How clean is too clean?

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Children don’t come with user’s manuals. But every mom comes home from hospital knowing that she should sterilise things that go into her baby’s mouth, and get people to wash their hands before touching her baby.

Everyone agrees that this is a good starting point. But it’s the next steps – slowly starting to expose babies to an unsterile world – that cause a lot of confusion and concern. We’ve all heard of the hygiene hypothesis: the idea that as we live in cleaner environments, our immune systems target harmless substances because they’re not fighting viruses, bacteria and parasites.

The argument is that the more ‘good dirt’ children are exposed to, the better for their lifelong health. So when and how to start this? “The hygiene hypothesis is debated in medical circles, but there seems to be some truth to it – if the immune system is not busy fighting off bacteria, it switches to allergens,” says Dr Deon Smith, a Cape Town paediatrician.

He suggests that when babies start to crawl and put things into their mouths, let them – obviously within reason. This slow exposure to dirt will help them to build up stronger immune systems that target the right infections later in life.

Immune boost

“Babies are born with a healthy dose of their mothers’ antibodies. But because these aren’t their own, they slowly leave the body, until at about six months, they’re gone,” says Dr Smith.

From this point, your baby must start to build her own immunity through controlled exposure to her environment. However, Dr Smith advises that sick people still be kept away from your child. If possible, the child should be kept away from a playschool or crèche until she’s two years old when her immune system is more mature.

“Obviously, this isn’t always possible, but as a best-case scenario, this is what’s best for the child,” he says. “They’re most vulnerable to infection between six months, when they no longer have their mother’s immunity and 18 months, when their own systems start to mature,” Dr Smith explains.

Keeping them at home can help prevent ‘crèche syndrome’, where babies constantly have runny noses, as their immune systems battle to deal with the host of infections with which they are being bombarded.

Dr Smith also points out that the younger the child, the worse she copes with an infection. “If children that are under a year old have a snotty nose, it will have a big impact on their lives – their sleep; their ability to eat. They’ll battle to clear secretions in the chest and nose and are more likely to end up at a doctor or physio,” he says. “The same infection in a two-year-old will have minimal impact. So, aside from worrying about their immune systems, consider how a small baby is going to manage being ill.”

A timeline of cleanliness

Pre-term babies

Babies born before 34 weeks of gestation haven’t received the load of antibodies from their moms. They’re particularly vulnerable to infection. Parents should be diligent about hand washing, sterilisation and banning visits from small children or sick adults.

0 to 6 months

  • Get everyone to wash their hands before holding your baby.
  • Sterilise bottles, dummies and toys that may go into your baby’s mouth.
  • Tell sick people to stay away.
  • Don’t let the family pet lick your baby, but it’s fine for them to be in the same space.

6 to 12 months

  • Sterilise all milk equipment until about nine months. After this, a good wash in hot water will do.
  • Let your baby explore his world and put safe objects into his mouth.
  • Use common sense about what’s clean and what isn’t without going overboard.
  • Wash your hands often to avoid transmitting infection, but it’s not necessary to prevent healthy people from touching your child.
  • Keep away from sick people.

12 to 18 months

  • Use common sense to keep your child’s environment clean, but let him explore the world around him.
  • Keep washing your and your child’s hands to avoid transmitting any infections.
  • Keep your little one away from sick people.
  • Let your child play with the family pet, but deworm both your child and pet frequently.

18 to 24 months

  • Your child is well on his way to having a healthy immune system.
  • At two years, you can send him to a play school. Because he’s exposed to so many children all day long, you’ll see an increase in the infections he gets.
  • Keep him home if he’s sick and limit his exposure to other children if they’re sick.
  • Keep up hand-washing as a good measure for staying healthy.
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