Help! Does my child need antibiotics???

Did I read your mind?

It’s one of the first few questions we ask ourselves when our children have a persistent infection. I know I do!

Another question often left unanswered is ‘Why doesn’t my GP just prescribe the antibiotics?’

I hope this post makes things a little clearer for you as I attempt to tackle this common misunderstanding.

Be warned, I am going to make this very basic to avoid this post from becoming a novel but if you have any separate questions, please leave me a comment.

The most common types of infection are bacterial, viral or fungal. In children, viral infections occur most often. Examples of viruses are 1) the Flu virus, also known as Influenza 2) Respiratory Syncytial Virus, causes Bronchiolitis, 3) Rotavirus, leading to vomiting and diarrhoea.

Viral infections are usually treated with supportive management eg hydration and mineral replacement with diarrhoea and vomiting symptoms, steam inhalation, hydration and simple pain relief for the flu. Some antivirals exist but only treat specific strains of viruses.

Bacterial infections are treated with antibiotics, also known as antibacterials or antimicrobials. They are usually broad spectrum, meaning one particular antibiotic, can treat a group of bacteria depending on the nature of the infection (skin, ear, nose and throat, stomach). The best way to treat any infection would be to isolate the virus or bacteria and then treat it using targeted therapy. Sometimes this can’t always be done.

The table below gives you a some indication if the infection is viral or bacterial based on their symptoms:-

Not all children with a fever necessarily have an infection. Fever can also be due to teething or a reaction post immunisation. I would suggest ruling these out first before you go onto treating him/her for an infection.

When you see the doctor with your child, they will tend to look out for the above symptoms in order to help them decide if the infection is viral or bacterial. Some viruses can last for as long as 14 days! You just have to wait for it to resolve and in the meantime treat any dehydration, fever or pain.

So if your child has a fever (presumably secondary to an infection), and you are giving Calpol regularly (every 4-6hours, in babies above 2 months) and they are still getting hot in between, I would try adding in Ibuprofen. Give it a few days, but if the temperature is persistently over 38°C, go and see the doctor. Look for a runny nose with thick green discharge +/- a cough. This may be an Upper Respiratory Tract infection. Look for blood in stools indicating a bacterial gastroenteritis. Discharge from ear/from mouth may be an ear infection or tonsillitis.

Once you have seen the doctor, he/she may suggest waiting a few more days and then returning for a further review. If you as a parent have a feeling that there is something else going on, then don’t ignore it! Go back and see the doctor again and relay your thoughts. Ask for a prescription of antibiotics to use only if things get worse. If it is a bacterial infection, you should see a change in your child within 24-48hrs of starting the antibiotics. If so, please do not stop the antibiotics. Please finish the prescribed course (usually 5,7,10 or 14 days).

Why don’t GP’s just prescribe antibiotics anyway? Well, firstly remember that viral infections are more common in children and you need to be sure you are treating the correct illness. Secondly, the more frequent one takes antibiotics, the likelihood of that person becoming resistant to it. This may mean that a particular bacteria cannot be destroyed by the antibiotic as your body is resistant to it and therefore it will not do what it is intended to do. You may run into problems finding an antibiotic that actually treats the bacteria. Next time you are told that it is not appropriate to give antibiotics, remember the above points.

So there you have it folks, I hope this helps. I wanted to share this with you as I went through quite an ordeal with Alyvia when she was 5.5 months. She had a high fever, runny nose and cough and we continued to give Calpol and Ibuprofen but she was still feverish 5 days later, with no improvement. I took her to the emergency department and was told she had acquired a Pneumonia. She was given antibiotics straight away and started to recover within 24 hours. That’s all she needed. I felt upset that we went through such emotional trauma with our baby when the signs were there in the first place. We thought we were over-diagnosing her (an additional perk of being married to another doctor!).

I always feel that parents know their children the best. Trust your instincts!

Lots of love

MCD

xxx