Antibiotics and babies. Your thoughts.

[slapdashsal]

Off the back of another thread I posted yesterday, just wondering your thoughts on babies and antibiotics.

Dd has just turned one and started nursery a month ago. Predictably she's been unwell pretty much constantly ever since. She had her first course of antibiotics the week after she started as she got strep throat. She then had to have a second course to clear it up fully. That did the trick and for about 5 days she was happy and well. She's now got a horrible cough that sounds very much like it could be a chest infection.

According to NHS online most chest infections clear up on their own but they can be dangerous occasionally. I'm reluctant to keep going down the antibiotic route for every illness because I know kids can build resistance to them. Especially since she only finished her second course a week ago!

Where do you stand on this? Would you rather them have them and get better sooner? Or is it better to let their bodies fight off bugs and viruses on their own? At what point would you say right they need antibiotics now? Dd is very distressed and unwell at night but during the day she is happy and playful so I'm not overly worried yet but I know things can go downhill quickly and it's also nigh on impossible to see a Gp on the same day where I am.

If she needs one for a chest infection then you are literally risking her life not getting them.

Yes, don't take them unnecessarily, but chest infections with tiniest aren't to be messed with.

people dont become resistant to anti biotics, bacteria do

GPS don't throw antibiotics around they won't give them if she didn't need them. See how her cough goes but take her to the Dr if it doesn't clear up.

I have taken my two to the doctor loads with a nasty cough and they've not once been given antibiotics for it so I think it's definitely worth getting it checked out. They don't prescribe them unless really necessary IME.

I don't know for certain that it is a chest infection. It's a hacking, wheezy cough that is worse at night but that could be a number of bugs.

She was prescribed antibiotics a few weeks ago for something else - strep throat.

The advice on NHS is to manage symptoms at home as the majority of chest infections are viral therefore antibiotics won't work. Obviously if she became very very unwell I would take her immediately or to a&e if really necessary.

My point was, is it better to let them fight it a bit first or to immediately try and get antibiotics?

It's not really a case of 'trying to get antibiotics'. If you are concerned about your child, take them to the doctor and let them make the call. There are some horrid viral coughs around but you know your child best.

The doctor shouldn't give antibiotics unless it's necessary. If you think it might be then take them to a doctor. Mumsnet can't decide for you how ill your child is. Use the expertise available.

I would be careful of telephone appointments though, because I do think my son was unnecessarily given antibiotics over the phone once (based on the reaction of his consultant when I mentioned it).

It’s not for you to decide whether to try and get antibiotics

take them to the doctor and they can determine whether it’s bacterial and needs antibiotics or whether it’s viral.

it’s not for you to decide. Don’t take an unnecessary risk

Is that the advice for a 1 year old!? I would be amazed if it was.

take her to a doctor and let them decide the best course of action

The huge majority of respiratory infections do not need antibiotics. Even most simple bacterial infections will resolve without antibiotics. It's also quite unlikely to get two different bacterial infections in such a short time. A chesty sounding cough is still much more likely to be a bronchitis, or an upper respiratory infection causing a bit of mucus then it is a pneumonia.

As you say when starting nursery they get exposed to loads of infections, all those toys that all the children are chewing on and sharing, it's very common to have a period where they frequently pick up infections. This isn't necessarily a bad thing it's building their immune system.

If it's just the cough, mild fever, but otherwise well - eating and drinking, playing, wet nappies, settles with calpol, generally looks ok then my practice isn't to push the GP to prescribe any antibiotics.

If on the other hand things don't seem right, i.e. look really unwell, really difficult to get fluids down, seem to be struggling with their breathing then I would take them to the GP.

Yes it is better to wait and not rush off to the Dr's but if its nor clearing or getting better then children need to see medical attention. Your initial post wasn't clear to me.

Antibiotics… helping to keep the infant mortality rate low

I take them to the doctors with a cough if I can hear wheezing (i.e. bronchitis) or crackles (pneumonia). You have to be driven by the symptoms not by what you hope to be prescribed. Usually it’s ventolin rather than antibiotics anyway.

The decision about antibiotics is the doctor's. They will not give them if they are secure that it is a viral infection, but any baby of this age needs seeing by a doc if their cough is chesty.

The problem with babies is that they get very ill very suddenly; they get better equally quickly.

I would not take a chance with this one. Doc is the way to go. It will take him/her five minutes to listen to her chest.

If it’s bacterial antibiotics will help.
If it’s viral they won’t.

This is the NHS advice. It includes a section about when to go to the doctors/A&E
https://www.nhs.uk/conditions/baby/health/colds-coughs-and-ear-infections-in-children/
Sitting in a hot steamy room can help. As well as vapor rubs etc. Hope she gets better soon.

I think it depends on your DC; one of mine I get anti biotics for quite early on as from experience I know that if we don’t catch it early she gets really poorly and we’ve ended up in hospital; GP is happy to trust my judgment when we’re heading down that route although it’s only once or twice a year so not over use. My other DC fights it off much better and I’ll wait a little longer for him. After 3-4 days of not eating much or not playing like they would usually I’ll consider the GP though

You're bound to get a range of opinions on this, and there are different considerations.

For me as someone who works in healthcare I wouldn't want my children to ever have antibiotics if possible. They can cause considerable damage to gut health/microbiome. But of course if they're unwell with a pneumonia then the balance moves in favour of having antibiotics.

The following is a great website from the NHS/royal college of paediatrics giving advice on an array of childhood illness symptoms:
https://www.what0-18.nhs.uk/parentscarers/worried-your-child-unwell

It is the doctors decision but to be blunt I don't have a lot of faith in my doctors. I've had instances with dd and indeed my other kids when antibiotics haven't been given when clearly needed. I've also had occasions where I've insisted and been given them off the back of a phone consultation without even being seen.

Dd is clearly poorly but not worryingly so at the minute. I'm not a risk taker but in the present climate I'm also not one to rush off to the GP at every single slight sign of illness. I can't anyway, you have to fight tooth and nail to see them.

She doesn't have any of the red flag signs on the NHS website for getting urgent care so I'll keep a close eye for now.

Antibiotics are wonderful things but when misused can obviously cause resistance to bacteria (thanks pp) and no longer be effective. I just don't want to jump the gun I guess.

DH is a medic and has the same stance re our children. DC2 had some antibiotics over Christmas for a double ear infection which wouldn't go away but we got antibiotic and steroid ear drops rather than oral.

@SleepyRich that link is really helpful thank you, I've just watched the video on RSV and feel a lot more reassured for the moment. Hopefully there will be no deterioration.

You really are chopping and changing your views what is It you want from the thread? You don't trust your GPS .that's not something people can agree with and validate you about. Sometimes kids get better on their own Sometimes they need a Dr and medical intervention.

Ask her doctor. They will always know best.

OP - If they got better without the antibiotics then they didn't need them.

Chest infections can be viral or bacterial. Antibiotics will only work for bacterial.

Actually there are no clear diagnostic tests to differentiate a bacterial chest infection from other types of chest infection that can be done in the surgery Even a chest xray,the current gold standard diagnosis, has an accuracy of about 70% let alone what you can do with a stethoscope. Bronchitis can just as easily lead to a crackly sounding chest as a bacterial pneumonia.

I've just written a paper on this topic as part of my masters in advanced practice, even when you have every sign and symptom - for example fever, productive cough, localised crackles on chest, increased breathing rate and pulse, reduced oxygen levels - only about 30% of these patients have a bacterial infection which would be benefiting of antibiotics. If you just include patients seen in primary care with fever and a productive cough only 5% of them will need antibiotics. However currently 50% of these (so 10x too many) will be prescribed antibiotics. So the current practice involves massive over prescription of antibiotics which is why there's so much of a push for antibiotic stewardship and to really cut down on antibiotic use.

What a GP is extremely good at is risk stratification and identifying signs that a child is not coping/not a 'minor' illness so if you've got concerns that this is something more/your child is very unwell, they;re not coping with their symptoms - then absolutely a great resource to access and very important to do so.

What isn't helpful is what we are seeing some people do is this idea that every cough or so throat needs a GP to review for a checkup.

Why am I changing my views? I don't have much faith in my GP for the reasons listed. Ideally I'd like to avoid them and for her to avoid having antibiotics again if she can manage it. However if she becomes really unwell then of course I will take her for a proper assessment.

What I hoped for (and what I've got) was some advice from healthcare professionals and a really useful link that's helped me to assess her symptoms as they stand at the moment.

The state the country is in at the moment it's not practical or possible for every single person to go to the GP every single time their child displays any sign of illness so it's helpful to see the red flag criteria and the symptoms that you can watch and wait a while for.