One fact I've learned in my years as a doctor treating kids: Parents just want to do what is right. But defining what's "right" isn't always that simple. And this is especially true when it comes to our children's health. I'm a firm believer that there are some common instances in pediatrics when doing right means doing less.
When Your Child Has a Fever
I admit that fever feels very different to me as a mom than it does to me as a doctor. The great news -- which is also challenging to hear -- is that most fevers are mild, go away on their own, and never require treatment.
First of all, what is fever? When your child is ill, an elevated temperature generally shows that her body is working to get rid of a virus or bacteria.
That means that having a fever may actually be protective and productive. Research has found that some children who have fever throughout the course of a viral infection recover even faster than those who don't.
Most pediatricians consider a fever to be a temperature above 101°F or 101.5°F. (In babies 1 to 3 months, 100.4°F is a fever, but tell your doctor right away if your newborn has a temperature above 98.6°F.) Many parents believe, though, that fever starts around 99°F or 100°F, which is by definition simply an elevated temperature. We doctors don't care so much about the specific number; when you tell us that your child has had a temperature of 101°F versus 103°F, we don't think there's much difference. We don't like a fever above 104°F, but any number under that doesn't really reflect how sick she is. We're more concerned with how she acts and eats, and most important, how many days a fever has persisted. Fever for up to three days can be normal with an infection, especially with a mild respiratory illness, but if it's not going down after three days, talk to the doctor.
You don't need to treat a fever if it's under 104°F and your child seems fine. But if you decide to give her acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), your goal is not to go from 103°F to 100°F. Your goal is to make her feel better. So if your child is acting more like herself but her fever hasn't actually gone down much, that's okay.
When Your Child Has an Ear Infection
Most of the time, this is just bad luck after a cold. At least half of kids with an acute ear infection recover without any antibiotics, found a recent study in Pediatrics.
Ear infections can be caused by either viruses or bacteria when excess fluid gets trapped in the middle portion of the ear. When that space fills with mucus or pus, it gets inflamed, causing pain. So the best medicine you can give your child once you first think he has an ear infection is a pain reliever like ibuprofen or acetaminophen. These infections hurt; don't wait for antibiotics to "kick in" and don't make your child tough it out. Antibiotics only help if bacteria have caused the infection.
There's been a lot of progress over the years to cut back on unnecessary antibiotics prescribed for ear infections. One study found that only 434 of every 1,000 children with ear infections now receive antibiotics, as compared with 760 out of 1,000 back in 1995. Overusing antibiotics can create more resistant and aggressive bacteria, so we want to use them at the right times. Last year, the American Academy of Pediatrics (AAP) released new guidelines to help physicians do a better job of handling ear infections.
For a diagnosis, an ear can't simply be red or have a bit of fluid behind it; the eardrum has to be bulging and filled with fluid or fluid has to be draining from the ear. If your doctor says, "It looks like an early ear infection" or "The eardrum is a little red," chances are your child doesn't meet the criteria and shouldn't be treated with antibiotics (typically amoxicillin -- the pink stuff). Press her to explain whether the eardrum is bulging and full of fluid. If there is no bulging or draining fluid, antibiotics may not be necessary. Time may be the best medicine. (If your child does need treatment but has had amoxicillin in the last month, the doctor should change the antibiotic to avoid resistance.)
Here's who typically needs antibiotics: all infants younger than 6 months; children 6 to 23 months of age with a double ear infection; those with severe pain; and those at risk for complications, such as those with a weakened immune system or with underlying chronic health problems. Lots of parents worry that amoxicillin isn't the best first choice, but data continue to suggest it is. If your child has pinkeye or drainage from his eyes along with an ear infection, he should immediately take a drug such as Augmentin, which combines penicillin and an ingredient called clavulanate. Bacteria that cause both ear and eye infections tend to be more likely to resist amoxicillin.
When a child older than 2 years has an ear infection but no fever or severe ear pain, you can keep an eye on him for two days without giving him antibiotics. But if he's still in pain or if symptoms haven't improved in 48 hours, follow up with your doctor. If symptoms go away in two or three days with only pain medication, the ear infection is likely healing (and was probably viral). But if symptoms aren't better in that time, he needs to start antibiotics or switch medications.