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Baby care handwashing

2008 January 20 · 3 Comments

Lynne asks how old a baby can be before a caregiver (or stranger) cuts back on frequency of handwashing before touching the child.

I haven’t kept up with the latest pediatric advice. I would check with a doctor first or the university extension program, especially about a specific baby. Surprisingly, this is another topic difficult to locate specifics for implementation. I suspect the information needed (with supporting documentation) is there, just locked behind subscriptions and as an unfunded person I can’t get to it.

Lynne’s question is really about assessing risk. Here are general guidelines.

  • Age-related development terms are: Newborns or neonates are under 1 month old; Infants or babies are usually 3 months to 18 months; toddlers 12-2 years
  • Situation posed by Lynne is likely–
    “Normal” or routine baby maintenance
    involving some strangers and family
    with or without other babies around
    We aren’t talking about neonates (newborn) nor day care and play groups nor nurseries. We aren’t speaking of health care providers (who are exposed to many ill people).

In general, my guess would be 18 months is an age when others can resume everyday handwashing, certainly no sooner than 12 months or whenever infants can get around on their own (crawling or scooting). Their immune system should be in good shape then. If I remember my development biology correctly, babies get some immunity protection from their mothers for the first few months, while they switch over to their own developing system. However, getting born is a shock. Babies even experience a growth suppression then growth spurt. A lot is going on with them, so hand hygiene by others is important.

I would think there are three four main considerations–
* everyone should practice good hygiene (not excessive germ phobia) because as people we share our environment This includes keeping the living areas clean and dry.
* babies usually have pretty intimate contact with others (diapers, kissing, sharing food, sharing toys, mouthing everything) so others need to be aware of how they transmit germs to babies (don’t share chewed food or teething toys, for example)
* babies are developing their own immune systems. They need exposure to the normal environment, but intense exposure or exposure to contaminated environments can overwhelm.
* if you live in a community with an ongoing outbreak of salmonella, listeria, RSV, pneumonia, TB, norovirus, etc. and / or difficult access to clean water, then be extra vigilant with hand hygiene. see related, Give germs the boot, not our babies: unwashed hands make everyone sick

As babies get older, regular hand hygiene *by everyone* should be sufficient (by everyone is the key) for simple contact with the baby. That is, wash hands after bathroom use, after food preparation, after returning home from work, after contact sports, after petting the cow, etc.

I’m not real happy with this answer because I think it is too general. However, I’ll keep looking. I don’t really trust a lot of those new baby books either, but I don’t have access to their science to evaluate them. If anyone runs across a better suggestion, please let us know.

Protecting Against Flu – Infant Care
http://www.cdc.gov/flu/protect/pdf/infantcare.pdf

for hcw (health care workers) http://www.cec.health.nsw.gov.au/campaigns/cleanhandssavelives/documents/FAQ020207.pdf

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3 responses so far ↓

  • mpb // 2008 January 21 at 12:29 pm | Reply

    For teaching children to wash hands, I did run across the University of Rhode Island Cooperative Extension Cooperative Extension Fact Sheets Early Childhood Educators #2 Hand Washing
    http://www.uri.edu/ce/faceit/Facts%20Sheets/Early%20Childhood/ec2.html

    They feature suggestions from Kid Care which seems to be the Penn State cooperative extension series of handouts and training for caregivers. The back issues are available here http://westmoreland.extension.psu.edu/Family/Toddler/TTlink.htm however there is no index or table of contents and no way to search the issues.

    Here’s the main resource, http://betterkidcare.psu.edu/page02.html They do have several interesting resources but I find it difficult to find specifics throughout the website and they don’t allow browsing through the directories to see what is there.

    [Reminds me of a paper-based or analogue information system rather than a world-wide web system which would have more consistency and ease of locating what is needed. They are not the only website based on paper and at least they have some Internet presence. But, for remote areas and areas trying to conserve energy and cash, an Internet information system would do a lot to prepare folks for environmental change, disasters, the future, etc. Available expertise (human) is necessary to the information, too, but many of us have no such expertise at hand and distance and asynchronous learning is necessary.]

    The various suite of websites are not coordinated so here is another source of the Kid Care newsletters with a list of titles, (only a partial set, 2004 to 2007)
    “Toddler Topics Archive A learn-at-home newsletter to help you parent your toddler”
    http://berks.extension.psu.edu/Family/TodTopicsArchive.html

    There still isn’t much at all on babies and hygiene.

    See related post about Song to time hand washing for hygiene and disease prevention

  • mpb // 2008 January 22 at 3:53 pm | Reply

    Bringing Your Baby Home
    “Don’t be shy about accepting visitors slowly. Ask anyone who’s ill to wait until they’re feeling well and no longer contagious before they visit. It’s also a good idea to ask visitors to wash their hands before holding your baby because a newborn baby’s immune system is weak.”
    http://www.kidshealth.org/parent/newborn/first_days/bringing_baby_home.html

    That’s not very helpful. Most of the site uses javascript from 3 or 4 different websites making it confusing. However, their ringworm answer seemed pretty good, http://www.kidshealth.org/parent/infections/fungal/ringworm.html

    Speaking of shigella–

    The best way to prevent the spread of Shigella is by frequent and careful hand washing with soap, especially after they use the toilet and before they eat. This is especially important in a child-care setting.

    If you’re caring for a child who has diarrhea, wash your hands before touching other people and before handling food. (Anyone with a diarrhea should not prepare food for others.) Be sure to frequently clean and disinfect any toilet used by someone with shigellosis.

    Diapers of a child with shigellosis should be disposed of in a sealed garbage can, and the diaper area should be wiped with disinfectant after use. Young children (especially those still in diapers) with shigellosis or with diarrhea of any cause should be kept away from other kids.

    Proper handling, storage, and preparation of food can also help prevent Shigella infections. Cold foods should be kept cold and hot foods should be kept hot to prevent bacterial growth.

    http://www.kidshealth.org/parent/infections/stomach/shigella.html

    Respiratory syncytial virus (RSV)

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