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Tips of the Week for November, 2017

Antibiotic Prescriptions for Children: 10 Common Questions Answered
11-13-2017

Parents need to know that using antibiotics when they are not the right medicine will not help and may even cause harm to children.

Antibiotics are medicines used to treat infections and they target bacteria, not viruses. Before prescribing an antibiotic, your child's doctor will find out if it is the right medicine to treat your child's infection.

Read on for answers from the American Academy of Pediatrics (AAP) to common questions about the use of antibiotics. Talk with your child's doctor if you have other questions.
1. My child has a really bad cold. Why won't the doctor prescribe an antibiotic?

Colds are caused by viruses. Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines.

2. Don't some colds turn into bacterial infections? So why wait to start an antibiotic?

In most cases, bacterial infections do not follow viral infections. Using antibiotics to treat viral infections may instead lead to an infection caused by resistant bacteria. Also, your child may develop diarrhea or other side effects. If your child develops watery diarrhea, diarrhea with blood in it, or other side effects while taking an antibiotic, call your child's doctor.

3. Isn't a nose draining yellow or green mucus a sign of a bacterial infection?

During a common cold, it is normal for mucus from the nose to get thick and to change from clear to yellow or green. Symptoms often last for 10 days.

Sinusitis is a term that means inflammation of the lining of the nose and sinuses. A virus or allergy can cause sinusitis and in some cases, bacteria can be the cause.

There are certain signs that bacteria may be involved in your child's respiratory illness. If your child has a common cold with cough and green mucus that lasts longer than 10 days, or if your child has thick yellow or green mucus and a fever higher than 102°F (39°C) for at least 3 or 4 days, this may be a sign of bacterial sinusitis.

If your child has developed bacterial sinusitis (which is uncommon), an antibiotic may be needed. Before an antibiotic is prescribed, your child's doctor will ask about other signs and examine your child to make sure an antibiotic is the right medicine.

4. Aren't antibiotics supposed to treat ear infections?

Not all ear infections are treated with antibiotics. At least half of all ear infections go away without antibiotics. If your child does not have a high fever or severe ear pain, your child's doctor may recommend observation initially.

Because pain is often the first and most uncomfortable symptom of ear infection, your child's doctor will suggest pain medicine to ease your child's pain. Acetaminophen and ibuprofen are over-the-counter pain medicines that may help lessen much of the pain. Be sure to use the right dose for your child's age and size. In most cases, pain and fever will improve within the first 1 to 2 days.

There are also ear drops that may help ear pain for a short time. You can ask your child's doctor if your child should use these drops. Over-the-counter cold medicines (decongestants and antihistamines) don't help clear up ear infections and are not recommended for young children.

Your child's doctor may prescribe antibiotics if your child has fever that is increasing, more severe ear pain, and infection in both eardrums.

5. Aren't antibiotics used to treat all sore throats?

​​No. More than 80% of sore throats are caused by a virus. If your child has sore throat, runny nose, and a barky cough, a virus is the likely cause and a test for "strep" is not needed and should not be performed.

Antibiotics should only be used to treat sore throats caused by group A streptococci. Infection caused by this type of bacteria is called "strep throat." Strep throat generally affects school-aged children and not children younger than 3 years.

If your child's doctor suspects strep throat based on your child's symptoms, a strep test should always be performed. If the test is positive, antibiotics will be prescribed.

6. Do antibiotics cause any side effects?

Side effects can occur in 1 out of every 10 children who take an antibiotic. Side effects may include rashes, allergic reactions, nausea, diarrhea, and stomach pain. Make sure you let your child's doctor know if your child has had a reaction to antibiotics.

Sometimes a rash will occur during the time a child is taking an antibiotic. However, not all rashes are considered allergic reactions. Tell your child's doctor if you see a rash that looks like hives (red welts); this may be an allergic reaction. If your child has an allergic reaction that causes an itchy rash, or hives, this will be noted in her medical record.

7. How long does it take an antibiotic to work?

Most bacterial infections improve within 48 to 72 hours of starting an antibiotic. If your child's symptoms get worse or do not improve within 72 hours, call your child's doctor. If your child stops taking the antibiotic too soon, the infection may not be treated completely and the symptoms may start again.

8. Can antibiotics lead to resistant bacteria?

The repeated use and misuse of antibiotics can lead to resistant bacteria. Resistant bacteria are bacteria that are no longer killed by the antibiotics commonly used to treat bacterial infection. These resistant bacteria can also be spread to other children and adults.

It is important that your child use the antibiotic that is most specific for your child's infection rather than an antibiotic that would treat a broader range of infections.

If your child does develop an antibiotic-resistant infection, a special type of antibiotic may be needed. Sometimes, these medicines need to be given by IV (vein) in the hospital.

9. What are antiviral medicines?

​Influenza (flu) is a viral infection that can cause cold symptoms for which an antiviral medicine will work. An antiviral medicine may be prescribed for children that are at higher risk of becoming severely ill if they get the flu. For most other viruses causing cough and cold symptoms, there are no antiviral medicines that work or are recommended.

10. How can I use antibiotics safely?

Antibiotics aren't always the answer when your child is sick. Ask your child's doctor what the best treatment is for your child.
Ask your child's doctor if the antibiotic being prescribed is the best for your child's type of bacterial infection. For instance, certain antibiotics such as azithromycin are no longer effective for the bacteria causing most ear and sinus infections.
Antibiotics work against bacterial infections. They don't work on colds and flu.
Make sure that you give the medicine exactly as directed.
Don't use one child's antibiotic for a sibling or friend; you may give the wrong medicine and cause harm.
Throw away unused antibiotics. Do not save antibiotics for later use; some out-of-date medicines can actually be harmful. Call Poison Help at 1-800-222-1222 or check the US Food and Drug Administration Web site for information on the safe disposal of medicines.

Additional Information:

Get Smart About Antibiotics
Antibiotics for a Sore Throat, Cough or Runny Nose?
How Do Antibiotics Work?
Guidelines for Antibiotic Use
Medication Safety (Video)
Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics (AAP Clinical Report)
The Diagnosis and Management of Acute Otitis Media (AAP Clinical Guideline)

Last Updated
11/6/2014

Source
Antibiotics and Your Child (Copyright © 2010 American Academy of Pediatrics, Updated 05/2014)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

All information provided by HealthChildren.org. For additional information, please go to the following link: https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Antibiotic-Prescriptions-for-Children.aspx

Caring for a Premature Baby: What Parents Need to Know
11-06-2017

 

Fast Facts

  • Premature birth occurs in about 11 to 13 percent of pregnancies in the US.
  • Almost 60 percent of twins, triplets, and other multiple deliveries result in preterm births.
  • A birth is considered "preterm" when a child is born before 37 weeks of pregnancy have been completed. Other categories of preterm birth include late preterm (34–36 weeks), moderately preterm (32–36 weeks), and very preterm (less than 32 weeks).

It is important to recognize that preterm deliveries, even if late preterm, should never be done for the convenience of the mother or obstetrician. Research has shown that late preterm babies have significantly greater risk for negative outcomes, and all efforts should be made to have babies reach full term. See Let Baby Set the Delivery Date: Wait until 39 Weeks if You Can.

Characteristics of Babies Born Premature

If your baby is born prematurely, she may neither look nor behave like a full-term infant. While the average full-term baby weighs about 7 pounds (3.17 kg) at birth, a premature newborn might weigh 5 pounds (2.26 kg) or even considerably less. But thanks to medical advances, children born after twenty-eight weeks of pregnancy, and weighing more than 2 pounds 3 ounces (1 kg), have almost a full chance of survival; eight out of ten of those born after the thirtieth week have minimal long-term health or developmental problems, while those preterm babies born before twenty-eight weeks have more complications, and require intensive treatment and support in a neonatal intensive care unit (NICU).

How Your Premature Baby Looks

  • The earlier your baby arrives, the smaller she will be, the larger her head will seem in relation to the rest of her body, and the less fat she will have.
  • With so little fat, her skin will seem thinner and more transparent, allowing you actually to see the blood vessels beneath it. She also may have fine hair, called lanugo, on her back and shoulders.
  • Her features will appear sharper and less rounded than they would at term, and she probably won't have any of the white, cheesy vernix protecting her at birth, because it isn't produced until late in pregnancy. Don't worry, however; in time she'll begin to look like a typical newborn.
  • Because she has no protective fat, your premature baby will get cold in normal room temperatures. For that reason, she'll be placed immediately after birth in an incubator (often called an isolette) or under a special heating device called a radiant warmer. Here the temperature can be adjusted to keep her warm.
  • After a quick examination in the delivery room, she'll probably be moved to the NICU.

How Your Premature Baby Acts

  • You also may notice that your premature baby will cry only softly, if at all, and may have trouble breathing. This is because her respiratory system is still immature.
  • If she's more than two months early, her breathing difficulties can cause serious health problems, because the other immature organs in her body may not get enough oxygen. To make sure this doesn't happen, doctors will keep her under close observation, watching her breathing and heart rate with equipment called a cardio-respiratory monitor.
  • If she needs help breathing, she may be given extra oxygen, or special equipment such as a ventilator; or another breathing assistance technique called CPAP (continued positive airway pressure) may be used temporarily to support her breathing.

Preemie Parents: How to Cope with the Stress

As important as this care is for your baby's survival, her move to the special-care nursery may be wrenching for you. On top of all the worry about her health, you may miss the experience of holding, breastfeeding, and bonding with her right after delivery. You won't be able to hold or touch her whenever you want, and you can't have her with you in your room.

To deal with the stress of this experience, ask to see your baby as soon as possible after delivery, and become as active as you can in caring for her. See How You Can Participate in the Care of Your Baby in the NICU.

  • Spend as much time with her in the special-care nursery as your condition—and hers—permit. Even if you can't hold her yet (until she's stable), touch her often. Many intensive care units allow parents to do "kangaroo care"—or skin-to-skin care—for their babies once the infants don't require major support to their organ systems.
  • You can also feed her as soon as your doctor says it's OK. The nurses will instruct you on either breast-or bottle-feeding techniques, whichever is appropriate for the baby's needs and your desires.
    • Some premature babies may initially require fluids given intravenously or through a feeding tube that passes through the mouth or nose into the stomach. But your breast milk is the best possible nutrition, and provides antibodies and other substances which enhance her immune response and help her resist infection.
    • In some cases, if it's too difficult for your premature baby to nurse at the breast, you can pump breast milk for feeding through a tube or bottle. Once you are able to start breastfeeding directly, your baby should nurse frequently to increase your milk supply. Even so, mothers of premature babies sometimes find it necessary to continue using a breast pump in addition to feeding frequently to maintain a good milk supply. See Providing Breastmilk for Premature and Ill Newborns.
  • You may be ready to return home before your newborn is, which can be very difficult, but remember that your baby is in good hands, and you can visit her as often as you'd like. You can use your time away from the hospital to get some needed rest and prepare your home and family for your baby's homecoming, and read a book for parents on caring for preterm babies. Even after you've returned home, if you participate in your infant's recovery and have plenty of contact with her during this time, the better you'll feel about the situation and the easier it will be for you to care for her when she leaves the special care nursery.
  • As soon as your doctor says it's OK, gently touch, hold, and cradle your newborn.
  • Your own pediatrician may participate in, or at least will be informed about, your infant's immediate care. Because of this, he will be able to answer most of your questions.

Your baby will be ready to come home once she's breathing on her own, able to maintain her body temperature, able to be fed by breast or bottle, and gaining weight steadily.

Additional Information on HealthyChildren.org:

 

Last Updated
11/2/2015
Source
Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition (Copyright © 2015 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

All information provided by HealthyChildren.org.  For additional information please go to https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Caring-For-A-Premature-Baby.aspx

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