(no subject)

[rivka]

Everyone's read articles about those awful parents who push for antibiotics when their kids probably just have a viral infection. Everyone has rolled their eyes and thought, "Great, we're all going to be killed by superbugs because you place your ignorant anti-scientific opinions over the judgment of your doctor."

Me too. Honest. Except when it gets more complicated.

I am 90% sure that Alex has a sinus infection. Here is my evidence: she had a cold for two-three weeks that didn't seem to bother her much, and then abruptly she became sicker. And miserable. She has a hacking, not-that-productive cough which is bad at night and early morning, and much less bad during the day when she's been up for a few hours. She's yellow-green congested. She complains of a headache and sore throat in the morning. She has awful morning breath. Her complexion is pale and washed out, with dark circles under her eyes. She's low-energy and incredibly pathetic in the mornings and evenings, but perks up reasonably well by around noon. No fever.

To me, this is pretty clearly a sinus infection. I think she feels okay - but not great - when she's been vertical for a while, and then everything goes to hell when she lies down all night and her sinuses drain and drain. She was up coughing from 4 to 5:30 this morning.

I kept her home today and brought her to a nurse practitioner at her pediatrician's office. Her lungs are clear. Her ears and throat look fine. She claimed that it hurt when the NP pressed on her sinuses, but then she also claimed it hurt when she pressed on her shoulder. Not a reliable historian, as we say. Also, the appointment was at her perkiest time of day.

The NP said she couldn't be sure if it was a new viral infection coming right on the heels of the previous one, or a bacterial infection taking advantage of the previous viral infection. Given that Christmas is looming, she wrote Alex a prescription for amoxicillin and suggested that I hold onto it for 24 to 36 hours, to see which way things are going.

Instead, we are going ahead and getting it filled. Because I think that if her appointment had been at 8am instead of 3pm, the diagnosis would've been clearer. Because on Thursday we're going to ask this child to get on a plane and undergo two takeoffs and two landings, and I've done that with a sinus infection before, and I don't want to ask her to do it, and I'm not sure that only 24 hours of antibiotics (if we delay) would clear things up sufficiently. Because I feel like I know my kid, and I know what she's like when she comes down with a fresh cold, and this isn't it.

Because, when it comes right down to it, I guess I'm like those horrible parents in the magazine articles.

Comments

[naomikritzer]

No, you're not. You know the difference between bacterial and viral, and have evidence that this is bacterial. The parents in the magazine articles either don't know, or don't care.

[brooksmoses]

Honestly, I would be more inclined to guess that she's rather closer to (at least some of) the parents in the magazine articles than that -- but not because I differ from you in thinking that what she describes sounds entirely reasonable. My difference is that I wouldn't trust the articles to worry about being entirely accurate in portraying people, when there's more interest to be had in using them as examples for sensationalism, so I'd suspect that at least some of them probably have just as good reasons that got ignored by the article authors.

[aloha-moira.livejournal.com]

I agree with Naomi. And, as I have also flown with a sinus infection (and two layovers, to boot) I more-than-wholeheartedly support your decision!

[going-not-gone.livejournal.com]

I think you're more knowledgeable about things medical than most parents, and given that you're taking her on a plane in the near future, I'd err on the side of caution too.

[kightp.livejournal.com]

Y'know what I hate? Cultural memes that overgeneralize and make really, really good parents *feel* like horrible parents. That's what I hate. Especially when the meme starts out as a good idea ("breast-feeding is healthier for babies that bottle feeding," frex) and gets twisted into some kind of mandate ("...and if you can't breast-feed for any reason you are a Bad Person and should feel guilty for the rest of your life.")

That's what I hate.

You? You're an observant mom with scientific training and a level head. You know your kid, you know what's in store for her this week, you know the difference between viral/bacterial symptoms.

[wcg.livejournal.com]

This.

[fiction-theory.livejournal.com]

You are so NOT a horrible parent from a magazine for this. For one, you're fully aware of the consequences of giving a child unnecessary antibiotics, and for two you're basing your decision on knowledge, including your knowledge of your child.

There may be articles on horrible parents in magazines, but there are also articles about how parents knew something was wrong even when doctors told them otherwise and it turned out that they were right. While being a parent doesn't give you a medical degree, it does give you pretty good authority to say that you know your kid. Especially when the doctor sees your kid for less than an hour and you live with them all the time.

From what I can tell, you're a tremendously thoughtful, mindful parent who knows her child very well.

I think you're absolutely right to give her the antibiotics, especially given the upcoming plane trip. Also? Even if the antibiotics don't work and it turns out it's something viral, it's not like doing it this *one* time is going to cause the Superbug That Ends the Human Race.

As for those other parents, maybe them screaming for antibiotics for their children isn't the best thing to do, but in the Pantheon of Parental Sins, being a slightly over-zealous advocate for your child's well being is among the least.

[ratphooey.livejournal.com]

Nope. You're an educated, thoughtful parent.

[kate-schaefer.livejournal.com]

Alex could have a new viral infection which is causing most of the symptoms, but she could also have an opportunistic minor bacterial infection which the antibiotic can get under control while her immune system works on the viral part, in which case, again, no guilt for giving her the antibiotic.

[platypus]

Your decision is just a wee bit more nuanced than that of parents who think antibiotics are the magic cure for all illness. And you're certainly not the kind of parent who'll give her a few of the pills and then stop if she improves, which seems like the worst of both worlds.

[bosssio.livejournal.com]

everyone in our family has had this sinus infection - I had to have two rounds of antibx to kill it - and I NEVER take antibx for anything.

I knew it was an infection when the antibx fixed me within 24 hours, an illness I had been struggling with for weeks.

[windsea.livejournal.com]

Not at all. And I second everything everyone has previously said.

You might want to think about Gravol for the plane trip. It won't kill pain, but it will help her sleep, and possibly not notice the pressure changes as much. I've flown with the kids when they had ear and sinus stuff going on, and it was heartbreaking and horrid.

[rivka.livejournal.com]

*Googles Gravol* Oh! Yes, we call it Dramamine, and she'll certainly get it for the flight. She's had motion sickness problems before - albeit not since we turned her carseat around so she could ride facing forward - and so we routinely medicate her for long trips.

Gravol is an antihistamine, too, which might help clear up her ick temporarily for the flight.

[mjlayman.livejournal.com]

My right eustachian tube is permanently swollen shut, so I use generic Benadryl when I go to Minicon and back.

You're being reasonable -- you've observed her over time and the NP had a few minutes.

[jerusha.livejournal.com]

Did you wail that the doctor was unfairly withholding the Magic Medicine that would make your child All Better if only they would let you have some? Then you're not one of Those Parents. And the NP knew you weren't one of Those Parents - Those Parents (or People) don't get handed prescriptions for antibiotics and implicit blessing to fill it or not as seems best.

You are making a clear distinction in symptoms between bog-standard viral URI and what's going on now. And if you weren't flying soon, you might opt to hold off, but I think you'd be justified in going ahead and treating now even without the flight. With the impending travel, gods yes treat now! Even if it turns out not to have been bacterial after all, IMHO if you finish the course you'll not really be contributing to the resistance problem. (Besides which, amoxicillin? Is decades old. Anything that's serious about resistance is already resistant to amoxicillin.)

[shandra.livejournal.com]

One round of amoxicillin is not going to destroy the planet or your child. Enjoy the flight!

[fairoriana.livejournal.com]

I'd like to take this opportunity to remind you that you ARE a doctor. *grin*

[dornbeast.livejournal.com]

I guess I'm like those horrible parents in the magazine articles.

I doubt it. You aren't going to stop dosing Alex because "she's better now."

You're asking for antibiotics as a reasoned decision, not a knee-jerk response, akin to "Onoz! My child haz teh snifflez! I can has amoxicillin?"

And if you weren't going on the plane, you'd probably do exactly what was suggested, and hold on to the prescription.

Feel free to correct me if I'm wrong.

[jinian.livejournal.com]

Some doctors are not giving antibiotics for sinus infections at all now, because supposedly they get better at the same speed regardless, but that is crazy talk. I think you're doing fine.

[rivka.livejournal.com]

That is the craziest crazy talk I have ever heard, which given my profession is certainly saying something.

When I get a sinus infection and don't get around to going to the doctor? I have it for months. WTF they get better at the same speed regardless? Maybe if the only antibiotic you prescribe is placebocillin, but otherwise? No.

[johnpalmer.livejournal.com]

I have seen a reference to research making that claim. I've seen similar stuff for ear infections.

I do wonder if there's some additional assumptions.

e.g., I know I saw something that said that a yellow or green discharge wasn't sufficient to make antibiotics necessary. Now, if you tell me "kids with a yellow/green discharge have the same average recovery time with or without antibiotics" I'll believe that. But I won't believe there's *no* difference between bacterial infections treated with antibiotics and not.

[eeyorerin]

I had a doctor tell me that once even after he confirmed that the infection I had was bacterial and not viral. I felt like I did not want to contribute to the Antibiotic Resistance Problem, so I went home without them.

...two months later, when I was still sick, it turned out that I needed antibiotics to clear things up in about a week, which I got from a different doctor. (Ah, practitioner roulette at student health services, how I don't miss you.)

[rivka.livejournal.com]

Now, now. I feel certain that the infection would have cleared up in exactly two months and one week regardless of antibiotics, and you just didn't have enough faith to make it the last few days...

*eyeroll*

[micheinnz.livejournal.com]

No, you are not like those parents in the magazines, because you didn't march into the doctor's office and demand pills, then do everything short of holding your breath until you turned blue when the doctor said they probably weren't necessary.

Instead, you were observant, considerate of Alex's (and your own and Michael's) needs, took medical advice and did what you believed to be the best thing for everybody concerned.

Worlds apart.

[tendyl.livejournal.com]

I think you're very smart to fight this before you take off on a plane trip.

[ailbhe]

We got sinus infections just before our scheduled trip to Sweden (to see Rob's family) in spring and had to cancel because there was no way we could get the kids well enough to fly in the time available. You are so wise to have done as you did. I, too, have flown with sinus infections and it's really not funny. I couldn't inflict it on a child in my care without compelling reason - like a deathbed visit, not like a wedding or funeral.

(Though we don't give Emer oral medication at all nowadays, since Feb/Mar 2007. If she's not ill enough to get suppositories or injections, she's not ill enough to risk inhaling antibiotics and vomit.)