Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Scott Webb (Host): When it comes to taking our newborns out in the cold, we want them to be warm, but not too warm. And my guest today has some great tips and suggestions for bundling up those newborns in cold weather, signs they're ready to go inside, and more. And joining me today is Dr. Bianca Williams. She's a pediatrician with Duly Health and Care.

Doctor, it's so nice to have you here today. I was mentioning to you that my kids are a little bit older, so fighting a different sort of battle with them, like my 17-year-old, you know, getting her to dress appropriately for the weather, and I can't make her do it anymore like I could when she was a baby. But that's basically what we're going to talk about today is, can we take our babies out in the cold? How do we bundle them up? When do we know if they're too hot? All that good stuff. So, let's just start there, like general guidelines for dressing a baby in cold weather.

Dr. Bianca M. Williams: Yes, 'tis the season. So, the general rule of thumb for older babies and for young children is to dress them in one more layer than you yourself would wear. However, for the younger infants, the name of the game is several thin layers to keep them nice and dry and warm. And then, you always want to remember boots and gloves and mittens, hats. So, those things sometimes get forgotten with younger infants, but don't forget those.

I do have some parents too, that really want a specific answer to this question lately. So, what I've been telling parents is to start with close-fitting layers such as tights or leggings, long-sleeved bodysuits work as well. And then, on top of that, you want to add your pants and a warm cap like a sweater. And then, finally, a thin fleece jacket, depending on, you know, the temperature outside might be all you need. So, those are some things I say in the clinic.

Host: Yeah. And of course, we could have a separate conversation about how to get those body suits on little squirmy babies. But now, I think we get the point, which is to dress them a little bit warmer than we dress ourselves, those layers are good, sort of build up from the inside out, so to speak.

Dr. Bianca M. Williams: Correct. Yes.

Host: Yeah. Is there a way to tell if our baby's too hot or too cold when they're bundled up? Because, you know, they can't really tell us per se. We can sense their unhappiness, right? But do we really know if they're too hot or too cold?

Dr. Bianca M. Williams: So, that's actually a really good question because an infant that is too hot or an infant that is too cold, they both can have extreme fatigue and they can seem tired. So then, you're questioning yourself, you're like, "What's going on here?" So, infants that are too cold would also have shivering in addition to being a little bit tired. Older infants or children, their speech might become slurred, which is kind of scary, and they can become clumsy. So, that's kind of your, "Hey, are things too cold here?"

Too hot of an infant, they begin to have nausea and vomiting associated with their fatigue, in addition to breathing can become faster than usual. We call that labored breathing. So although both situations, the kiddo can be very tired. You want to look out for those additional symptoms to let you know which direction to go in.

Host: Yeah. That's good. As I was saying, you know, kids can't always tell us what they're feeling, what they're experiencing and good to know that there are some signs and symptoms that we can look out for. And just along those lines, you know, we want to keep them warm, obviously, in the cold, but we want to not risk overheating them because overheating is bad, right? So, just some general guidelines for that.

Dr. Bianca M. Williams: This might not be intuitive, but newborns have a larger surface area, body surface area, than the rest of us. So, they actually lose a lot of heat. So, don't forget those hats and socks and booties and mittens, because you actually want to make sure your infant doesn't get too cold. That's a big issue with them. You could also use waterproof snowsuits or coats on top of that. But although you might be thinking, hey, I don't want to overheat them, really you don't want them to get too cold.

Scott Webb: Right. Right. We want them to be warm enough, but not too warm and definitely not too cold. So, a lot to think about as a parent, and I'm sort of glad I'm past all of that. Great to have your expertise here today. And if we have to take the baby in the car during the winter months, which of course comes up going to grandma and grandpa's house, wherever it might be, the pediatrician's office, of course, what are some best practices for safety when we think about winter clothing in those winter months?

Dr. Bianca M. Williams: You know, good thing your 17-year-old doesn't need to be strapped in a car seat, right?

Host: Yeah.

Dr. Bianca M. Williams: So, this is a hot topic, especially for the American Academy of Pediatrics. Taking a few extra minutes to ensure that the car seat is secure, there's nothing bulky between your child and the straps, it's well worth it. And parents, I know you really want that peace of mind. So, in general, you don't want to have your infant in bulky clothing, no winter coats. no snow suits.

There's two reasons for this. The first is that you want those straps to be nice and tight. So, one kind of trick I love is I love for parents to pinch those straps and if you're able to pinch the straps together, then that car seat is too loose and you want to kind of tighten up those straps. The second thing you want to avoid is eventually that car is going to warm up. So, you want to make sure that your infant doesn't get overheated in that bulky snow suit by taking it off before you put them in the car seat. You can always put that coat or blanket over the straps thereafter. So, those are some really good tips.

A few other things. The car seat cover should only be used if it actually came with your car seat. A lot of people try to put car seat covers from other car seats onto their new car seat, and actually those have not been crash tested. So, you want to make sure your infant is safe, and only use what comes in that box. Something to look out for as well is to make sure that the Consumer Product Safety Commission has approved the car seat, and you can find that on the box labeling.

One last thing, and this is a, "Hey, you're an expert parent if you do this." So, keeping the carrier portion of the infant seat inside the house while it's not being used is like, "Hey, you're a grade A. You've been through this, you're tried and true." That way, that car seat carrier portion doesn't get cold while it's in the car, and your child's body heat does not get lost to it when you use it.

Host: That's such great advice, and for any of us who've ever had to check the carrier part, you know, of a car seat when we've gotten on a plane, and then you get it back and you realize how cold it can get. I mean, just great advice. And assuming that it's safe to have a baby outside, and it seems like it is, provided we do our part, of course, is there any rule of thumb, per se, about how long is long enough? How long is too long to have them outside?

Dr. Bianca M. Williams: Yes. So, what are we really looking out for here? So, we're really looking out for something called hypothermia, low body temperature, and frostbite. I think we all know when we go outside, our fingers can get so cold that they start to feel like they're burning. So, those are the two things that you're really looking out for when an infant is in the cold. You would not want to have an infant below freezing, cold weather, for longer than 15 to 30 minutes. So, that's kind of a general rule of thumb. And signs of hypothermia, which is that low body temperature that we were just talking about would include shivering, crying, that decreased attentiveness that we discussed.

Additionally, that frostbitten finger or toe, or if you're concerned about that, the skin will begin to turn red. What you can do in that scenario is take a warm washcloth, not hot, but a warm washcloth. And put it on baby's fingers, toes, ears, or nose, and then call your pediatrician. So, just make sure you don't have that baby outside for longer than 15 to 30 minutes. If you see signs of hypothermia or frostbite, you call your pediatrician.

Host: Yeah. When in doubt, call the experts, call your pediatrician. They're the best. They know everything. It's awesome. Very helpful, especially for new parents of newborns. Wondering if there's just some common winter hazards for babies and what those might be and how we can avoid them.

Dr. Bianca M. Williams: Yeah. So, I actually talked about this with a patient in clinic recently. They came in with a stroller and I want to remind parents that the stroller covers that came with the box, they're completely safe to use. However, I've seen some parents draping blankets over strollers in order to keep infants more warm. Now, the draping of the blanket over the stroller, it can cause the free air circulation, you know, to dwindle, to decrease. So, you want to actually put that blanket over the infant and not draped over the stroller. So, that's one hazard that I've run into recently.

Additionally, I love baby carriers. They are a great way for parents to transfer their own warm body heat to their infant. However, you want to make sure that baby's head is not covered by the baby carrier. You want to make sure that free air flow around baby's head, it's so important that it's there.

Host: Yeah, good stuff. I love doing podcasts like this because, for me, I start to reminisce, I start to think back, "Well, what did I do? Was I doing the right thing?" And sort of grading myself as a parent 17 years ago.

Dr. Bianca M. Williams: Oh, no judgment. No judgment.

Host: Oh, I appreciate that doctor. Are there some common illnesses that affect newborns in the winter months and what can we do to protect them, whether that's in vaccinations or anything else? What's your best advice?

Dr. Bianca M. Williams: Yeah. So although car seats are a hot topic, I think this might be the most important topic. Now is the optimal time to immunize patients against the fall and winter respiratory viruses. So, check and make sure, is my child due for the flu vaccine? Is my child due for the COVID-19 vaccine? I've gotten these vaccines myself and so have my family members. I'm so happy that we are protected. I want to put a little bit of a plug in for this RSV vaccine that I know some people have heard about. So, your infant, your baby is probably due for the RSV vaccine if they are less than eight months old.

They could be due for it if they're older than that, and they have any medical conditions that indicate, okay? So, check and make sure. There are two ways that a baby can get RSV protection. The first is that mom can get vaccinated against RSV before she delivers. So, I want moms to ask their OB-GYNs, "Hey, am I eligible for this RSV vaccine?" The second option is for your newborn to get vaccinated. And something that's very important, is that the infant does not need both. And that's something that we've been talking about lately with parents.

Scott Webb: Oh, that's good.

Dr. Bianca M. Williams: Yeah. So, flu, COVID-19, RSV, those are the viral illnesses that can cause severe illness, even in healthy infants. So, I want you guys to go out and double check your vaccine records.

Host: Yeah. It's, again, so great to have experts because I was thinking, "Well, yeah, mom, get it; baby, get it; everybody, get it." But as you're saying, the babies really only needed one. If mom got it during pregnancy, then the baby doesn't also need to be vaccinated for RSV. So, I'm just making a little list in my head here. I think I'm way old to be a parent again of a newborn for everybody's sake. But just keeping track here.

Dr. Bianca M. Williams: You know, anything can happen.

Host: Yes, unfortunately. So true. So, I had this situation where we brought, you know, our newborn home, and she had a four and a half year old brother who was going to school and bringing home germs and illnesses and all that that implies. What can we do to not necessarily protect, you know, the one going to school, but the one who's at home when brother or sister comes home?

Dr. Bianca M. Williams: Oh, yeah, yeah. So, this happens so frequently where I'll have a school-age kid in my office, they put their fingers in their mouth, then touch their newborn infant, and I just kind of cringe. But typically, we suggest that others' hands and faces, including adults, stay away from babies hands, face, and mouth, not only outdoors, but indoors as well. So, what I tell parents is to have their school-age child wash their hands immediately after they get home from school and then no face kisses.

Host: Yeah, it was so cute, right? Her brother would come home and he would want to see the baby, he'd want to hang out with his sister and like, "Wait, wash your hands or I'll wash your hands for you before you go near that little bundle of joy." Doctor, this has been great, great to reminisce, great to benefit from your expertise. I'm sure parents agree.

I just want to finish up here, talk about baby's skin, which is so important and so precious when they're little like that. How do we, you know, help their skin stay comfortable and hydrated during the winter? Which of course, all of us adults-- my skin is so dry right now. I'm scratching my arms because I don't use lotion enough. But what do we do to help our babies?

Dr. Bianca M. Williams: You know, skin gets chapped and eczema is a common, common issue. So, you're going to want to bathe your infant about two times a week and then moisturize. Many ask, "Which moisturizer should I use?" And there's so many brands out there, right? So, in general, you just want to use one with very few ingredients. I would recommend Aquaphor, Eucerin or Vaseline. Those are the trifecta for me. And then, I don't know if people know this, but indoor temperatures can also cause chapped skin. So, you want to keep the indoor temperature around 68 to 72 degrees for infant. That's a good rule of thumb.

Host: You know, you mentioned Aquaphor there. We still keep that in the house. My wife swears by it. It's one of our go-tos in the medicine cabinet. And you're so right, just being indoors. We're talking so much about being outside, but indoors, proper temperature, you know, having the humidifier going, if you have one in your house or your apartment, whatever it is.

Dr. Bianca M. Williams: Oh, yeah, you've been through this before,

Host: Oh, my wife was very clear to me how we need to keep the house humidified and keep moisture in the air for her sake, for the baby's sake, all of that. Good stuff today, doctor. Thank you so much for your time.

Dr. Bianca M. Williams: Oh my gosh, Scott. Thank you so much for having me. I hope that this was helpful.

Host: Absolutely. Thanks again. ​And for more information, go to dulyhealthandcare.com. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health and Care.