Should I Take My Three-Week Old to the Family Reunion?

Today Dr. Lara Zibners addresses a concern that was raised on our Vaccinate Your Baby Facebook page (now the Vaccinate Your Family Facebook page), which addresses the difficult task parents face in protecting their newborn babies from vaccine preventable diseases before they are old enough to be vaccinated themselves.  If you have a vaccine-related concern that you would like to provide for discussion, please email Vaccinate Your Family at info@vaccinateyourfamily.org. You can also get the answers to many common questions about vaccines on our Vaccinate Your Family website.

I have a 3 week old son and I plan on vaccinating him appropriately. However my family is having a reunion next week and I want to go. I have been very strict about only having vaccinated visitors. Is it ok to go to this reunion when I can’t check to see if every person is vaccinated? There will be 20-40 people there. Also, my brother-in-law doesn’t vaccinate his kids and I haven’t let them or their kids meet my baby yet. Am I being crazy or should I stick to this? I just want to do what’s best for my baby.

Wow! You plan on getting out of the house with a 3-week old? That’s ambitious. I’m impressed. I’m also incredibly impressed with your concern about exposing your new little one to vaccine preventable illnesses. Not to mention how delicate and difficult the topic is when friends and family willingly don’t vaccinate and risk the health of their children and yours. It’s awkward, as I’ve already said.

But moving on from that, I think we need to have a real conversation about what vaccines can and can’t do. I am blatantly pro-immunization. I, along with the overwhelming majority of physicians and scientists, believe that vaccines truly are the greatest medical innovation of all time. They have saved more lives than any other medical advancement in history. Vaccines work, they are safe, and they save lives.

But let’s be honest – vaccines don’t provide 100% immunity to every single individual vaccinated. Some vaccines work better than others. That is why “herd immunity” (also known as “community immunity” or “community protection”) is so very, very important. 

They can have side effects, although the vast majority of those are mild and short-lived. And most importantly, they aren’t the only thing you should be doing to protect your children. Vaccines are not child safety seats. They aren’t bike helmets. And they definitely aren’t protective bubbles against every possible infection that could threaten the health—or even life—of a newborn.

We have a few rules in pediatrics. Like “Mountain Dew is not an appropriate drink for a toddler.” Or “Never stick your fingers inside a conscious child’s mouth.” And then there is this one: “All babies less than 4 weeks old with fever get the full shebang.” And by shebang I mean blood work, urine tests, spinal tap and whatever else might clue us into the source of a temperature over 100.4F. Then we throw in some IV antibiotics and a hospital admission until the test results are back. That’s just one of our rules. No thinking about it. No discussion. We just do it. Sound’s a bit rash, don’t you think?

Well, actually, it’s a rule with a lot of history and background. In fact, the rule stretches to babies under 3 months to the extent that they at least get blood and urine tests and extremely close follow-up. You might be wondering if this is because these babies are too young to be vaccinated. But that’s only part of the equation. Newborns are also at risk from infections acquired during birth. As in from dear old Mom’s nether regions. (C-sections don’t negate this risk. His head was hanging around down there for some time, amniotic sac or not, you know what I’m saying?) In all seriousness, there are a few infections that can be transmitted from mother to baby before, during and after birth. On top of that, a newborn’s immune system is still immature, making him highly susceptible to any other infectious agents that might come along.

“Dr. Zibners,” you might be thinking. “Why don’t you try examining the patient and then decide whether she really needs all that before just blindly jabbing the wee one with tubes and needles?”

Ah, I wish it were that simple. One of our other sayings in pediatrics? “Never trust a newborn.” It’s not that we think your precious darling is purposely deceptive or inherently sneaky. It’s because little babies can have very few symptoms or signs and yet be in perilous danger. A slight fever might indicate meningitis, an infected joint or bacteria in the blood stream. Then again it might indicate a common cold. In fact, the latter is more often the case. But the point is, we can’t tell. And the risk of missing an infection that could cause permanent disability or even death far outweighs the risk of a few tests and a couple of days in the hospital.

Which means the decision to expose your new baby to spaces in which you can’t control the number of people or whether those people are potential vectors for infection extends beyond a conversation about vaccines. You have to weigh up the risks and benefits for you and your family. General advice is to avoid public places, such as the grocery store or church crowds until the baby is well past this danger stage, ideally older than 3 months. At this point he should have had at least one set of shots and a fever doesn’t mean an automatic visit to the pediatrician or ER.

But obviously this advice doesn’t work for everyone. Your family has to eat, doesn’t it? I completely understand when parents’ don’t heed our advice because it may be impractical or even impossible. I’m going to confess right here and now that I put my 6 day-old on a flight from California to New York. But the risk/benefit analysis went like this: my daughter, Zoe, was born via surrogate, 3000 miles from our home. And my daughter Eva was 3 ½ months old and her final adoption hearing –in Florida–was the week after Zoe finally decided to make her appearance. It’s wasn’t ideal, but what was I going to do? The neonatologist gave me his blessing but I will tell you, I was one sweaty, hyperventilating freak show for 6 hours that day. Fortunately, as is most often the case, she was completely fine. I knew that was the most likely outcome but I had to be okay with my decision if she had developed a fever a few days later. The point is, sometimes life gets in the way of our best intentions and, as parents we just have to do the best we can.

If you must travel with a newborn, my advice is to limit—wherever possible—exposure to germs. Germs from strangers, family or friends. If you can, go by car. We all know air travel is asking for a cold, don’t we? Whichever way you travel, try to keep the baby far from curious and well-meaning hands. No aunties kissing your newborn.  No snotty nosed cousins coming within spitting distance. Because the simple fact is that the more people your little one is exposed to, the higher the risk of her becoming ill.  We must realize that few adults are up-to-date on their Tdap boosters, which is contributing to record numbers of whooping cough cases nationwide.  And don’t even get me started on measles cases that are unknowingly imported by U.S. travelers. (Note from Vaccinate Your Family: Measles cases are still being imported into the U.S. in 2019. Learn more.)

Of course, this brings us back to the beginning. Everyday we wake up and perform risk/benefit analyses for our kids as we try to do our best to keep them safe and healthy. Vaccines are a critical part of this analysis. I completely empathize with your predicament. But I think your question is really twofold. First, is it worth traveling with a 3 week-old and exposing him to crowds of people? And second, is it worth the additional risk if some of those people are willingly unvaccinated?

It’s a personal decision and one that is, I know, really, really hard. Good luck. 

Dr. Lara Zibners

While the decision to immunize may be an easy one, sometimes our efforts to protect our children can interfere with our relationships with our friends and family.  Especially when others are willingly unvaccinated.  If you’ve had to handle a situation similar to the one mentioned above, feel free to share your thoughts and suggestions in the comments below.