Little Girl got a fever on Saturday. We never would have known aside from the fact that she felt like a hot water bottle when we picked her up. We took her temperature. 104.2 degrees. Wow. We called the doctor. Did she have any other symptoms, the doctor wanted to know. Coughing? Sneezing? Boogie nose? Nope. “Okay, well, just give her alternating doses of Motrin and Tylenol, and keep an eye on her. If she has a high fever without symptoms for more than 24 hours, she needs to be seen.” She could have a urinary infection, explained the doctor. By Saturday night, though, her fever was down. Sunday, she woke up with an almost normal temperature, so we went out to the beach to enjoy the beautiful Indian summer here on the Island. That night, however, her temperature was back up to 104. She fit the criteria in my book: 104 after 24 hours. I took her over to the after-hours doctor service my doctor suggests.
After doing an exam, that doctor said Little Girl’s ear was red. She had an ear infection, she said, and she was going to prescribe antibiotics. My doctors, I explained, always liked to wait a few days before giving antibiotics for an ear infection. In fact, Little Girl has never been on antibiotics. The doctor was firm, though, and wrote a prescription for amoxicillin. By that time her fever was down to 100. Taking everything into consideration — the lower fever, the lack of pain, the fact that she was playing peek-a-boo with the fish on the wall — I decided to wait to talk to my own doctor before filling the prescription. Monday morning rolled around. Little Girl’s fever was hovering around 100 without the benefit of Tylenol when I made the call. Going on that information, my doctor said I could wait until Wednesday to give the antibiotics. They would take another look at her ear, and make the determination then.
My doctors are not bad doctors for doing nothing. In fact, they are doing something pretty impressive. They are following a set of 2004 guidelines published by the American Academy of Pediatrics and the American Academy of Family Physicians. The guidelines cover treatment for acute ear infections, asking doctors to use an antibiotic-free treatment plan for most kids, treating them with pain relievers and observation for the first 48 to 72 hours. If pain is moderate to severe, and if fever is high, treatment may be indicated. However, if the fever goes down — which it usually does — no treatment is necessary. (They do suggest antibiotic use for babies younger than six months, but even then they ask doctors to prescribe the most basic antibiotics.)
This wait-and-see approach is smart because more than 80 percent of ear infections clear up on their own. And there’s another benefit to avoiding antibiotics, according to a May 2009 Consumer Reports blog: Fewer ear infections in the future. “If children had taken antibiotics, there was a 63 percent chance they’d had at least one subsequent infection. The risk was only 43 percent for children who’d been given an inactive placebo,” according to the magazine.
The reason for this change in protocol is simple but scary: Over-prescription of antibiotics has created superbugs — nasty, antibiotic-resistant germs like MRSA that can cause big problems. Ear infections are the main cause, according to the University of Texas. “Ear infections are the driving force behind antibiotic resistance, a troubling medical issue, as physicians often administer antibiotics for the painful, persistent ailment.” I was actually surprised to read that one U.K study found kids under five are still prescribed antibiotics 2.2 times, on average, per year even as researchers and scientists call for less use of the drugs.
So we’re going back to the doctor tomorrow to get Little Girl’s ear checked out. She’s been fever-free since yesterday. She’s running around. She’s laughing. She’s eating and drinking. I think we made the right decision — with our doctor’s help.
Please note: I am not a doctor, and I don’t profess to be. I am a crunchy mom who believes in and supports Western medicine. I’m not saying to skip the doctor if your kid has a fever. Self-diagnosis is not smart or advisable. It can even be dangerous. (Trust me, I ask my doctor’s opinion before making medical decisions for me or my children. I think I called my pediatrician more during Little Girl’s first year than I did for Big Girl’s!) However, if you’re sitting in the doctor’s office being handed antibiotics, it’s not a bad thing to ask — if your doctor is prescribing them for a simple ear infection — what he or she thinks of the AAP’s ear infection guidelines. Sometimes, it’s as simple as saying, “What would happen if we waited to treat this?” Doctors want to be helpful. Parents want to help their kids. This can result in doctors doing something to appease parents. They may not want to give an antibiotic, but do so to make the parents — not the kids — feel better.
What has your doctor done for ear infections? Do you routinely get antibiotics? Do you insist on treatment because you hate to see your kids in pain? I’d love to hear about it. Want to learn more about avoiding ear infections? Check out this smart Consumer Reports story.