Friday, September 24, 2010

A slight case of paranoia with a bit of reality thrown in for good measure...

When my daughter was nearly 6 weeks old, we flew to Sydney so she could meet grandparents, great grandparents, aunts and uncles and family friends. It was a lovely trip. Unfortunately, she was exposed to Pertussis (Whooping Cough), probably at the airport or on the flight on the way home. Two weeks later she developed a cough which steadily got worse over the next couple of weeks.*
A at about 6 weeks old

After several trips to the GP and many phone calls to Nurse-on-Call, we eventually ended up in the Children's Hospital in an isolation ward for a few nights so that her symptoms could be managed. The GP didn't pick it up because the symptoms look so different in an infant compared to an older child or adult. As infants don't have the muscle strength to do the characteristic cough, when it gets severe enough they stop breathing instead. As a parent, it's incredibly distressing to witness, and requires being on high alert ALL the time so that you can sit the baby up during a coughing fit to try to keep their airways clear. The only treatment available for Pertussis is a course of antibiotics, which limits the contagious period to 5 days from the beginning of the course of antibiotics (as opposed to 3 weeks if left untreated). It does nothing to treat the symptoms, which need to be constantly monitored and managed.

In the last couple of weeks, a five week old baby in South Australia died as a result of Pertussis. This was apparently the fourth infant in Australia to die in the last 12 months, when typically in this country, there is only one Pertussis related death each year. The disease is not life threatening for most people over the age of 12 months (though when my sister had it a few years ago, she broke a rib with all the coughing), but in small babies they don't have the strength to cough as effectively, which means their airways can be compromised, and they can end up too exhausted to feed which further reduces their strength, which can spiral down into a very bad place to be. Fortunately, if you make it past the worst of it about 2 weeks after the cough first appears, there are no lasting side effects once the 3 month (very) gradual recovery is complete.

We were lucky. My daughter's case was considered 'moderate', which meant she didn't get to the point of needing to be tube-fed and only had oxygen waved over her face during a coughing fit rather than it being attached permanently. Thankfully she was a great feeder from birth, and consequently a fatty-boom-sticks which I suspect put her in a more resilient position to start with than many babies often are. She is now completely healthy, and amazingly, given the levels of adult anxiety she was exposed to while she was sick, is a joyful, carefree, adventurous little thing. It doesn't seem to have had any long term impact.

A last weekend seesawing enthusiastically at the park...

But now we're about to have another baby. And the rate of Pertussis in the community is again significantly higher than normal. And I'm feeling slightly paranoid. I REALLY don't want this child to get it. I'm not sure I could be as together if it happened again - I know a lot more about it and the potential consequences now than I did last time! Sometimes lack of knowledge is a good thing... We WILL vaccinate this child**, but it will still be completely unprotected for the first 8 weeks of life.

The conversation with my rational brain goes something like this:
My SIL had a baby 2 months ago and when they left the hospital they were advised that, in addition to ensuring that any adults who were likely to have regular contact with her (like parents and grandparents***) were up to date with their vaccinations, to keep her away from public places, especially those with air conditioning (like shopping centres). My advice at the time was to be cautious and sensible but that they couldn't let the unlikely possibility shut them in the house for the first 8 weeks! Obviously that applies to us, too!

Here is a sample of the conversation with my slightly less rational brain:
Our daughter caught it in one of those public place scenarios!! We can't go anywhere public then!! Well at least not to the shops. Or church. Or cafes. And only people who are up to date with their vaccinations can come into our house!! And so on...

There's got to be some kind of middle ground here! Listening too closely to my irrational brain is a recipe for serious mental health issues. However, it's not completely crazy. I suspect that not being cautious enough and getting into the same situation again would result in psychological catastrophe too. Obviously, we won't be going anywhere near airports or public transport for the first few weeks of life (been there, done that, outcome not good). The question is: Where do we draw the line? When does caution become paranoia? What do you think?

*She was vaccinated, but babies don't receive their first lot until they're 8 weeks old, by which stage she'd already picked it up.
**I know there are many people who don't agree with vaccination, but it's something that we're committed to, especially in this situation.
***Babies typically pick it up from parents or grandparents who have not been vaccinated in the last 5 years. Most adults don't realise the vaccinations they received as children or teenagers have well and truly lost their effectiveness! And most adults who have Pertussis often don't get diagnosed until after they're no longer contagious, because it's the fact that it lingers for such a long time that often results in a diagnosis being made.


Sue said...

Oh it would have been so completely stressful for you! I think sometimes lack of knowledge is a good thing if you are anxious (like I usually am) it just makes you worse. Little babies are probably best at home with family coming to visit. I guess the only thing is to make sure they wash their hands everytime they pick up the baby which some people dont do!

Posie Patchwork said...

Oh darling, this is a stressful situation. When i had my babies, i can't think of any warnings or things to worry about, we took them everywhere & they never got sick (including lots of plane trips while they were very young). Now they are starting high school, still, no coughs or colds & we live in Canberra, brrrr.
If you love being home & don't get cabin fever, you can make all your trips out in the real world - to the park, garden, just not the supermarket etc. You won't go crazy, it's just how it will be for the first couple of months.
Nowadays you can be at home & not starve. You've had an experience which is going to play on your mind. I'm all about vaccinations (i'm a pharmacologist) but also letting children play in dirt & be exposed to the world to build up their immunity (i'm a practical mother of 4). I did breastfeed for a long time, maybe that helped, i just know all the incubated children with spotless floors & zero exposure to the world, get very sick at school. Mine were barefoot & discovering the world, they rarely get ill.
But that's all fine when they are walking . . . i'd seek some advice about this, is there some form of mask or cover to prevent picking up a disease.
Just know, mother instinct will kick in, you're not crazy, just informed & aware, it's your baby, no one can tell you what to do or how to do it any better than your choices. Good luck, pats to tummy, love Posie

Vic said...

What a completely stressful and horrible time for you! No advice at all apart from to say that you should always trust that mother's instinct, even if you think you'll seem crazy to everyone else. Don't want to take your wee babe to a shopping centre? Then don't. Trust yourself and your instincts! Vic xx

Leonie said...

Oh honey, that is such a terrible thing to have gone through. No wonder you are hesitant going into it again. And rightly so. Listening to your instincts is absolutely the way to go. Especially when protecting your children. We have to let them experience so many things to help them grow but that is not one of them. Best of luck with the upcoming event and for getting through those stressful couple of months after the birth as well.

CurlyPops said...

Oh you poor thing. I've only seen video of babies with whooping cough but it was so distressing to watch, because there's really not much anyone can do to relieve the symptoms. It must have been really scary with your little one.

Gina said...

Hugs to you xxxx. I remember well the stress of it all.

I do think a middle ground is the way to go. Base yourself mainly at home but don't give up those important gatherings (unless the bub isn't feeding as well as A.). Feel free not to pass bub around much until after 8 weeks or ask people to check their whooping cough status!

Most of all, keep the doses of reality coming in order not to feed your own anxiety. Worry does not help. There have been thousands of babies born in the last few years who
haven't contracted the disease. Remember the fact that you at least have the knowledge of signs and awareness to push for care ASAP if you are incredibly unlucky enough to be exposed again! Perhaps those poor bubs who died did
not receive timely care... You WILL.

Feel free also to force Justin to drop in weekly for a reassuring check up!!!!

Lorajean said...

I feel you sister. I don't want to put Eli in day care. I don't want extra cooties coming home. I hope the birth goes smoothly and it's an easy transition. Spring babies are the best!

Seaweed and Raine said...

I know just what you mean! My 2nd baby started coughing at about 4 weeks of age. He had even seen the paediatrician about it - but it was diagnosed initially as Bronchialitis. It wasn't. When he had a couple of "blue" episodes, that was the final straw and we went and got a second oppinion. The result was 4 nights in Childrens ward with Oxygen, medication, and two very tired parents. He was let out on our wedding anniversary.
Seriously, you are the baby's parent. You have to do what is right for your family. Pray about it. God loves this baby too :)
All the best, and I hope this experience is filled with a whole lot less stress, and a whole lot more joy :)