Vaccination News Home Page

http://www.nytimes.com/2002/07/23/health/23RECO.html

Ways to Treat Common Childhood Maladies

By LAURIE TARKAN

number of misconceptions surround many of the most common childhood ailments and how or whether they should be treated with over-the-counter remedies. The following are common maladies and experts' recommendations for treating them.

BACTERIAL INFECTIONS Distinguishing between viral and bacterial infections can be difficult, but the American Academy of Pediatrics and the Centers for Disease Control and Prevention have published guidelines to help doctors make the call.

Advertisement

For ear infections, children under 2 should be treated quickly when they have signs of infection. But for children over 2, doctors need to obtain a clinical picture that is as accurate as possible before prescribing antibiotics.

In general, a child with a bacterial infection should have fluid in the ear, fever and pain and redness in the ear. General feelings of discomfort or other symptoms do not point to a bacterial infection. If there's uncertainly, doctors should wait and watch, said Dr. Susan L. Montauk, a professor of clinical family medicine at the University of Cincinnati College of Medicine. Children can be given medicine to treat the pain in the meantime.

Eighty percent of ear infections will go away without antibiotics within a week, said Dr. Richard E. Besser, director of the Campaign for Appropriate Antibiotic Use at the C.D.C.

For a bad sore throat, the agency advises doctors always to test for strep with a throat culture and to wait for the results before prescribing an antibiotic. The test is easy, but pediatricians do not always perform it.

For bronchitis, which is almost always viral, the C.D.C. recommends withholding antibiotics unless pneumonia is suspected or the cough lasts longer than 10 to 14 days without improvement.

Medical experts say using antibiotics judiciously can be the best thing a parent can do for a child. Children who have recently taken antibiotics and then contract other infections are three to nine times as likely to have a drug-resistant infection as they would have been if they had not taken the antibiotic, Dr. Besser said.
 

COUGHS AND COLDS Recent studies have found that cough medicines are no more effective than placebos in children and adults. Several groups including the American Academy of Pediatrics have advised against using them.

The effects of the decongestant pseudoephedrine are more uncertain. Although it is effective in children over 5, research is inconclusive for younger children. The dose in children's preparations, which is extremely low for safety reasons, may not be potent enough to have an effect.

Because of the lack of research, the Cochrane Collaboration, which publishes systematic reviews of randomized controlled trials, recommends against giving decongestants to young children. The American Academy of Family Physicians agrees. The American Academy of Physicians has no statement on the effectiveness of decongestants, but it does say that dosage guidelines for cough and cold mixtures are imprecise for children and that more research on dosage, safety and efficacy for children needs to be done.

Many pediatricians, however, continue to recommend decongestants because the physicians say they work for some children. The research does not contradict them.

"I've dealt with forceful parents who say, `I want something for my kids,' " said Dr. Robert Ward, a professor of pediatrics at the University of Utah and the past chairman of the Committee on Drugs for the American Academy of Pediatrics. In those cases, he said, decongestants are relatively benign remedies.

Pseudoephedrine has been associated with irritability, restlessness, lethargy, hallucination, hypertension and involuntary muscle movement in children.

"I don't think these drugs are totally harmless and I think we're wrong to recommend stuff that we know doesn't work," said Dr. Rita Mangione-Smith, assistant professor of pediatrics at the University of California at Los Angeles. "It's giving babies chemicals that are doing them no good and potentially can cause central nervous system irritability and make them be up more at night."

Dr. Jeffrey L. Brown, chairman of the pediatrics department at the New York United Hospital Medical Center in Port Chester, N.Y., takes a middle-of-the-road approach.

"I tell parents that if they feel they should give something, to give it, and only continue use if it's clearly helping," Dr. Brown said.

FEVER The fear of fever among parents or what doctors have called "fever phobia," has contributed to abundant use of children's fever reducers, acetaminophen, popularly Tylenol, and ibuprofen, or Motrin.

Many parents mistakenly believe that a high fever is dangerous, possibly leading to brain damage or seizures, and needs to be treated.

"The only time fever is associated with brain damage is when it's from an external source such as heat stroke from being locked in a car on a hot day," Dr. Brown said. "Intrinsic fever is not associated with brain damage."

Studies also show that aggressively treating fever does not prevent fever seizures and that the seizures, although frightening, are not dangerous or associated with brain damage or learning disabilities, Dr. Brown said. In infants under 6 months, fevers may signal a serious problem, and parents should always contact their physicians.

Fever should be treated strictly for comfort, experts say. "We overtreat fever when the child is already happy, and we're trying to make the thermometer happy," said Dr. Richard Gorman, chairman of the drug committee at the pediatrics academy.

If the child has a temperature of 102 but is comfortably lounging on the couch, then it is not necessary to treat the fever. If a child is miserable and irritable, then doctors recommend treatment if the temperature is over 101.

Not treating a fever may actually help a child get rid of an infection sooner, according to several studies. Having a high temperature is part of the body's defense mechanism, making the body an unfriendly host to the virus or bacteria.

Vaccination News Home Page

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.