Got a Cough? Hold the Antibiotics!

I was a pediatrician before I was a parent. It sounds funny to say, but I was helping parents comfort their own kids before I had the experience of being up all night with a sick kid.

Ever wonder if that antibiotic or test your doctor ordered is really necessary? Is it possible to get too much medical care? The national Choosing Wisely campaign was created in 2013 to help doctors and patients choose high quality, cost-effective care. To-date, more than 50 medical societies have jumped on board.

Did you know that some tests and treatments which seem “routine” actually are not necessary and can even put your child at risk? It’s important to get that conversation started with your doctor. Let’s break down some of the top issues I see every day in my office:

Antibiotics
I have been there. Up all night, fever climbing, kids crying. Certainly not a fun place to be. This is when you want something, anything to help. You go to the doctor. “What? No antibiotic?” Sometimes, there just isn’t a quick fix. The body has a remarkable capacity to heal itself, and more often than not, we shouldn’t interfere with that process. Choose a doctor who doesn’t give unnecessary antibiotics for straightforward sinus infections, bronchitis, throat infections and upper respiratory infections. What happens if you don’t do anything? In this case, less is often more. Most sore throats are viral and do not need antibiotics. Taking an antibiotic has risks. Your child could have an allergic reaction, develop side effects (severe diarrhea) or, even worse, become resistant to that antibiotic, leaving only a few options down the road when that antibiotic could have been life-saving. Don’t go to the doctor who gives an antibiotic “just in case.” Next time your doctor doesn’t give antibiotics, thank him for helping your child, because no antibiotic is often the best medicine.

Cough Medicines
“Hey, my kid was up ALL night coughing!” When that mom or dad instinct kicks in (usually in the wee hours of the night), cough and cold medicines look pretty tempting sitting on the store shelf. A lot of them even taste pretty good. However, they are not recommended for kids less than age 4. They are not effective, have side effects and can even be overdosed fairly easily (especially since they have combined ingredients which interact with other medicines you may be giving). Have your doctor see your child. The cough may need something else to make it better, or it may need to just run its course. Bottom line, lots of rest and patience are often the answer.

CT Scans (CAT Scans)
CT scans are often done in the setting of seizures, abdominal pain and head injuries. About ½ of kids visiting emergency rooms across the country for head injuries get a CT scan. Your doctor can use very specific criteria to determine when to scan and when not to scan. Unnecessary x-rays expose kids to danger, and a child’s organs are more sensitive to radiation than an adult’s organs, potentially increasing the risk of cancer down the road. A single CT scan can expose the human body to 150 times the radiation of a regular x-ray, or around a year’s worth of exposure to radiation from both natural and artificial sources in the environment. Choosing Wisely recommends that CT scans not be done for minor head injuries, routine abdominal pain or simple seizures due to fever.

Want to find out more about pediatric and adult recommendations? Medical societies across the nation have released recommendations addressing everything from urinary infections and back pain to sinus infections and heart disease.

To learn more about antibiotics, listen to our latest PediaCast episode.

Urgent Care versus Emergency Department

Emily Decker, MD
Dr. Emily is an Assistant Professor of Pediatrics in the Urgent Care and Primary Care Clinics at Nationwide Children’s Hospital. She has a strong interest in child advocacy, and serves as the medical director for CAP4Kids Columbus, a website that connects families with resources and opportunities in Columbus. Her energetic toddler twin girls keep her busy in her personal life, and her interests include traveling throughout Africa and Asia. She is an avid U.S. soccer fan as well and has been to the last four World Cups. Follow Dr. Emily on Twitter @CAP4Kids for local resources and opportunities for kids.

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