Your child has a fever, swollen glands and glazed eyes. You rush him to the pediatrician, eager for medication that will help him feel better. Whether or not your doctor prescribes antibiotics will depend on the bug that’s making your little one sick.
Antibiotics can effectively treat bacterial infections. They’re essential for some — but not all — cases of ear infections and bacterial sinusitis.
Viruses, however, cause the majority of childhood illnesses, and viral infections don't respond to antibiotics. Using antibiotics to treat a viral infection can also wipe out healthy bacteria in the body and can contribute to antibiotic resistance.
Here’s what you need to know about when antibiotics are warranted, and when it’s better to avoid them.
Can babies and toddlers take antibiotics?
Yes, babies and toddlers can and should take antibiotics to treat bacterial infections, such urinary tract infections, pneumonia or bacterial sinusitis.
If your doctor diagnoses one of these conditions, it’s important for your child to take the full course of antibiotics as prescribed to ensure you get rid of all of the bacteria making her sick.
Why overuse of antibiotics in babies and children can be dangerous
Antibiotics are not necessary for every illness. Giving them to your child when they aren’t warranted can be potentially harmful, with some research suggesting it may be especially problematic during the first year or two of life.
Many potential risks of antibiotics may relate to the disruption of the body's microbiome (i.e. the healthy bacteria, fungi and viruses in our bodies, most of which live in our gut). The microbiome has a number of important functions, including defending against bad bugs and supporting immune system function. Changes in the gut microbiome have been linked to increased risk of infections, autoimmune diseases and chronic inflammation.
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Overuse of unnecessary antibiotics:
- Exposes your child to the drug's potential side effects (like diarrhea and thrush) as well as the risk of allergic reaction
- Has been linked to an increased risk of conditions involving immune system functioning, including inflammatory bowel disease, celiac disease, diabetes and childhood asthma. More research needs to be done to understand the potential connection.
- Increases a bacteria's resistance to antibiotics over time, so that the same antibiotic may eventually not work on the same infection down the road.
- Contributes to the overuse of antibiotics in the community, which can lead to the growth of new bacteria strains that are resistant to antibiotics altogether. As more bacteria have grown stronger and become immune to treatment in communities across the country, this has become a major public health problem.
When do babies and toddlers need antibiotics?
Your doctor will prescribe antibiotics if he or she suspects a bacterial infection is the cause for your baby or toddler’s symptoms. The following illnesses may warrant a course of antibiotics for children:
- Strep throat
- Bacterial sinusitis
- Bacterial pneumonia
- Some types of ear infections (more below)
- Impetigo
- Bacterial skin infections
- Urinary tract and bladder infections
Some of your child’s symptoms may or may not require antibiotics depending on the illness causing them (one more reason to see your child’s pediatrician to get a proper diagnosis). Here are a few of those potentially gray-area symptoms:
Fever
The vast majority of all fevers in young kids are triggered by viral infections like the flu or a cold, which do not require antibiotics. Fevers are part of the body’s natural defense against infection, and your doctor can help determine whether the infection causing the fever needs further treatment or will improve with rest and lots of love from you.
A fever that’s triggered by bacteria (like bacterial sinusitis or strep throat) will usually — though not always — require antibiotics. Because the only symptom of a UTI in babies may be fever, if your child has an unexplained fever, your doctor may ask for a sample of your child’s urine.
Since some fevers can be serious, it’s essential to:
- Seek medical care immediately if your baby is under 3 months old and has a fever of 100.4 degrees Fahrenheit or higher taken with a rectal thermometer, or if a child of any age has trouble breathing, is not drinking or peeing, is lethargic, looks very sick and/or has not received all recommended vaccines.
- Call your pediatrician if your baby over 3 months has a fever of 104 degrees Fahrenheit or more, or if your toddler or older child has a fever that's not improving after two to three days.
If you have any questions or need reassurance, call your pediatrician.
Ear infection
Acute otitis media is a common childhood ear infection that happens when the middle ear becomes painfully clogged with fluid, usually due to a cold or other viral upper respiratory infection. This fluid becomes a breeding ground for bacteria, viruses or fungi. With any ear infection, a baby may:
- Pull at the infected ear
- Have difficulty sleeping (pain often becomes worse at night)
- Have fever
- Be tired or cranky
If you think your child has an ear infection (and especially if she has a fever), see your pediatrician. Your doctor may prescribe antibiotics if:
- Your baby is under 6 months old
- Your child is over 6 months and has a fever of more than 102.2º F, or if an infection is very painful and lasts for more than a couple of days
Many doctors take a wait-and-see approach before prescribing antibiotics to toddlers over 2 years old. That’s because most viral ear infections and even many bacterial ear infections get better on their own within two to three days, and antibiotics haven’t been shown to reduce pain or improve recovery. In the meantime, ask your pediatrician about giving your child acetaminophen or ibuprofen to ease the pain.
Sore throat
A sore throat is often the first sign of a cold virus infection, which does not require antibiotics. A sore throat caused by a viral infection is usually accompanied by one or more of the following symptoms:
- Runny nose
- Cough
- Hoarseness
- Pink eye
Strep throat is a bacterial infection that may require antibiotics. It’s very rare, however, for babies and toddlers under 3 years old to be treated for strep throat. The infection is most common in kids ages 5 to 15. Your doctor may test your baby or toddler for strep if there’s been an outbreak at her day care or if a close relative had strep.
If your child does have strep throat, a sore throat will usually be accompanied by:
- Fever
- Swollen tonsils
- Tiny, red spots on the roof of the mouth
- Swollen lymph nodes
Pink eye
Pink eye (aka conjunctivitis) is an inflammation of the membrane lining the eyes or eyelids, causing one or both eyes to look pink or red. It can be caused by bacteria, viruses, allergens (like pollen) or other irritants (like swimming pool chlorine). A bacterial infection may be accompanied by:
- Yellow or green discharge from the eye
- Pain
- An ear infection, which often occurs with pink eye
It can be difficult to nail down the exact cause of pink eye. If the white of your child’s eye turns red and looks swollen, see your child’s doctor for treatment.
Green mucus
When mucus turns yellow or green, it may be sinusitis, or an inflammation of the nasal cavity. It’s normal for nasal discharge to turn yellow or green a few days after the start of a cold.
Bacterial sinus infection is usually triggered after a viral infection like a cold, causing a fever and other symptoms to get worse. It’s relatively uncommon, occurring in only about 5 percent of all colds.
Doctors often take a wait-and-see approach to green mucus for about 10 days before prescribing antibiotics. Your doctor may also suspect bacterial sinusitis if symptoms get better and get worse again, or if your child has a fever of at least 102.2 degrees Fahrenheit for three days in a row accompanied by yellow or green nasal discharge.
Cough
Most coughs are caused by a viral infection, like a cold or the flu. But your doctor may recommend antibiotics for your child's cough if it doesn’t get better within 14 days, or if tests show your child has whooping cough or bacterial pneumonia.
Diarrhea
Although diarrhea has many different causes, most diarrhea is caused by a viral infection like rotavirus. More rarely, it can be caused by a bacterial infection. Your doctor may prescribe antibiotics if your child has bloody diarrhea.
When are antibiotics not necessary for babies and toddlers?
Antibiotics are not necessary for viral infections and will kill the healthy bacteria in your child’s system. Viruses are the cause for many common childhood ailments, including:
- The common cold
- The flu
- Hand, foot and mouth disease (coxsackie virus)
- Fifth disease (parvovirus B19 virus)
- Croup
How to avoid overuse of antibiotics
Controlling the use of antibiotics is not just up to your doctor; it’s up to you, too. Here’s how you help avoid antibiotic overuse in your baby and toddler:
- Recognize that antibiotics aren’t always the answer. Keep in mind that young kids get a lot of colds — six to eight per year, especially if they’re in day care. Most symptoms like runny nose, cough and congestion are linked to a viral cold and will get better on their own.
- Wait it out. If your child has a virus, often time is the best medicine. Ask your doctor if pain relievers can help ease the symptoms.
- Speak up. If your pediatrician suggests an antibiotic, don’t be afraid to ask why it's necessary.
- Follow instructions. If your little one does need an antibiotic, follow directions closely to kill off the infection as quickly as possible. And always give your child the full course of antibiotics, even if she seems better mid-course: When you stop early, bad bacteria can still linger and make your child sick all over again, requiring yet another course of antibiotics.
- Get a new prescription every time. If you have old antibiotics hanging around from a previous illness, never give them to your child. Every infection requires a specific drug and dose. Plus, it is likely they have expired.
- Wash your hands regularly. Washing after you use the restroom and before you prepare food reduces the risk of catching a bacterial or viral infection.
- Avoid raw meat and dairy. Protect your family from a foodborne bacterial infection by avoiding unpasteurized milk and skipping raw meats and fish.
- Get your child immunized. Some of the most contagious and dangerous bacterial infections can be avoided with vaccines, including diphtheria, tetanus and pertussis (DTaP vaccine) and pneumococcal disease (pneumococcal conjugate (PCV) vaccine). Indeed, research has shown that getting the PCV vaccine helps prevent antibiotic-resistant infections in kids.
- Get yourself vaccinated, too. If you're expecting, be sure to get the Tdap vaccine to give your baby protection from birth, and ask other caregivers to be sure their vaccinations are up-to-date, too, to protect your baby from whooping cough.
What antibiotic side effects should parents look out for?
As many as one out of 10 kids have side effects from taking antibiotics. Let your doctor know if your child has any of the following symptoms after using antibiotics:
- Watery diarrhea
- Diarrhea with blood in it
- Nausea
- Stomach pain
- Thrush
Seek medical attention immediately if your child has a more serious reaction to antibiotics, including:
- Blistering skin
- Itchy rash or hives
- Swelling of the face and throat
- Breathing problems
- Severe and persistent diarrhea (which could be a C. difficile infection)
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