But Doctor, Doesn't My Child Need An Antibiotic?

* (DISCLAIMER: If your child is ill, he/she needs to be examined by one of our physicians. Each child is different and we can never diagnose over the phone or on any type of social media/website. This blog is for informational and educational purposes only. Call our office for an appointment.)

Here we go! This is a blog I’ve been wanting to write for awhile. The use of antibiotics is a hot topic for both the medical and parenting communities. This seems to be a timely blog as summer brings it's own set of illnesses. So sit back and enjoy as I tackle some of the common myths. Antibiotics take one…

Typical scenario: Your 9 month old infant has had 3 days of runny nose (yellow nasal drainage), a cough (keeping him, the entire house and the dog up all night) and fever (highest temperature was 101.4). He has some vomiting mainly when he coughs really hard and is fussy. His appetite is decreased and he only wants to drink half of his usual bottle. After a third night without sleep, you desperately call our office and schedule a same day appointment with me later that day. I walk into the exam room and I find your little one fussy, snotty and clingy. I’m still happy to see him of course because even kids with dripping snot are adorable. His ears are not infected. His lungs sound clear. He does not have a rash. He has a soft tummy and he is well hydrated. Your child and I play with the tongue depressors a bit as I explain that a virus is likely causing his cold. The interventions for the common cold in his age group include fluids and saline nasal drops (or spray) to thin secretions. A cool mist humidifier can add some comfort. If fever is causing discomfort it can be treated with an over the counter medication like Acetaminophen or Ibuprofen (never give children aspirin!). Outside of close monitoring for breathing problems, signs of dehydration and more frequent vomiting, there is not much we can do at this point. “But Dr. S, the snot is yellow. Doesn’t this mean it’s a bacterial infection?” Actually, if you blow your nose on any given morning you will likely see yellow snot when you are well without other symptoms. Yellow snot can be present in a bacterial infection but it is not indicative of one. Many viral illnesses cause thick, yellow nasal mucous. Antibiotics do not work on viral infections. I consider the number of days your kiddo has been sick, the presence of concerning findings on my exam (like an ear infection or pneumonia) and if your child is worsening (even if only a few days into the illness). “But Dr. S, I want to catch the infection before it becomes a bacterial one. Can’t an antibiotic prevent a bacterial infection?” Not exactly. Viruses are usually handled well by our immune systems. Only sometimes are they complicated by a bacterial infection. Viruses can change the ability of the body to clear mucous leading to the increased attachment of certain bacteria. So, you cannot prevent this with an antibiotic because it would have to directly affect the environment that allows the bacteria to grow, not necessarily the actual bacteria itself. “But Dr. S, my child is not eating any food. Is this dangerous?” Well, if the child does not eat for a few days, there is no harm in that. They must drink, however, to keep up with their hydration. So, keep the fluids going as this helps hydrate them and can thin mucous. You don’t really need an over the counter med that breaks up mucous if you are drinking enough. “Dr. S, if you recommend letting our kids’ immune systems do the fighting during a virus, then why don’t we do this for a bacterial infection?” Now this is a great question! First off, we don’t actually have antivirals for most viruses anyway. But we use antibiotics for bacterial ones because they have saved millions of lives since they were discovered. Certain infections must be treated immediately such as urinary tract infections, pneumonia, skin infections, STDs and meningitis simply because they can cause very serious complications or death if not treated. Others, like Strep Throat and ear infections, usually require an antibiotic to prevent rheumatic fever and meningitis/mastoiditis. Also, in some cases, the illness will improve a day or two earlier making life (and sleep) easier for everyone. “But Dr. S, if it’s just a cold then why do we have to bring our child in for a visit?” I believe parents know their kids better than anyone. But, it is dangerous for you to attempt to diagnose a lung infection, ear infection, Strep, a rash or another illness (even if you do have your own stethoscope or otoscope) because so many symptoms overlap. We have seen thousands of ears and listened to thousands of lungs. First of all, kids do not always follow the textbooks. Secondly, one kid could have a headache with fever and be diagnosed with a sinus infection while the next kid could have meningitis. Both kids can look sick and have the exact same complaints on paper. But we need to examine your child, use our experience and make medical decisions based on what we find. This is why I think pediatrics should be recognized and respected for what it is…we have to examine kids who fight back:) kids who can’t talk :) kids who change things up all of the time. Kids who surprise us by beating the odds and some that cave quickly. The saying goes, “children really aren’t little adults”. Things can go south quickly and so we always encourage you to call us if you are worried. “But Dr. S, we (family members) all have a cold, our physician put us on antibiotics and we got better.” Did you get better because of the antibiotic or was it started just as you were recovering naturally (thanks to your immune system) and your improvement would have occurred anyway?

So, the next time your child has a cold and you expect an antibiotic, reread this blog and remember our goal is to keep your kid healthy and comfortable. Antibiotics are not always benign and can cause resistance issues, side effects, allergic reactions, even other types of infections. We’ve been there. Sick kids are exhausting. Just be patient. Trust your child’s natural defenses and trust your pediatrician.