Expecting a new grandchild? Here’s why you may need to see your doctor first

By Jacqueline Howard, CNN

(CNN) — When a baby is on the way, doctors often recommend that the mother get certain vaccinations to protect her newborn – and it turns out that other family members who may visit the infant, especially grandparents, are urged to be up to date on certain shots, too.

With the United States in the midst of respiratory virus season and its worst measles outbreak in decades, immunized family members can play an important role in protecting newborns who are too young to receive many of their own vaccines. Babies remain especially vulnerable during their first weeks of life, relying largely on antibodies passed from their mother and the immunity of those around them.

“For that six months, zero to six months, they are really vulnerable and at risk, and we have to protect them,” said Dr. Dhaval Desai, a dual board-certified internal medicine and pediatrics physician at The Atlanta Internists.

Anyone who is around a newborn should be up to date on all routine vaccines, especially the whooping cough vaccine, known as tetanus, diphtheria and pertussis, or Tdap; and the seasonal flu vaccine, according to the US Centers for Disease Control and Prevention.

Many doctors recommend some additional vaccinations too – and they emphasize that these vaccines are important for grandparents of children at any age. Mothers are given a lot of advice about vaccinations during pregnancy and in their baby’s first year, but grandparents may not have those same kind of check-ins with their doctors.

“This is a great time to make sure all vaccines are up to date,” Dr. Lori Solomon, associate professor and chair of family and community medicine at New York Medical College, said in an email.

Before meeting a new grandchild, ask your healthcare provider whether you’re up to date on these vaccines:

“Being up to date on all their vaccines is beneficial to grandparents for multiple reasons: First, it helps grandparents to keep themselves healthy and so that they don’t miss out on this special time with their new grandchild. Second, being vaccinated helps protect their new grandchild, especially in those early months when babies’ immune systems are still developing and they rely on all of us around them to be vaccinated to help keep infectious diseases away,” Dr. Michael Warren, chief medical and health officer at the maternal and infant health nonprofit March of Dimes, said in an email.

“New grandparents, or grandparents-to-be, should talk with their healthcare professional to find out whether they are up to date on all their vaccines or if they might need additional vaccines,” he said. “Ideally, grandparents should be up to date on all their vaccines before the baby arrives. And we know that babies don’t always arrive according to schedule, so getting a head start and getting vaccinated before the baby is due is a smart strategy.”

Vaccines for grandparents and other caretakers

Tdap

The Tdap vaccine can help prevent tetanus, diphtheria and pertussis.

“Pertussis is whooping cough,” Desai said. “It is a debilitating cough disease. We see babies stop breathing. It is a very frightening thing. Most recover from it, but it is something we want to prevent. So Tdap would be one of my non-negotiables for a new grandparent.”

For babies and young children especially, whooping cough is much more than just a bad cough; it can be incredibly dangerous. It triggers violent, uncontrollable coughing fits that make it hard to even catch a breath. Beyond that, severe infection can lead to complications like pneumonia, convulsions, permanent brain damage or death.

The Tdap vaccine is given as a single dose, and a booster is recommended for adults every 10 years.

Seasonal flu

Despite remaining low at the national level, seasonal flu activity is increasing in many parts of the country, and the CDC warns that early-season activity is higher than usual for this time of year.

Many people may think of the flu as just having cold-like symptoms, but for babies and toddlers, it can be especially dangerous. Because their immune systems are still developing, influenza can hit them hard and fast and can quickly spiral into serious complications including pneumonia, extreme dehydration, brain inflammation or death.

In general, everyone 6 months and older is urged to get an annual flu shot.

Protection provided by the vaccine lasts about six months in older adults, “so the recommendation is to get it in September or early October for protection during the typical winter flu season,” Texas-based pediatrician Dr. Ari Brown, a spokesperson for the American Academy of Pediatrics and author of the book “Baby 411,” said in an email.

“You can plan ahead depending on when the grandbaby is born and when you will be visiting with them.”

RSV

RSV is another common respiratory virus that can cause serious illness for babies and young children. Because their airways are so small, this virus can easily clog them with thick mucus, making it difficult to breathe. RSV was the leading cause of hospitalization among infants in the US before the introduction of RSV immunizations.

For older adults, a single dose of RSV vaccine is typically recommended.

“Talk to your doctor about the RSV vaccine, as it is given at age 50 to people with certain conditions like asthma, heart disease and insulin-dependent diabetes,” Solomon said. “For healthy adults the RSV vaccine is given at 75 or older.”

Covid-19

A single dose of the updated Covid-19 vaccine is recommended for all adults.

Covid-19 vaccination continues to be associated with a reduced risk of hospitalization, including among people at high risk of severe disease, such as older adults and infants. And getting vaccinated can help reduce the risk of spreading the virus to vulnerable family members like newborns.

A Covid-19 shot this season “protects you and lowers the chance” you’ll bring the virus home to loved ones, Dr. Celine Gounder, an infectious disease specialist at NYU Langone Health and editor-at-large for public health at KFF Health News, said in an email.

“The scariest thing a parent can get is a positive Covid test in a baby because you can’t do anything except supportive care,” Desai said. Infants are not old enough for treatment such as with the prescription medication Paxlovid.

“If I am a new grandparent and going to be watching a two-month-old once the parents go back to work, I want to be maximally protected against the routine viruses that are out there and protect my grandchild who cannot get the shot,” he said. “So, for a new grandparent, I think it’s very reasonable to get the Covid booster at this point.”

Measles, mumps, rubella

Unusually high numbers of measles cases have been reported in the United States this year, raising the risk of infections emerging in newborns.

Nationwide, more than 4,500 confirmed cases of measles have been reported to the CDC, and an ongoing outbreak in Pennsylvania has quickly become the largest and deadliest in the country in more than 30 years. Infants are among those who died this year.

But two doses of the measles, mumps and rubella or MMR vaccine provide about 97% protection against measles.

“If you’re unsure about your measles immunity, there’s no harm in getting another shot of MMR,” Gounder said.

Measles immunity sometimes can be checked with a blood test or by reviewing your vaccine records. But “we don’t usually recommend checking antibody levels,” she said.

If you were born before 1957, “the CDC counts you as immune because most people caught measles as children back then,” Gounder said. “Born in 1957 or later, with no record of a dose: Get at least one dose.”

If you have only one documented dose in your medical history, “get a second if your local health department advises it,” she said. For example, adults who’d gotten one dose were recommended to get a second during a measles outbreak in Texas last year. “If you have one dose and help care for the baby in an outbreak area, I recommend a second.”

Measles is one of the most contagious diseases in the world. Viral particles can spread through the air and remain infectious for up to two hours, even after an infected person leaves the area. And infants and young children are at higher risk of complications and severe disease.

“Here’s the motto I’m telling patients: if you don’t know if you’ve had measles if you’re older, or if you don’t know you’ve had the shot, there is no harm in getting one MMR booster,” Desai said. “That’s safe. It gives you the immunity, and it’s very appropriate.”

When to get vaccinated

It’s important to be fully vaccinated before visiting a newborn at the hospital or at home. “Ideally, it’s best to vaccinate at least 30 days before the due date,” Solomon said.

Most of the vaccines recommended for grandparents can be given at the same time, Gounder said.

“You can get most of them on the same day, in different arms. The only hard rule is for live injected vaccines: if MMR and varicella vaccines aren’t given the same day, they must be at least 28 days apart,” Gounder said, adding that it’s important to remember that you may need more than one dose for some vaccines.

Most of the vaccines take about two weeks to mount an immune response.

Getting vaccinated “four to six weeks before the baby is born is a safe window. For most vaccines, within two weeks you start getting the antibodies,” Desai said.

“Four to six weeks will give plenty of time, especially if you’re getting multiple shots, maybe you can space them out. The Tdap and the flu you can space out a little bit, so it gives you enough time,” he said. “I would say for those that have expectant daughters or daughters-in-law, then that third trimester of pregnancy is when you really want to proactively plan.”

‘Kiss the toes, not the nose’

Along with vaccination, there are other steps grandparents can take to help keep a newborn safe: “Stay away when you’re sick, wash your hands before you hold the baby, and don’t kiss the baby’s face,” especially during respiratory virus season, Gounder said.

Desai added that he often tells grandparents: “Kiss the toes, not the nose.”

There are some other vaccines that grandparents may want to consider, too, for the sake of their own health.

• The shingles vaccine is recommended for adults 50 and older. Vaccination is more than 90% effective at preventing shingles and certain complications in older adults with healthy immune systems. It is given as two doses. “The second shingles dose comes two to six months after the first,” Gounder said.
• The pneumococcal vaccine is also recommended for adults 50 and older. In adults, it’s typically given as a single shot, but in some cases, additional vaccination may be recommended. The vaccine helps protect against pneumococcal infections, such as pneumonia and meningitis.

“If you want to be readily available for your grandchild, not get sick and not put them at risk, then follow the age-appropriate adult vaccine guidelines,” Desai said.

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