Big Girl hasn’t been sick a lot in her first seven years. Colds and sniffles? Sure, but her visits to the doctor over the years have been for other things like traumatic incidents or weird symptoms like the time when she was not quite two that she stopped walking. (It was diagnosed as toxic synovitis, a virus that causes hip pain.) Or that same year when she tumbled off of a Little Tikes chair and got a concussion. Oh, and there were the two sets of stitches — one inside her mouth and one on her chin when she was three and four-and-a-half, respectively. So when I took her temperature and realized it was almost 102, I called the doctor. Nervous Nelly, that’s me.

He was really nice, but told me that it was probably viral, and that I should take a wait-and-see approach. If she was still sick by the middle of the week, I was to call for an appointment. And that even if it was strep it would probably go away on its own. Yes, it’s true, and why a lot of doctors are rethinking the automatic dosing that typically accompanies strep. It used to be that kids with a sore throat would rush into the doctor, who would invariably give antibiotics for strep because of the risk of rheumatic fever. However, as this article, Antibiotics for Strep Do More Harm Than Good in Emergency Physicians Monthly points out those guidelines were made in the 1940s when the country was in the middle of a rheumatic fever epidemic.

Meanwhile, according to research (and in this case the WebMD website): “Strep throat will go away in 3 to 7 days with or without treatment…The benefit of delaying the start of antibiotic treatment for a day or two is that your body is able to build up its own immunity to the infection, possibly reducing future occurrences of strep infection. It also reduces the chance of building a resistance to antibiotics.”

This is probably why she never got sick very much. I let her immune system flex its muscles, and called in the big guns for blood, lameness, and head injuries. (And spots and dots like the rash she got last summer. Oh, and Little Girl’s scary-high temperature of 104, because that just isn’t right!)

This is also why I’m really glad my doctors take a wait-and-see approach. I am hoping that this will be the case again, and that it’s simply a viral infection that Big Girl will get over in a day or two. Her nose is running, and she is coughing a bit, so I am thinking that’s hopefully what’s going to happen. I will watch her temperature, keep an eye out for any changes, and keep feeding her popcorn and strawberries, her two favorite, “Mommy, I’m sick!” foods.

Does your doctor take the wait-and-see approach or just dole out antibiotics? Have you ever considered asking, “What would happen if we wait a day or two?” I’d like to know. Oh, BTW: This wait-and-see approach works for my kids and their individual needs. I am certainly not suggesting anyone ignore doctors or withhold medical attention or treatments from their kids. Being sick is no joke, and I would highly recommend that everyone collect as much information as possible and make decisions based on what works best for your family with the help and advice of those you trust. Be informed. Be smart. Take health seriously!

Not a bad place to be hanging out with an ear infection.

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.

Two Trader Joe's soaps that don't contain Triclosan--and smell good, too.

Trader Joe’s disappointed me. It’s usually my favorite grocery store — closer than Whole Foods, and a heck of a lot less expensive. But last week as I was picking up my dishwashing soap (TJ’s Next To Godliness Automatic Dishwashing powder), my eyes were drawn to a bottle sitting right above it. A small bottle of antibacterial handsoap that contained–gasp!–triclosan.

You’ve probably heard of the stuff. You’ve probably even used it. But you may not know how dangerous it is. Triclosan is an anti-microbial chemical. Sometimes identified as Microban, you can find it everywhere including soaps, toothpaste, toys and exercise clothing. It’s also a pesticide, at least according to the Environmental Protection Agency, and one that is helping create antibiotic-resistant bacteria. Oh, and then there’s the whole dioxin problem: Sunlight turns triclosan into dioxin, one of the most toxic chemicals in the world. Whole towns have been abandoned because of dioxin.

Humankind aside, it’s also not good for the environment. The main problem, say researchers, is that it doesn’t break down. Instead, it enters the waters from sewage treatment plants and remains, harming marine life and other organisms. One study out of the Biodesign Institute at Arizona State University found that antibacterial agents including triclosan introduced into the New York City’s waterways a half a century ago are still there. (Want to learn more about the product and its sister product triclocarban? Food and Water Watch has an excellent primer.)

If it was a miracle product, you might argue, it would be worth it. What’s a few dead algae and live super bugs if it prevented the common cold? Except for one thing: research study after research study says that triclosan is no more effective at killing germs than a simple $1 bar of soap.

So with all this damning evidence, you’d think Trader Joe’s, which actually seems to have a social conscience, wouldn’t bother selling such a product. I don’t know why they do, actually. I emailed the company’s customer service when I got home, but have not heard back from them yet. I’ll keep you posted if and when I do. In the meantime I’m going to keep reading labels because sometimes even companies with what seem like the best intentions screw up.

June 3, 2010 UPDATE: As of May 24 the FDA is currently re-evaluating the safety of triclosan, according to a report in the Journal of the American Medical Association (JAMA). From the report: “The US Food and Drug Administration (FDA) is reevaluating the safety of antibacterial consumer products containing triclosan, in light of studies suggesting that this chemical may interfere with hormone function or contribute to antibacterial resistance.” Meanwhile, another May 2010 study found that nearly a third of the dioxins in the Mississippi River can be directly linked back to triclosan. Scary stuff, people. Scary stuff.