3 Winter Warnings


By now, you likely have gotten sick, know someone who has and, either way, are doing all you can to avoid catching the many winter bugs that come with the cold weather. While bundling up, keeping healthy and getting back to health, Breezy Mama turned to Carol Wilkinson, MD, PhD, and Medical Director of Kinsights, a site that helps parents organize their child’s health information, to discuss 3 winter warnings from car seat safety to the best soap to use to kill germs and when to say no to antibiotics for your child (and why!).

A few headlines have been in the news lately about doctors over-prescribing antibiotics for ear infections and other illnesses, such as coughs. What do parents need to know before giving their kids antibiotics unnecessarily?

The vast majority of colds, fevers, coughs, sore throats, and even ear infections are caused by viruses – luckily, we are generally able to fight these off on our own without any additional medications. Antibiotics are designed to kill bacteria and will not work against a viral infection. Overuse of antibiotics is a big problem both in the U.S. and abroad because it promotes the growth of antibiotic-resistant bacteria that are more difficult to treat.

The best treatment for most colds is fever control (with a medication like acetaminophen or ibuprofen), adequate fluids and rest.

When DON’T antibiotics help (so we know not to give them to our kids)?

If your child’s illness is viral, it won’t respond to treatment with an antibiotic. As mentioned above, a majority of colds, fevers, coughs, sore throats, and ear infections are viral.

What are common side effects of antibiotics, and what are the downsides of using antibiotics when they aren’t needed?

Like all medications, antibiotics have side effects – how these side effects manifest will depend on the type of antibiotic and the specific child. Many antibiotics will cause loose stools and even diarrhea, because in addition to killing the bacteria causing the ear infection or pneumonia, the antibiotic also kills some of our normal gut bacteria. You can ask your doctor about giving your child a probiotic along with the antibiotic to help with this. The other common reaction to antibiotics is a rash. As many as 10% of children can develop a rash after taking a penicillin-based antibiotic like Amoxicillin. Sometimes this rash can be so itchy and bothersome that your doctor will switch to a different antibiotic. If mild, it should not prevent your child from continuing the course of antibiotics or from being treated with it in the future.

Because use of antibiotics can lead to the development of resistant bacteria, it is very important that they are taken for their full duration – even when your child’s symptoms have improved.

When are antibiotics essential?

Your child’s pediatrician will make the call on whether or not antibiotics are needed.

Antibiotics should be used when there is strong suspicion of a bacterial infection. A high fever that lasts more than 5 days could be a sign of a bacterial infection, and you should bring your child to their doctor to be evaluated.

One of the most common uses of antibiotics is for ear infections. However, most ear infections are caused by viruses, and in older children the infection often resolves on its own. For children older than 2 or with milder infections, your pediatrician may ask that you wait and treat with fever and pain medications before starting an antibiotic.

Antibiotics are also often prescribed for urinary tract infections, bacterial pneumonias, skin infections and severe conjunctivitis.

Coughs, runny noses, vomiting and diarrhea are more likely to be viral, even with a fever, and usually will not be treated with an antibiotic.

The Food and Drug Administration is evaluating the effectiveness of anti-bacterial soap. Can it really do more harm than good? Why?

The majority of anti-bacterial soaps use a chemical called Triclosan that has been shown to kill bacteria at high concentrations and prevent the growth of bacteria at lower concentrations. Regular soap and water can also prevent the spread of bacteria by simply removing it from the skin.

The FDA is raising two questions. First, do anti-bacterial soaps actually prevent the spread of bacteria better than regular soap and water? And second, is frequent use of Triclosan-containing soaps harmful? Possible concerns include increased bacterial resistance to Triclosan as well as some reports in animals that Triclosan can cause changes in hormone levels.

So far there is very little evidence to support the benefit of anti-bacterial soaps at home or in schools, and given the risks of bacterial resistance in the community, I think its good that the FDA is pushing for more evaluation.

Do you also recommend families stick to plain soap and water?

The key here is to teach your children when to wash their hands and to use good hand-washing technique. Kids need to build their immune systems, so preventing them from coming in contact with germs at all times is not only impossible but also probably not best for their overall health in the long run.

That being said, kids need to be taught how to wash their hands well using soap (whatever kind it is) and water. After using the restroom and before eating are key times to saddle up to the sink and spend a good minute rubbing your hands with soap and water.

Is using hand sanitizer, such as Purell, also a potential risk?

In general, hand sanitizers use alcohol to kill off bacteria. Some hand sanitizers also contain Triclosan, so they pose the same concerns as anti-bacterial soaps. If traditional soap and water are available, this still should be your first choice for cleaning your child’s hands. For hands that are covered with dirt and grime, an alcohol rub won’t be able to get to all the bacteria. In addition, hand sanitizers can be toxic if accidentally swallowed, so be careful about leaving them around the house.

Can you explain why parents need to remove their child’s jacket when strapping them in a car seat? I get that they loosen the seat straps so they can fit, but doesn’t the jacket provide more padding, in a sense?

Car seats were designed so that the straps fit snugly against your child’s body. Extra padding from a sleep sack or winter jacket can allow for too much wiggle room to be effective in a crash. Too much slack in the harness can lead to excessive movement and even ejection of your child from the car seat during a serious crash.

Consumer reports has a list of steps to test whether your child’s coat is too bulky to be worn in the car seat:

Any suggestions for a child who is really cold as a result of not being able to wear their jacket?

I recommend having a blanket in the car to put over your child once buckled into the car seat. You can also put your child’s coat on backwards using the arms and the back of the coat like a blanket after he or she is buckled in.

Any other winter time health concerns you think families should know about?

Remember that blankets, quilts, sheepskins and other loose bedding may contribute to Sudden Infant Death Syndrome (SIDS). If you are worried about keeping your infant warm at night, skip the blanket and opt for a one-piece sleeper or a wearable blanket.

Screen Shot 2014-01-22 at 2.59.23 PMAbout Dr. Carol Wilkinson
Carol Wilkinson, MD, PhD, and Medical Director of Kinsights, is a pediatrician at UCSF focusing on developmental and behavioral issues. She guides the development of Kinsight’s health records interface and lends her perspective and expertise to the website’s community. Kinsights gives parents and pediatricians a secure place to discuss baby, children, and tween/teen health topics and easily access children’s health information on immunizations, allergies, and more. Kinsights was developed for parents to give moms and dads better, smarter answers to their parenting questions. Kinsights also helps parents organize their child’s health information, as they created a user-friendly interface that any parent could use to create a beautifully charted personal health record. Parents often get the most useful advice from each other, and Kinsights was developed to make that process easier by connecting you with parents who have been in your shoes before and who could provide relevant advice. For more information on Kinsights, please visit their website (https://kinsights.com/), like them on Facebook (https://www.facebook.com/kinsights), and follow them on Twitter (https://twitter.com/kinsights).

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