued this way until you were finished nursing, for over a year. And then beyond that because, whether a result of medication side effects, a natural tendency towards poor sleep, or, as the doctors warned us when you were born, babies’ habit of waking at the hour they were born for years, we continued to meet in the tiny quiet hours of the morning.  

3 AM is still part of my day, and still a time for me to worry about you. But it has become easier.

Now you are six. I still wake up at 3:00 nearly every morning, and come to your room to check on you.  I still check your breathing and your coloring. But your appointments have slowed from many per week to twice a year, and I have plenty of sick days saved up in case that bone marrow transplant decision must be made. Our savings is growing again, and we pay all our bills on time. Your medications have decreased and we never forget to refill them. Dad still stays home, now with your sweetest little sister. 3 AM is still part of my day, and still a time for me to worry about you. But it has become easier.

And, most importantly, it has become a time of deep gratitude, a time for me to reflect on the gift we were given of another day with you.

About the author

Kate Rodger lives in Lowell, Massachusetts with her husband and two children. She spends her weeks commuting with her son to her job as a special educator, and her weekends gardening, reading, dabbling in nascent theater companies, and spending as much time as possible with her family. She lives by the quote, “Today well-lived makes every yesterday a dream of happiness and every tomorrow a vision of hope,” and finds it especially relevant as she enjoys each day she has with her babies.