Navigating the Holidays with Covid-19, Kids and Pregnancy
Can grandma hold the baby? Is travel safe? An evidence-based guide to help you manage the holidays this year.
Navigating the holidays with kids, family and travel can be tricky during an average year. The Covid-19 pandemic adds an extra layer of complication—and worry—to what’s already a hectic, anxiety-producing time of the year for many parents.
Questions around how to mitigate the risks of Covid-19 in the face of holiday travel and family get-togethers are on the minds of lots of parents. Is it safe to fly with a baby during a pandemic? If you’re visiting friends or family, should you stick with outdoors only, or are indoor visits okay? What about seeing elderly relatives? And should everyone be vaccinated before you go?
Unfortunately, there are no right answers to many of these difficult questions. Navigating the holidays during a pandemic comes down to finding a way to manage risks—your own, your community’s, and those of the people you’ll be seeing. And while we can’t answer these tough questions for you, we can give you the evidence-based information you need to help inform your decisions.
We talked with Dr. Krupa Playforth, MD, FAAP, pediatrician and Babylist Health Advisory Board member, Dr. Mona Amin, DO, pediatrician and host of The Pedsdoctalk Podcast, and Dr. Brittany DiBardino, pediatrician at Tribeca Pediatrics, and asked them some of the most common questions from parents about navigating the current stage of the pandemic during the upcoming holiday season.
In This Article
Covid-19 + Kids + Pregnancy: The Latest Info
What’s the latest information about the risks and complications for infants and toddlers if they contract coronavirus? What about pregnant people?
“The most recent data is noteworthy because COVID-19 is now in the top 10 causes of death for the pediatric population,” Dr. Playforth tells us, “but I want to make sure parents retain some perspective. Although COVID can cause serious illness in infants and toddlers, the vast majority of cases are mild and children recover fully.” The reason pediatricians remain concerned, she says, is because to some extent COVID is unpredictable; even when we know risk factors, the data shows that a third of hospitalizations occurred in otherwise healthy children. In severe cases, hospitalized children can end up severely ill, requiring intensive care and artificial ventilation.
No matter the illness, very young infants under 3 months will always be a high risk population, but even in this population most will recover, Dr Playforth says. “Some of the complications pediatricians want parents to remain alert for after an infection include lingering respiratory issues, MIS-C (which is seen two to four weeks after infection) and potential neurologic issues,” she notes.
According to Massachusetts General Hospital, “pregnant people experience changes in their bodies that may increase their risk of serious infection. Studies during outbreaks of other related coronavirus infections (SARS-CoV, MERS-CoV) as well as influenza have demonstrated that pregnant people are more susceptible to severe illness.” The risks and complications for pregnant people who contract Covid-19 are: “an increased risk of hospitalization, intensive care unit admission, need for mechanical ventilation, and even death compared to reproductive-age, non-pregnant individuals.” The risk for these complications are greatly reduced by being vaccinated against both Covid-19 and influenza.
What’s the best resource for parents to get the most up-to-date information on Covid-19 + kids?
Always consult with your pediatrician about any questions or concerns you have about coronavirus and children.
Dr. Amin also recommends the following resources:
Most advice for pregnant people regarding COVID-19 is similar to the advice for the general population in the United States.
The best sites for staying up to date are:
- Centers for Disease Control and Prevention (CDC): Guidance for Higher Risk Populations (CDC)
- The American College of Obsteratricians and Gynecologists (ACOG)
Travel: What’s Safe and What’s Not?
What’s a good framework to start from when trying to decide on travel this holiday season?
When thinking about traveling during the pandemic, here are the questions you need to ask yourself as you make your decision:
- Is anyone in your family high risk? (Immunocompromised, severely obese and/or over 65 years old?)
- Is anyone you’ll be visiting considered high risk?
- Is the coronavirus in high transmission in your area or in the area you’ll be traveling to?
- How old are your children and how likely are they to practice pandemic-safe measures like mask-wearing and physical distancing?
- How many of your immediate family members are fully vaccinated and how many of the folks you’d be visiting are fully vaccinated?
“It is important to think about every decision in terms of risks and benefits,” says Dr. Playforth. In general, you want to weigh things like whether or not any family members are higher risk, who is fully vaccinated (remember, this means two weeks out from their second shot in the series), the COVID rates in your community, and how difficult quarantining or infection would be logistically, she explains.
In terms of the benefits of testing before gathering, Dr. Playforth offers this recommendation: “I think there is a lot of benefit to focusing on antigen (rapid) testing for any members who plan to participate in family events, because the rapid tests are sensitive for how contagious a person might be at the time of the test, and they are easy and can even be done at home.” On the other side, she adds, make sure you consider also the very real benefit to families spending the holidays together. Families spending time together is important, particularly for the youngest and oldest members of our families. That is not a small part of the equation.
“As you plan holidays, be mindful of the fact that no child under 12 will be technically ‘vaccinated’ before Thanksgiving,” adds Dr. Playforth. Even those in the 5-11 year age cohort who received their vaccine within the first few days of approval would not be far out enough from their second vaccine in the series to be considered protected until early-mid December.
If you are pregnant, it’s important to consider the spread of Covid-19 variants in many states in the U.S. and around the globe. Travel increases your chances of getting infected and spreading Covid-19. If you are unvaccinated, avoiding travel is the best way to protect yourself and others from getting sick, according to the CDC.
If you must travel or if you’re vaccinated, be sure to discuss your plans with your healthcare providers and check the most up to date CDC guidance.
Planes, trains and automobiles: what’s the risk?
Depending on where you are traveling to, there are certain testing protocols in place which allow some forms of public transportation to be lower risk, but low risk is not the same as zero risk, explains Dr. Playforth. “Obviously masking, washing hands well, distancing where possible, and other common sense measures will also help here. With infants, it is easier to curtail their activities and exposures during travel (babywearing can help!), but toddlers are less predictable and more apt to run around and touch surfaces, etc,” she explains.
“Air travel requires spending time in security lines and terminals, which can bring you in close contact with other people and frequently touched surfaces. Check with your airline to see how full the flight is and what precautions they are taking. Physical distancing is difficult on crowded flights, and sitting within 6 feet of others, sometimes for hours, may increase your risk of getting Covid-19,” says Dr. DiBardino.
“Driving will pose a lower risk,” says Dr. Amin, but you’ll need to be mindful of certain things. Here’s what she recommends:
- Take hand sanitizer, hand soap in a reusable travel container, and/or hand wipes along on your trip.
- If you use a rest stop, touch any items in the restroom for your child and wash their hands and your hands after use.
- Bring plenty of snacks and water on your trip to limit having to purchase things on the road.
Covid-19 Testing: Helpful or Harmful?
Does a negative Covid-19 test mean it’s safe to celebrate with family and friends during the holidays?
“Testing before travel is highly recommended and decreases the risk of a COVID exposure during the holiday,” says Dr. Playforth. “With that said,” she adds, “it is certainly possible to have a negative COVID-19 test and still have COVID; low risk is not the same as zero risk. Each family will have to make a decision based on their risk threshold.”
There is also the question of what type of test is used—the rapid antigen tests have decent sensitivity for a person who is symptomatic or at their most contagious stage, but they have a lower accuracy than PCR tests. “The PCRs are the gold standard for tests, but it may be more challenging to get results quickly,” says Dr. Playforth.
What is as important as testing is talking through what everyone is comfortable with when gathering and setting some rules that everyone will follow during holiday visits.
- Will everyone wear masks?
- Will you meet outdoors or indoors?
- Will you practice physical distancing?
- How many people will be in the group?
- Will everyone be vaccinated?
Hosting and Visiting Family and Friends During Covid-19
Is gathering indoors with a mask safe?
“There are degrees to which you can mitigate the risk of socializing indoors with friends or family, none of which are perfect,” says Dr. DiBardino. “Each individual needs to decide how to cope with the balance between seeing others and the risk of contracting Covid-19 depending on their risk factors for developing severe illness. At the minimum, judicious use of masks, hand hygiene and staying six feet apart will reduce the rate of transmission. Additional measures include having all members of the social gathering vaccinated or quarantining for roughly 10 days before the social event.”
“[Everyone’s definition of] ‘safe’ is relative,” adds Dr. Playforth. “Masking and being indoors with a group of vaccinated people is low risk for contracting COVID, but low risk is not the same as zero risk. So the decision ultimately will need to be based on your family’s risk threshold, which will not be the same from family to family.”
If you’re pregnant, be sure to discuss the risks of specific social gatherings with your healthcare providers.
If you do decide to meet indoors, is there anything you can do to mitigate the risks?
“The most important thing is going to be to try to ensure everyone is vaccinated against COVID and the flu, and practicing good hygiene (hand washing, staying away if sick, etc),” says Dr. Playforth. “I would argue that there is also a role for rapid testing at the start of the family event, and if you are really concerned, and have access to the tests, you can even test more often through the event.”
Other things that may help include improving ventilation (open windows, or outdoor dining if weather is permissive) and staying home when sick. For groups that are mixed (both unvaccinated and vaccinated), try to have everyone take rapid tests right before the gathering at the very least, and consider masking if you have higher risk or more vulnerable family members, she adds.
What about visiting elderly parents or grandparents over the holidays during the pandemic? Is it safe?
“It’s important to look at risk. A family member over age 65 with any medical problems (cancer, COPD, heart or kidney disease, obesity, sickle cell, Type 2 diabetes, smoking) is higher risk than an elderly family member who is healthy,” says Dr. Amin.
“If elderly family members who are not high risk are fully vaccinated, especially if they have had boosters, the risk of them contracting severe infection or a poor outcome is very low,” notes Dr. Playforth. And, she explains, there are significant benefits to spending time with family, especially for the elderly, many of whom had to forego family holidays last year. “Those traditions, and that time together is so important,” she says. “I think having an open discussion with your extended family about what risk threshold works for everyone is so important, although I understand this can be challenging in families with different beliefs.”
Experts Referenced in this Article
- Dr. Krupa Playforth, MD, FAAP, pediatrician, mother and Babylist Health Advisory Board member
- Dr. Mona Amin, DO, pediatrician, mother and host of The Pedsdoctalk Podcast
- Dr. Brittany DiBardino, pediatrician at Tribeca Pediatrics
