Your Child’s Sick: Do You Know if They Need Antibiotics?

Antibiotics are wonderful things. Since penicillin was first found and produced in the early twentieth century and used during the Second World War, it and related antibiotics have saved countless lives and cured many an illness quickly.

Antibiotics work by inhibiting certain growth factors and processes needed by bacteria to reproduce and flourish. As with many significant discoveries, penicillin was found purely by luck when an early twentieth century biochemist was trying to grow Staphylococcus (a type of bacteria). He opened the Petri dish to find that the growth of Staphylococcus seemed to be inhibited by a white substance growing next to it; that substance was studied and named “penicillin”, and indeed, did prevent growth of bacteria. The huge toll of injured and dying soldiers during the Second World War stimulated a renewed interest in the now decades old “antibiotic”, and it was pressed into service on battle fields around the world. Its successful wartime use spread to the private sector. Although initially used to help cure life threatening illnesses, it began to be used for even minor illnesses that would begin a trend that is still going on today.

The number of antibiotics in use today and their complexity is overwhelming and new ones are produced in ever increasing numbers. The primary reasons for producing a new antibiotic are to be able to treat an increasing number of bacteria known to be producing new diseases in people. Also the old antibiotics become outmoded when the existing bacteria develop very intricate mechanisms to shield themselves from the effects of the antibiotics (resistance).

Antibiotics are ineffective against viral infections, but many times well meaning health care professionals put them into use to possibly stop the advance of the viral illness (or secondary bacterial infections). Sometimes, antibiotics are dispensed at the insistent request of the parents who, in a misguided attempt to help “cure” their child of a viral illness, wish to use the latest antibiotic. At least in Pediatrics, an overwhelming majority of illness is due to viral infections and therefore speaks against the use of an antibiotic.

When antibiotics are used indiscriminately and in large amounts the following things can occur:

1. More “allergic reactions” because of the widespread use of these drugs
2. Increasing numbers of bacteria are developing resistances to these new and old drugs (leaving very few effective antibiotics for some very dangerous bacteria)

This is a trend that will probably continue unless health care professionals make this information available to the public. It is important to note, as new antibiotics are developed, the cost of delivering these to the portion of the population that really need them becomes prohibitive and adds tremendously to the cost of health care in this country. The process of getting a new medicine through the testing and the FDA is both very time consuming and expensive

Most of your child’s illnesses will be viral in origin and will not need an antibiotic. In addition, some routine illnesses that children get, such as ear infections, have been scrutinized carefully by researchers and their findings suggest that antibiotics may not be needed in mild ear infections. In fact, there are times that even severe ear infections can be followed carefully without the use of antibiotics as long as the pain is controlled. Every attempt is being made to limit the use of all antibiotics in general. There are certainly situations that require an antibiotic such as strep throat and certain types of pneumonia, but your doctor will discuss the options at the time of your visit.

Think both locally and globally when it comes to the use of antibiotics: it will help your child and children all over the world.

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Editor’s Note: with temperatures fluctuating wildly, (often by as much as 20 degrees on a day to day basis), it’s no wonder we’re seeing sniffles, sneezes and coughs that just won’t go away. With the questions on every parent’s mind: “is this a cold? maybe the flu? should I take them to the doctor? do I need to keep them home from school an extra day”, it seemed the perfect time to re-share this Dr Joe classic from 2010 (Antibiotics…Not Always the Answer).

Bronchiolitis or “Wheezy Bronchitis” and Kids

One of the more common illnesses that is encountered during the winter months in infants and young children is a respiratory problem referred to as Bronchiolitis or “wheezy bronchitis”. This is a condition caused by a viral infection that attacks the respiratory tree, both upper (nose and throat) and lower (the smaller airways leading to the air sacks in the lungs). It is most commonly caused by RSV or Respiratory Syncitial Virus. It can also be caused by other winter time viral infections but the exact cause is relatively unimportant as the symptoms are nearly the same.

Your child will usually develop signs and symptoms of a regular cold with sneezing, runny nose, mild cough, and sometimes a low grade fever. At this stage it will be impossible to tell if this will progress to bronchiolitis, but most of the time this will remain a cold and your “cures” are limited as your doctor will tell you. In a certain number of infants and young children, after a few days of the cold, the cough might progress to a more significant stage and the infant or young child may show some signs of having difficulty breathing; more rapid breathing rate than normal will usually be the first of such signs, but fever alone can raise an infant’s rate of breathing, and if you are unsure call your baby’s Doctor and he/she will help you figure that out.

Because the primary problem with bronchiolitis is swelling in the respiratory passages (lower and upper), air might have to begin to squeeze through narrower passages in the lungs and similar to what we have presented about asthma in the past, this may lead to wheezing. Wheezing is a whistling (musical) type of noise when your child breathes out versus noisy breathing in noticed in those infants with the upper airway cold. Admittedly this may be difficult to see by non- medical parents, but you can ask your Doctor how to do this in a reliable and repeatable manner.

Most infants and young children will remain in this stage and, as long as he/she is feeding well , does not have fever over 103, and seems fairly cheerful with his/her usual skin color, you do not need to worry, and all the symptoms will resolve as the cold goes away.

Occasionally, the situation can worsen with more difficulty breathing, now showing itself by your child using more muscles of his/her body to help force the air through the small airways in the chest: those muscles might include the abdominal, neck and intercostals (muscles between the ribs). At this stage your child should certainly be under the care of a physician, who might, depending on the appearance of your child admit him/her to the hospital so that more intensive care can be used to help him/her breathe.

The illness is self limited in that between 3 and 7 days normal resolution will take place. The worsening progression that I outlined above will generally not happen very fast and you will have time to see that your child is getting worse. Anywhere along the way, should you have doubts about your ability to adequately monitor your child’s status you should be talking to his/her Doctor.

I would like to stress once again that most bronchiolitis illnesses in infants and young adults remains mild and in fact may be indistinguishable from a normal cold.

6 Summer Illnesses Parents Must Know: How to Spot & Treat Them

You may not think of summer as a major season for sickness, but there are a number of illnesses that occur only in the warm months — and most often in kids. These viruses and bacteria live and breed where kids like to hang out: in lakes, pools and wooded areas.

The main culprits are enteroviruses (which are transmitted through the digestive tract) and viruses carried by deer ticks, says Dr. Jeremias Murillo, an expert in pediatric infectious disease at the Children’s Hospital of New Jersey at Newark Beth Israel.

There are no vaccines for these viruses, so parents need to be vigilant and prudent, advises Murillo. Steer clear of dirty-looking lakes and overcrowded pools, which can be contaminated with infected feces and sewage. Avoid wooded areas where tick-carrying animals live. And if you’re going hiking, wear white clothing with long sleeves and pants, and check frequently for ticks.

Here’s how to spot and treat the six most common summer ailments:

Summer Sickness No. 1: Enteroviruses

Enteroviruses include Coxsackie viruses; ECHO virus; and hand, foot and mouth disease.

• Source: Water contaminated by human feces, such as lakes and under-chlorinated pools.
• Signs: Upper-respiratory infection; diarrhea and vomiting; pinkeye; skin rashes; and blisters in the mouth and on the hands and feet. Can lead to viral meningitis. Symptoms develop three to seven days after infection.
• Treatment: None. Clears up after a few days.

Summer Sickness No. 2: Lyme Disease

• Source: Bacteria spread by infected ticks.
• Symptoms: A single bull’s-eye rash, body-wide itching, fever, chills, muscle pain, stiff neck and headache. Symptoms come and go. If not treated, Lyme disease can spread to the brain, heart, and joints.
• Treatment: Antibiotics.

Summer Sickness No. 3: Babesiosis

• Source: Parasites spread by infected deer ticks.
• Symptoms: Shaking, chills, very high fever, loss of appetite, and a type of anemia that can lead to jaundice and dark urine. Often misdiagnosed as malaria.
• Treatment: Antimalarial medications and antibiotics.

Summer Sickness No. 4: Ehrlichiosis

• Source: Bacteria spread by infected ticks.
• Symptoms: Fever, headache, fatigue, muscle aches, diarrhea, flat red rash, and tiny areas of bleeding on the skin. Can also cause anemia and blunt the immune system, leading to other infections. Symptoms develop seven to nine days after the bite.
• Treatment: Antibiotics.

Summer Sickness No. 5: Rocky Mountain Spotted Fever

• Source: Bacteria spread by wood.
• Symptoms: Prominent, generalized rash that starts in hands and feet and spreads to the rest of the body. Also, chills, fever, severe headache, muscle pain, mental confusion. Can affect organs if not treated immediately. Symptoms develop two to 14 days after the bite.
• Treatment: Antibiotics.

Summer Sickness No. 6: E-coli

• Source: Bacteria found in sewage-contaminated lakes and other water
• Symptoms: Sudden, severe and bloody diarrhea. Also, fever, gas, loss of appetite, and stomach cramping. Symptoms develop 24 to 72 hours after infection.
• Treatment: None. Sickness disappears in a few days.

Most cases of these illnesses are fairly mild, but some can lead to serious complications — and very rarely, death. Being aware of the causes and signs can help you protect your kids — and ensure your summer fun.

Kids and Enteroviruses (Gastrointestinal Tract Illnesses)

Enteroviruses: Now you see the word that describes those viral infections that affect the gastrointestinal tract to one degree or another. These become more prevalent during the warmer months of the year, and therefore may affect a lot of children of early school age during the beginning and end of the school or nursery year.

Your child or toddler may experience vomiting, diarrhea, abdominal pain and fever in one combination or another, but these illnesses, as a rule, tend to be short and mild. In general the diarrhea usually does not contain blood or mucous as these are found in the diseases that are usually caused by bacterial agents. The stools are usually clear to yellow/brown and may be watery or just very soft. Vomiting, fever, and diarrhea usually occur simultaneously but the vomiting is first, followed in rapid order by diarrhea and possibly fever. There are literally hundreds of named viral illness that can cause these symptoms including an enterovirus that you are familiar with; poliovirus is an enterovirus that is usually mild but until the advent of polio vaccine, this virus was capable of infecting the brain and causing any number of disturbing and sometimes permanent symptoms. It should be said at this point that even though these are usually mild illnesses they are all capable of very rare brain invasion.

I have spoken of the symptoms of these illnesses and it is now important to help parents decide what are the symptoms that should be evaluated by a doctor. The younger the child or infant, the shorter period of time with these symptoms are needed to cause dehydration.

Signs of dehydration in an infant or child are (but not limited to): fussiness, decreased volume of urine or frequency of urination, dryness of the tongue surface- not necessarily the lips, a lack of interest in his/her surroundings and listlessness.

In other words parents always know when their child is acting really sick. A short talk with your Pediatrician will determine whether your child should be seen in the doctor’s office or things may be managed at home.

Certainly severe dehydration is very rare and has very significant symptoms that probably will not be missed by a parent.

As with all viral illnesses, the best way to prevent spread in the home starts and ends with good vigorous hand washing. Children will probably be contagious about one day prior to symptoms (you can’t know) and a day after any fever decreases to normal. If your child is in diapers, you will want to keep him/her at home until the diarrhea at least slows, and your child is acting normal with normal temperature.

My Child Has a Mouth Sore – What Can I Do?

Mouth sores come in many different forms and are quite common in people of all ages, including young children. These irritating lesions usually aren’t a cause for concern, but can be quite annoying and painful. They can make eating, drinking and brushing teeth uncomfortable. However, there are several steps you can take to relieve your child of pain associated with a mouth sore and even help prevent sores from occurring.

Types of Mouth Sores

The first step in knowing how to treat a mouth sore is to figure out what type of sore it is. Most types of mouth sores can be distinguished by how they look and where they appear. The most common mouth sores to look for include:

• Cold sores – Also called a fever blister, this type of sore is usually found on the lips and around the mouth. It is a red, raised blister caused by the contagious herpes simplex virus type 1 (HSV-1). A child can contract the virus by kissing, sharing utensils or even a slobbery toy with an infected person. So as you can imagine, toddlers and preschool-aged children as especially susceptible to the virus.
• Canker sores – Canker sores are ulcers that occur inside the mouth and have a white or yellowish, concave center with a red border. They can form inside the cheeks, lips, the base of the gums, and on or under the tongue. Unlike cold sores, cankers sores are not contagious, but are brought on by a variety of causes. Biting the lip or cheek, diet, poor immune system, and stress are all factors that can contribute to a canker sore.

If your child has one of these types of sores, there are several things you can do to help remedy any pain or discomfort associated with the sore. Over-the-counter topical medications such as Abreva, Zilactin, Anbesol, Orajel or Orajel Baby, and pain relievers like ibuprofen or acetaminophen can usually do the trick. Check the label on medications for age recommendations, and consult with your doctor before using it for a younger child. Ensure that your children are brushing their teeth with care and using a soft bristle toothbrush. Additionally, monitor what type of food they eat, as chips and other abrasive foods or spicy foods can irritate the sore even more. Common mouth sores will eventually heal on their own within a few days to a week.

While it can be difficult to prevent your child from getting a mouth sore, discouraging them from sharing cups and utensils or putting toys in their mouth can help prevent cold sores. Likewise, discouraging lip biting and ensuring your child has a well-rounded diet can help prevent canker sores.

If you find that your child’s mouth sores reoccur frequently, aren’t going away after several days, or are occurring with a fever, consult a dentist or doctor. A prescription medication or mouth rinse may be given to help progress healing and prevent more sores from returning.

Kids Will Get Sick: 5 Facts a Pediatrician Wants You to Know

The warnings you were given as a child about not going out with your hair wet or you’d catch pneumonia, don’t sit too close to the television or you’ll damage your eyesight – it’s probably safe to say what they lacked in accuracy they made up for in good intentions. But as we enter into the time of year when colds and other infections seem to thrive, it seemed like a good opportunity to set the record straight, debunk some of the myths and provide you with some useful information to get you through the worst of it…just in case you or someone else in your family starts to feel sick…

Fallacies vs Realities:

1. Being out in the cold or wet weather can lead to a “cold” in a child. A “cold” or an upper respiratory infection is almost always due to a viral infection which, aside from certain colds being more prominent during certain seasons, is unrelated to the outdoor temperature. A cold happens when a viral agent attaches to the inside of the mouth nose or eyes. The viral particles enter the very specialized cells in these areas and replicate in to more of the same particles and even fever which then can invade further causing the associated symptoms. The same is true for the fear of “catching pneumonia” when one gets cold and/or wet.
2. When the mucus in one’s nose green it automatically signifies the onset of sinus infection or contagious disease. A sinus infection is not contagious for the same reason that it occurs. Inflammation or possibly bacteria works its way into the sinus cavities, set up shop and cause the symptoms of the resulting pain and sometimes swelling. The reason, as with ear infections, that these are not contagious is that both of these occur in fairly small closed spaces and the inner contents cannot get out; concurrently antibiotics have a difficult time getting in, so it usually takes c little longer to cure these infections. For a frame of reference, consider the rapid “cure” that occurs when one contracts strep throat, an easily accessible area, after antibiotics are used.
3. Once the fever is down after the use of acetaminophen or ibuprofen during an illness, that illness is over and the concentration should be placed on “breaking” the fever. In fact each illness has its own symptoms, including how high the fever goes or how long it lasts. Some fevers do come and go within the same illness and the use of medications to” cure” the fever and hence the illness is fallacious. Certainly one will want to give their child some relief from the symptoms and these medications are good for that reason.
4. A child who has a “high” fever will get brain damage. In fact, fever itself is merely a symptom of an illness such as other symptoms; runny nose, cough, headache, etc. While high fever itself is seldom ever responsible for brain damage some very rare but very significant illnesses for which the fever may be an accompanying symptom may result in brain damage: e., meningitis, encephalitis and others. But to be complete, and fair to all parents worrying about their child with fever, fever by itself is not the only symptom one sees with such serious illnesses. If there is a very high fever, contact with your Doctor will help sort through the causes.
5. High fever will cause seizures in my child. There is a small population of children who will, in fact, develop a mild, non-harmful seizure during the initial rise in that fever. Although these seizures are not harmful to your child, it is important to know if there might be another reason for such seizures, and your child should be seen by a physician immediately- usually an Emergency room Doctor. Also a little known fact is that the seizure will only seldom repeat itself during the same illness. Again the parents will want to use a medicine for fever because of the discomfort your child will have and the fact that another seizure is possible.

These are just a few; more to come down the road…

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