Antibiotics and allergy

A recent JAMA Pediatrics study has identified an association between antibiotic treatment 0-6 mo of age and risk of allergic diseases like food allergy, hay fever, eczema, and especially asthma.  The research looked at almost 800,000 infants from 2001-13 who subsequently received >160,000 prescriptions for antibiotics, finding the highest risk for penicillins and lower but significant risks for cephalosporins and sulfa drugs.  Asthma incidence increased by 47%, and multiple prescriptions–especially with different drugs– in that age group “upped the ante” on those risks.

Researchers and allergists speculate that use of antibiotics alters “the microbiome”which can disrupt the natural protective properties of those intestinal bacteria. Disrupting that balance, they postulate, interferes with normal body immune development which can explain the study’s findings.  I will stress that this study demonstrates an association.  In other words, it may be showing that taking antibiotics in infancy increases the risk of allergic disease, or that children with allergic diseases end up receiving antibiotics earlier and more frequently.  We don’t know which for sure, but it certainly is important to keep in mind when we are considering prescribing antibiotics, especially in these little kids.

One aspect of this story that I wish to note is the frequency of antibiotic prescription at so called urgent care centers.  Some studies report that 46% of patients received antibiotics for conditions that did not warrant their use; nationwide, 40% of all outpatient antibiotic prescriptions originate from urgent care encounters.  The CDC estimates that, nationwide, 23,000 people die each year from antibiotic resistant bacterial infections with names like MRSA, “c dif,”, VRE, CRE.  Many public health officials fear that, with antibiotic overuse, those numbers may explode into the millions in the decades to come.

To their credit, many urgent care center organizations are working diligently to improve their performance in that area by such initiatives as developing best practice protocols and partnering with organizations like the George Washington University Antibiotic Resistance Action Center to educate their providers about this issue.  However, as the patients and their histories are not well known to these caregivers–who are often nurse practitioners or physician assistants with less experience and clinical training than MD’s or DO’s–making progress with this is a great challenge for these facilities.

I recommend exercising caution in utilizing  urgent care centers for your children and in particular that age group–0-6 months.  Generally if you can get the fever down (even if it goes back up later), your child has an appetite for fluids and is holding them down, urinating at least 3-4x/24 hours, then the situation is likely stable and can wait for the regular doctor’s office to open.  Remember– fast does not necessarily equal good.  I stress the term “generally”–OF COURSE each situation must be judged based on the condition of that particular child at that particular time.

But before rushing off to the urgent care center or the ER keep the above in mind and give me a call before you go.  I’m here to  help you make the best decision for your child.

Image courtesy of Children’s Healthcare of Atlanta.  Thanks for following.

Carseat Installation Safety

Carseat/booster seat usage is now almost universal in the US. This has greatly reduced serious injury from auto accidents in children.  Nevertheless crashes remain a great hazard in children (25% of all accidental injury deaths) and the National Highway Safety Administration finds still that 72.6% of carseats are not installed properly.  Here are some things to remember.

For newborns and infants be sure you place the seat at the proper angle.  Too low may not provide sufficient protection.  Too upright too soon may result in serious head injury in a crash as the child could flop violently during impact.  Head control is an evolving process in infants and is usually not reliable until past the first birthday.  Also, being too upright too early can even risk some airway compromise.

Pay attention to positioning of chest clips and straps. The clip should be at chest level(too high, again, bad for airway, too low and the child can slip through). The shoulder straps should go through the slats BELOW the child’s shoulders in a rear facing carseat and in the slats ABOVE the shoulders when forward facing. Don’t forget the tether strap must be secured to the anchor at the base of the back of the seat.

Be careful with winter coats and other bulky outerwear. These can cause laxity and allow the child to slip through in a violent collision. Better to use a light jacket and then cover the restrained child with the coat or heavier blanket. When properly restrained, you should not be able to pinch any loose material of the engaged straps between your fingers.

Use seat belt clips ONLY from the one seat.  DON’T install the carseat in  the middle by using the outside belt restraint from the other seats ; if the middle does not have its own seatbelt then it’s better to secure the child in the seat at either side that does have one. Only use the middle seat if it has a seatbelt or anchors specifically for that seat.

Be sure to follow weight and height/length guidelines listed for that specific model.

The latest guidelines for forward facing carseat now is to delay turn around well past 2 years.  It’s more weight than age.  Most children will be comfortable rear facing until AT LEAST 35 lbs.

No rush to get a young child out of the booster seat. Most modern boosters are designed to accommodate a child to at least 65 lb (that’s an 8 year old, folks!). To check if your child is safe out of a booster seat, note the positioning of the 3 point harness contact points. The shoulder harness should contact the sternum and the lap belt should go across the hips.  If they contact the neck or the waist then then those soft areas can sustain serious injury from the belt itself in a collision.

Finally, all modern cars have front airbags.  These are designed to cushion impact by contacting the chest area of a person at least 90 lb and 58″. Smaller persons can be struck in the face, again, causing serious trauma during a collision from the bag itself. They should sit in the back.

Studies suggest that following these guidelines can lower your child’s risk of serious injury in a car accident by as much as 75%, so please keep them in mind.

Thanks for following. Image from Sunday Times Driving.