I'm writing this blog post about infant colic about 10 pm, which is right around the time the average 2 month old baby with colic really gets riled up. Colic is a description of what about 25% of babies do between 3 weeks and 3 months of age, from about 6 pm to midnight (or all day and night, if you're really unlucky!). Colic really just means intense uncontrollable crying, and nobody is really quite sure what causes it. We do know that it is uncommon in babies under 2 weeks, and almost always goes away in time for their 4 month checkup. Because babies with colic have not historically responded to pain medicine, we don't believe that pain is the primary reason babies are crying - it's probably more of a sensory dysregulation or overstimulation response. Some strategies which can help your baby with colic calm down include turning on a vaccuum cleaner or some loud radio static in the background (what we call "white noise"), trying to see if your baby will suck on a pacifier dipped in a thick sugar water solution (don't let your baby drink the sugar water straight, though), and gentle vibration, from a bouncy seat, or even a car ride. Most babies with colic don't have a specific identifiable medical reason for colic. However, there has been some interesting research suggesting that probiotic drops (marketed as "Gerber Soothe" drops) may help a bit. Some breastfed babies may respond to elimination of some foods, like dairy and caffeine a mom's diet (that's right, caffeine - right when you really needed it!). Some formula fed babies may respond to hypoallergenic formulas, like Nutramigen or Alimentum. Remedies like simethicone gas drops, acid blocking medication or Gripe Water have less evidence to support their use. Regardless of the cause of your babies colic, remember to take breaks, put your baby down and step outside once in a while. And remind yourself that all that fussing will pass - at least until he becomes a teenager!
And here it is... the #1 Myth about cold symptoms and antibiotics in children (if you missed the previous 9 myths, check out my other blog post from today).
MYTH #1: GREEN MUCUS FROM THE NOSE MEANS BACTERIAL SINUS INFECTION. This myth has been proudly handed down to us from previous generations. Up until the last decade or two, many doctors believed that green mucus meant bacterial infection and, therefore, antibiotics. Studies have shown us that the color of mucus coming out of a child's nose doesn't tell us much about the cause of their illness. In fact, many colds start out with a clear runny nose, which gets thick and green right before it dries up and goes away. So don't worry about the color. But if a cold is severe or is not improving in 10-14 days, please come in so we can check it out.
Over the years, we pediatricians have become quite a bit better at avoiding unnecessary use of antibiotics in our patients with cold symptoms. So, today, I'd like to give you a "Top 10" list (David Letterman style) of common misconceptions about antibiotic use and respiratory infections.
Myth #10: My child has a stuffy nose, and now has a headache, so he probably has a sinus infection. Sometimes, but nasal and sinus congestion can be caused by bacteria or viruses. Cold viruses cause most cold symptoms with headache, so often all that's needed is a good dose of ibuprofen or acetaminophen, and if your child is older, maybe some nasal saline washes. Most headaches and congestion from cold viruses starts to improve in 10-14 days - but if the symptoms are severe, or last longer than this, please come and see us.
Myth #9: If my child develops a fever with cold symptoms, we need an antibiotic. Even high fevers don't mean a bacterial infection is present. It's usually safe to treat a fever with comfort measures and ibuprofen or acetaminophen and watch it for 2-3 days unless there are other symptoms that have you concerned, such as breathing changes, poor drinking, or signs of significant pain. Most of the time, if a fever has been there longer than 3 days, it's worth a visit (of course, young babies should come in much sooner if they have a fever, especially if they are under 3 months old).
Myth #8: If my child's cough becomes junky, then he probably needs antibiotics for a chest infection. A productive cough does not always mean bacterial bronchitis or pneumonia. Young children have a thin chest wall, so even a little postnasal mucus will make there chest rattle with every cough. Most of the time, that's OK, but if they are breathing fast or hard, if they're wheezing, if they have a fever that won't go away, or if they just look sick, a visit is probably worthwhile.
Myth #7: My baby is pulling his ears and has had a cold, so he must have an ear infection. Ear pulling is a common behavior for babies - I think they do it just to make their parents nervous. Keep in mind that most babies will have ear pressure changes when they have a cold, even when they don't have an ear infection. But if they seem like they are in a lot of pain when they are pulling, it's often worth a look.
Myth #6: Amoxicillin didn't work for my child's sinus infection when she was little, so it won't work now. Having an infection that is resistant to simple antibiotics once doesn't mean you'll have a resistant infection in the future. It's often a good idea to revisit the simple antibiotics even if they haven't worked for your child in the past - let's save the stronger antibiotics for when we really need them!
Myth #5: All kids with pink eye should be treated with antibiotic eye drops. Pink eye often goes away by itself, especially if it's mild, if a child is older, and if there isn't a lot of thick mucus coming out of their eyes. Remember that viruses as well as bacteria can cause pink eye. If you're not sure, please give us a call and we'll help you figure it out.
Myth #4: Kids with ear infections always need antibiotics to get better. Not always! Research indicates that ear infections can and do sometimes go away on their own, especially in children over 2 and children who don't have a problem with frequent ear infections. So if your child is older and the infection is mild, managing the pain with ibuprofen and waiting a couple of days can be a reasonable option, even if the ear is infected.
Myth #3: Pus on the tonsils means my child has a bacterial throat infection. Not really - most kids with white spots on their tonsils have (you guessed it) a viral infection. Less than a third of kids with sore throat have strep. But if your child's throat has been sore for more than a couple of days, the only way to know for sure is with a strep test in the office.
Myth #2: If my child has bronchitis, that must mean she needs an antibiotic. Most kids with bronchitis have viral bronchitis, and get better without antibiotics. We will help you decide if an antibiotic is necessary. If your child has had a productive cough for longer than 2 weeks, if they have a fever with their cough for longer than 3 days, or anytime they look sick or have signs of increased breathing effort, please come in so we can take a listen.
And just to be dramatic, let's put Myth #1 in a separate blog post. Stay tuned...