DEAR DR.PAUL: My four year old son seems to be sick all
the time. We are constantly at the doctor's office getting antibiotics
for his infections. I am worried and wonder how can I tell if
my son's proneness to upper respiratory infections is a symptom
of an underlying problem?
DR.PAUL ANSWERS: Your question brings up two points.
First, that many children, especially when first entering a
day care or school setting, usually get sick frequently. The
other point is the use, and sometimes overuse, of antibiotics
in these children. We know that the average child who first
enters daycare will get about 12-14 infections (either colds,
or gastroenteritis) per year. This is because a child who attends
daycare or school for the first time is exposed to many new
germs in these settings.
As the years go by, the child develops immunity or protection
against these infections and is sick less often. This means
that a four-year-old child, for example, may be sick more frequently
than every month and if each infection lasts about a week, a
child can then seem to be sick all the time. This is a common
situation.
The obvious concern is whether there is an underlying problem
making a child prone to a large number of infections. One important
clue lies in whether a child is growing well despite the repeated
infections. Fortunately, in most cases, these children grow
normally, according to the growth curves. This is a very important
and reassuring find.
Another clue we look for is how severe the infections are: Do
they require hospitalization such as for a severe pneumonia
or infection of the blood? In most cases, the infections are
not serious and usually subside on their own. This pattern or
trend helps reassure us that the child has no underlying problem.
If there is a suspicion of something more serious, then further
tests are necessary. However, this is not the case in the majority
of children with frequent infections.
The other point raised by this question is the need for antibiotics
in a sick child. Clearly most infections we see in children,
such as colds and gastroenteritis (diarrhea and vomiting), are
usually caused by viruses. Viral infections do not require antibiotics
and usually subside on their own. The need for antibiotics depends
on the presence of an infection that we suspect is caused by
a bacteria, such as an ear infection, "strep-throat" infection,
or pneumonia confirmed by a chest x-ray.
However, if there is no suspicion of a bacterial cause of an
infection, I do not feel that antibiotics are necessary. Overuse
or misuse of antibiotics, has resulted in certain bacteria becoming
more resistant to commonly-used antibiotics.
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
