Bugs and Baby

During the winter season, viruses and bacteria causing upset stomachs, coughs and colds seem to be everywhere. This week, we’ll be talking about two ways to protect your family from catching a bug just before Christmas!

Handwashing is one of the best ways to reduce the risk of getting infected by a winter bug or spreading it around. For example, good handwashing can reduce days off school due to stomach bugs in children by half. It also helps fight antibiotic resistance by reducing the amount of antibiotics used. A good lather of soap and water forms little pockets, called micelles, that trap germs, chemicals and dirt so they can be washed away.

Here are some key hand hygiene tips for parents of infants:
- Lead by example: wash your own hands regularly including before eating or cooking, after using the toilet or doing nappy changes, playing outside, coming home, or touching anything with lots of germs.
- Use soap and water whenever possible, and always if your hands are visibly dirty; save the hand sanitiser for when you’re out and about without access to water and soap
- Regular soap is fine; there’s no need to use antibacterial soap at home
- Bar soap works just as well as liquid soap to remove germs, and can also help reduce single use plastics
- Wash hands for 20 seconds, which is about as long as it takes to sing ‘Happy Birthday’ twice
- Using star/reward charts is a great way to encourage infants and small children
- Remind them as often as they need – children will all need time to understand the need to wash away germs and chemicals that they can’t see

Food allergies and intolerances can vary from mild and inconvenient to severe and dangerous. It’s unsurprising that lots of parents want to know if there is anything they can do to reduce the chances of their baby developing a food allergy.

One frequently asked question is when to introduce your child to foods like peanuts. Today’s recommendations come from trials such as the LEAP (Learning Early about Peanut) study, which allocated children at high risk for peanut allergy to either early peanut consumption or avoiding peanuts until 5 years. They found that those who were given peanuts early in life were less likely to develop allergy to peanuts compared to those who avoided peanuts.

Therefore, it is now recommended that children eat commonly allergy-causing foods at 6 months of age, when they start to wean onto solid foods. Foods which commonly cause allergies include peanuts and eggs, but also gluten, seeds, soya, cow’s milk, and shellfish. Some children at higher risk of allergy might benefit from starting at 4 months – this includes children with eczema, or who already have a food allergy. However, this should be discussed with your GP or health visitor.

Another commonly asked question is whether what the mother eats when she is pregnant and breastfeeding makes a difference. Currently, there is no clear evidence that mothers avoiding allergy-causing foods reduces the risk of food allergy in their children, and so there is no need to avoid peanuts, eggs, or any of the other foods listed above.

Your baby’s skin is the first defence against infection and allergy and is still developing throughout their first year.

Babies’ skin is thinner than that of older children or adults, and so it is also more fragile and sensitive. It’s also easier for bacteria to get through the skin and cause infection. Therefore, it’s really important to look after your baby’s skin to keep it healthy and strong!

You should bathe your baby every few days and use warm water when you do. Try to avoid cleansers that contain soap, fragrances, or antibacterial agents because these can all irritate the skin. After bath time, pat your baby’s skin dry with a towel and don’t forget their skin folds.

Moisturise your baby’s skin daily, or more often if it looks or feels dry. Avoid any creams or lotions with fragrances. Keep the lotion itself clean by using a pump bottle or keeping a spoon or spatula to get lotion out of a pot.

The nappy area is particularly prone to rashes and skin damage because it’s covered and often moist. Try to change nappies frequently and have some nappy-free time as often as you can. It’s better to clean with tepid water and disposable towels or cotton wool instead of baby wipes. Apply a barrier cream, preferably with zinc, at each change.

Newborn babies are protected from infection by antibodies (infection-fighting proteins) passed to them from their mother via the placenta or breastmilk. However, this protection will gradually wane during infancy and they will need to develop their own defences.

Young children will meet, and may develop, many infections during their early life. This can be viral, bacterial, or fungal. A healthy infant with good nutrition will be able to fight these infections off with their own immune cells T and B cells and antibodies. The infant’s immune system will often ‘remember’ the infection the next time they meet it, and be able to fight it off faster. It’s also possible to ‘learn’ some infections that aren’t severe enough to make the infant feel unwell.

Besides meeting infections, an infant will also meet lots of bacteria, particularly through their mouth, gut, respiratory system, and skin. As we learned in our posts on baby feeding, many bacteria will settle and grow in the gut from birth which supports the development of the immune system. This process continues during infancy. Additionally, these exposures through eating and breathing will shape the immune system’s reaction to foreign proteins. Vaccination is another important way to teach the immune system to fight certain infections and is usually timed to give the infant good protection as their immunity from their mother wanes.

There are so many factors contributing to how the immune system develops throughout infancy that it’s easy to see why different adults will have very different immune responses to the same infection!

As we learned last time, breastfeeding provides a great start to your baby’s life as they develop their immune system and meet infections for the first time. However, lots of new parents find that breastfeeding isn’t a good fit for their family, or just isn’t possible.

Without breast milk, babies won’t be able to gain infection-fighting antibodies or other immune-supporting proteins from their mums. At the moment, these can’t be replicated in formula milk.
However, another key factor in the development of a healthy immune system is the growth of healthy bacteria in the gut. Aside from helping digestion, these bacteria can change the way baby’s immune system works and support the gut’s defence against incoming infections. These bacteria are especially important for babies born preterm.

Formula feeding does not provide bacteria, but research is ongoing to see if this could be helped. Two options being studied are prebiotics and probiotics. Prebiotics are food ingredients which can’t be digested and absorbed but do stimulate the growth of healthy bacteria. Probiotics are live bacteria which are selected for their ability to create communities of healthy bacteria in the gut. Although both are currently used in some specific settings, such as research studies or very unwell babies in intensive care, in the future these could become available to more babies who are formula-fed.

One of the most basic ways babies fight infection is with specialised proteins called antibodies. During pregnancy, antibodies can be passed from mother to baby through the placenta, which will help protect babies for the first few weeks. However, this immunity is only temporary. So what happens next?

Antibodies against infections a mother has immunity to can also be passed on through breast milk. Colostrum – the thick, yellow milk produced in the first few days after birth – has an especially high number of antibodies, so breast fed babies will have this extra boost in their immunity straight after birth. Additionally, breast milk continues to have antibodies in it, and will also contain antibodies against infections a mother encounters while she is breastfeeding. Therefore, breastfeeding provides an ongoing source of immunity for as long as babies are nursing.

There are other benefits to breastfeeding beyond antibodies. Breast milk’s nutrients and specialised proteins help to stimulate and support the development of both a strong immune system and the proteins needed to avoid it over-reacting. Finally, breast milk also helps babies to grow the healthy bacteria they need in their guts to prevent infection.

It’s easy to see why breastfed babies are less likely to suffer from common and serious infections. However, breastfeeding isn’t possible for all babies – so next up, we’ll talk about how formula feeding might affect the immune system.

At birth, your baby will go from their protected home during pregnancy into a world filled with bacteria, viruses, and other causes of illness. Your new baby’s immune system will be learning how to protect them from infections, but also needs to learn not to react to friendly, healthy bacteria or to damage itself.

The first defence against infection is your baby’s skin and special cells lining the airways, lungs, stomach and gut, which act as a physical barrier.

When a bacteria or virus manages to invade, your baby’s immune system can fight back from birth. Specialised immune cells may do this by destroying the bacteria or virus, protecting other cells from infection, or making the environment difficult for bacteria to grow in. As your baby encounters more bacteria and viruses, their immune system will start to ‘learn’ which are potentially harmful and will react more quickly the next time they meet the same bacteria.

Another important part of your baby’s immune system development is how they’re fed. We'll be coming back to this soon, so watch this space!

Bacterial infections can be dangerous in pregnancy and for newborn babies. It’s not uncommon for pregnant people or newborns to take courses of antibiotics to avoid becoming seriously ill, but many new parents worry whether these can harm their new arrival.
Scientists have studied the gut bacteria of babies who had antibiotics during their first week after birth. They found that babies who were given antibiotics were more likely to have altered gut bacteria than those who didn’t have antibiotics. For example, babies who had antibiotics had lower numbers of some ‘healthy’ bacterial species, and greater numbers of some illness-causing bacteria. A longer course of antibiotics led to greater changes that lasted for a longer period of time.
Although breastfed babies also had changes in their gut bacteria with antibiotics, their bacteria went back to normal more quickly than babies who were formula fed. This is probably because breastfeeding provides healthy bacteria, but also because breastmilk has sugars which promote the growth of healthy bacterial species in the gut.
Similar studies have been done in older infants, with the same findings. In the future, we may be able to give babies probiotics to help their gut bacteria recover, but studies are ongoing to work out how best to do this.
Antibiotics can be really important to keep you and your baby as healthy as possible if you’re faced with an infection – but it’s worth remembering that they might need some time to get their gut bacteria back to normal, and that breastfeeding can really help with this.

Reference: Van Daele E, Kamphorst K, Vlieger AM, et al. Effect of antibiotics in the first week of life on faecal microbiota development. Archives of Disease in Childhood - Fetal and Neonatal Edition Published Online First: 09 May 2022. doi: 10.1136/archdischild-2021-322861

Pregnancy vitamins are recommended for many people to support a healthy pregnancy and baby. There are lots of reasons to take them, but some may help your immune system too.

Vitamin D supports a healthy immune system and is recommended for many people during pregnancy. People who don’t see as much sun or people who are South Asian, African, Caribbean or Middle Eastern are more likely to have low levels. However, researchers are still learning when the best time to start taking vitamin D is.

Iron is important for the development of infection-fighting immune cells, and you might find out from your pregnancy blood tests that your iron is low. Some studies have shown that taking iron with other supplements may increase its benefit; for example, taking vitamin C with iron helps it to be absorbed. Lactoferrin, which is commonly found in milk and has a key role in our absorption of iron, might also promote healthy vaginal bacteria during pregnancy.

Lots of important vitamins and minerals can also be found in a healthy, varied diet. You should always talk with your midwife or doctor about taking any vitamins or supplements, as brands often have different doses of vitamins and minerals and some can be harmful.

Some fertility clinics offer immune system testing or treatment as part of their service – but why?

Many patients have fertility problems that we can’t explain. One theory is that a pregnancy could be ‘rejected’ by the patient’s immune system, like how a transplanted organ can be ‘rejected’. Some people thought that giving medications to change or suppress the immune system might help increase the chance of having a successful pregnancy.

Although there are lots of immune cells – known as ‘Natural Killer’ or ‘NK’ cells – in the womb, the placenta provides a barrier so that these cells cannot reach the embryo or foetus. There is no clear evidence yet that the immune system is to blame for infertility or miscarriage. The best way to test these cells also isn’t certain.
Using medications to alter the immune system has been studied by researchers, but so far they don’t seem to increase the chances of having a successful pregnancy. Treatments to suppress the immune system can also put people at risk of side effects including serious infections that could harm them and the baby. Therefore, these treatments are usually only offered in research studies or in very specific circumstances.

In the UK, we offer everyone who is pregnant three vaccinations: Flu, COVID-19 and the 4-in-1 vaccine that protects against whooping cough, tetanus, diphtheria and polio. Some people may also be offered additional vaccinations, for example to protect them against diseases they may encounter while working or travelling.

These vaccines are “inactivated” and cannot cross the placenta or harm the baby. Vaccines based on live, weakened organisms are not usually offered in pregnancy because there is a small chance that they could infect the baby.

Vaccination against flu and COVID-19 are offered because we know that these diseases are particularly dangerous in pregnancy. If you catch either of these while you are pregnant, it’s more likely that you will need intensive care than if you weren’t pregnant. It’s also more likely that your baby will be born preterm or stillborn. Flu and COVID vaccination protect you and your baby against this. We have data showing flu vaccination is safe and effective in pregnancy going back to 2005. For COVID-19 vaccination, we have studied safety in more than 200,000 pregnancies. These studies have shown no increased risk of any pregnancy problems following vaccination – in fact, we find that COVID vaccination reduces the chance of stillbirth.

We offer the 4-in-1 vaccine to protect your baby from whooping cough and tetanus after they are born. Between birth and receiving their own first vaccinations, at eight weeks old, your baby is very vulnerable to these diseases. When we vaccinate you, you make antibodies which cross the placenta into your baby and will give them protection against whooping cough and tetanus after they are born. We have been protecting babies against whooping cough in this way since the 1940s, and from tetanus since the 1960s.

With thanks to Dr Viki Male

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The immune system in pregnancy
It’s often said that the immune system gets weaker in pregnancy – but this isn’t quite true. Rather, the immune response changes, with antibody responses becoming stronger while cellular immune responses become weaker. Since cellular immunity protects us against viral infection, one consequence of this is that we are more susceptible to certain viral infections in pregnancy – like flu and chickenpox. Viral infections that cause pneumonia – like flu and COVID-19 – are also more serious at the end of pregnancy because of increased strain on the lungs and heart.

Another consequence of this change in balance is that some people who suffer from autoimmune diseases may notice a change to their symptoms during pregnancy. Diseases that are caused by cellular immunity – like MS – typically get better whereas those caused by antibody – like lupus – get worse.

We don’t know if these immune changes in pregnancy are beneficial, but we do have evidence that they are not necessary to allow the pregnancy to succeed. Since antibodies cross the placenta to protect the baby after it is born, one possibility is that tipping the balance in favour of antibody responses may give the baby better protection. Antibodies also protect us against parasitic worms and this may be particularly helpful in pregnancy to avoid the nutritional burden of worm infection, at a time when extra calories are needed to supply the baby.

With thanks to Dr Viki Male ✨