Two main types of germs – bacteria and viruses – cause most infections. Illnesses like strep throat, urine infections and some types of ear infections are examples of bacterial infections. Bacterial infections can be cured with antibiotics.

However, viruses, not bacteria, cause most infections in children. Viral infections, such as colds and most cases of diarrhea and vomiting, cannot be cured with antibiotics. Your child will recover from viral infections when the illness has run its course.

Besides not curing the disease, there are three other major downsides of treating viral infections with antibiotics:

First of all, potentially, your child may have a reaction to the drug that may be harmful. These reactions can be as simple as developing an itchy rash and as serious as causing swelling and closing of the throat.

The second problem is that bacteria may become more resistant each time you give antibiotics randomly to your child. If you child becomes infected with antibiotic-resistant bacteria, it may be necessary to use more powerful medicines, which may need to be given intravenously in the hospital. Even then, some antibiotic-resistant bacteria are very difficult to treat. Antibiotic-resistant bacteria can also spread to others in the family and community.

Finally, at the end of viral illnesses, children can frequently break out in a red, widespread rash. If a rash occurs while your child is taking antibiotics, we are left with a difficult question: is the rash from an allergy to the medication or is it unrelated to the antibiotic and caused by the virus instead? Sometimes it is difficult to know the answer, and your child may end up labeled as allergic to a family of antibiotics. For your child’s future, a potentially useful and safe antibiotic might not be used when your child really needs it.

Does this mean that I should never give my child antibiotics?
Antibiotics are among the most powerful and important medicines we know. When used properly, antibiotics can help your child. But, antibiotics are not always the answer and, in fact, may be harmful in cases of colds and other viral infections.

If antibiotics may have side effects and create resistant bacteria, should I stop giving the antibiotic when my child is feeling better?
No. If an antibiotic is prescribed, make sure your child takes the entire course and never save antibiotics for later use.

If mucus from the nose changes from clear to yellow or green, does this mean that my child needs antibiotics?
Yellow or green mucus does not mean that your child has a bacterial infection. It is common for the mucus to become thick and change color during a viral cold.

My child is missing school, and I am using up time from work staying at home with him or her. Could you just help us out and give antibiotics a try?
The burden of infections is indeed great for families. However, if your child has a viral illness, an antibiotic will not shorten the course of the fever or help with the other symptoms. Antibiotics will not get your child to school or you back to work sooner. If your child develops side effects from the antibiotics, he or she will feel worse instead of better.

Can viral infections become bacterial?
Viral infections may sometimes lead to bacterial infections. But treating viral infections with antibiotics to prevent bacterial infections does not work, and it may lead to infection with antibiotic-resistant bacteria. Keep us informed if the illness gets worse or lasts for a long time, so that treatment can be given as necessary.

My child has a sore throat and feels terrible. Isn’t that enough to convince anyone that he or she needs antibiotics?
It’s not always easy – even for physicians and nurse practitioners – to tell the difference between viral and bacterial infections on the basis of symptoms alone. Sore throats are a good example. A sore throat plus a runny nose and a cough is usually just a cold. But if your child is older than 2 years of age; has a sore throat with a fever but no cough; has swollen neck glands; and, has yellow or white patches on his tonsils, then he or she may have strep throat. The problem is that most people with strep throat do not get all of the clear-cut signs or symptoms.

A recent study showed that if doctors rely only on asking questions and examining the patient with sore throat, they guessed wrong about strep throat roughly 40% of the time. Physicians and nurses got the best results if they relied on a throat swab for checking for a rapid strep test or a 2-day throat culture. So be patient if your provider swabs your child’s throat instead of immediately prescribing antibiotics. In the long run, that will increase the chances that the medicine will work when you child really needs it.

My child seems to be sick all the time with a cold. Is that a sign that he or she is less capable of fighting infections as compared to other children?
It may sound a bit impersonal, but it’s been shown that, on average, the number of colds per year is anywhere from 3-10 colds. If each cold lasts the usual 10-14 days, this translates to up to 140 days (or 4-5 months) of cold symptoms per year! Therefore, it’s possible for children to be sick almost continuously for periods of time during the year, especially during the winter. In the wintertime, cold viruses are 3 times more common, and children tend to stay indoors for prolonged periods and can spread viruses more easily.

Children tend to get sick more often in part because they probably shed viruses for longer periods of time; because they tend to share nasal secretions and saliva more easily through toys and shared objects; because they do not wash their hands as often; and, because their immune system is encountering sources of infection that are that are new to them.

Finally, there are some causes for cold-like symptoms, such as allergies, that are not caused by viruses. Allergies tend to flare up in the spring and summer months with the surge of pollen, grass and ragweed. If your child is over 3 years of age; sneezes a lot; has a clear nasal discharge that lasts over a month; doesn’t have a fever; and, especially, if these symptoms occur during pollen season, your child could have a nasal allergy. Some children are sensitive to indoor allergens and irritants such as molds, dust mites, pet dander and smoke. Talk to your doctor if you suspect allergies, as there might be medications or changes you can make in the home environment that might help your child.

Since antibiotics are not helpful for viral infections, how about over-the-counter remedies?
Perhaps a few children might benefit from the nose-drying and cough-suppressive effects of cold medicine. However, these preparations are useless for the majority of kids. They certainly do not shorten the duration of a cold. Also, children are susceptible to the side effects of these medications such as jitteriness, racing heart rate and behavioral changes. If you are planning to give these products a try, it’s probably better to avoid drugs that have multiple ingredients because they increase the risk of side effects. Similarly, it is actually better not to use combination cold medicines with fever reducers (e.g. Tylenol or Motrin/Advil and decongestants/cough suppressants). Give the fever reducer separate from the cold medicine. That way you can give the maximum safe dose of the fever reducer without overdoing it with the cold medications.

In cases of vomiting and diarrhea, practically none of the medications used for adults are indicated and can be actually dangerous for children. Do not use them.

If antibiotics are not always helpful and over-the-counter remedies do not work that well, what can I do to help my baby with a cold?
In cases of young children with colds, remember that children cannot breath through the mouth and suck at the same time. If your child is breast or bottle-feeding, you must clear the nose so he or she can breathe while sucking. Clearing the nasal passages is also important before putting the child down to sleep. The best remedy you can use to help with dry nasal mucus is to put a few drops of warm clean water or saline solution in to each nostril. Then, after waiting a few seconds, you can wipe the nose gently with a soft facial tissue paper.

It also helps if the child is breathing humidified air. In order to avoid sending molds and other impurities from a dirty vaporizer or humidifier into the air, the best way to get humidified air into the house is to crack a window open. That way, the moist air from the outside can come in. Raising the head of the bed so that nasal secretions do not trickle in the back of the throat also helps.

By the way, some of the same approaches (i.e. humidified air, head elevation) may help in older children.

How soon can my child return to daycare or school after an infection?
The main requirement for returning your child to daycare or school is that the fever is gone and the symptoms are not excessively noisy or distracting to classmates and staff or teachers. It does not make sense to keep a child home until we can guarantee that he or she is not contagious because viral shedding can last 2 to 3 weeks!

How about alternative medicine approaches to preventing or treating infections?
Although alternative medicines are becoming more and more popular for use in adults, they have not been studied very carefully in children. Besides, some of the therapies that have been studied, such as the use of Echinacea and vitamin C for the common cold, have no proven benefit for children. We also know that “lack of vitamins” is not the cause of common infections, and too much vitamin C (more than 2 grams) can cause diarrhea.

It may be that, in the future, more and more of the homeopathic remedies will be scientifically shown to help. Research is being directed into the role of dietary supplements in treating childhood diseases. But, for the meantime, the jury is still out on most alternative remedies. Until then, the most helpful thing to remember is that “natural” may not necessarily mean “safe” or “effective”.

What is the best way to prevent the spread of infections?
Hand washing helps to prevent the spread of gastrointestinal and upper respiratory infections better than all other methods. Hand washing (with running water and soap or a waterless antibacterial cleanser) is especially important after using the toilet; changing diapers; coming in contact with pets; handling foods, especially raw meats; and, before and after touching your nose, eyes and mouth.

Infectious diseases that were killers or causes of life-long disabilities in children, such as polio, measles or tetanus, have been practically eliminated thanks to vaccinations. Therefore, we encourage you to make sure your child is up to date with immunizations.

Fevers and Infections:
Fever is common in both viral and bacterial infections. (Please click on the FEVER section in our website for more information about proper ways to check a temperature in children, dosing charts for fever reducers, instructions on when to call your pediatrician if your child has a fever and other topics about fever). Most fevers are caused by viruses and may last 3-5 days.

Perhaps, one of the most common and valid questions about infections is: Can we use a fever to predict whether an infection is dangerous or not? The problem with this question is that it only takes into account the fever and nothing else. Besides looking at the thermometer, it helps to look at the child having the fever.

First of all, think of the age of the child. If your child’s age is between birth through 3 months of age, any rectal temperature equal or greater that 100.4 degrees Fahrenheit or 38 degrees Celsius is an emergency. Regardless of whether the cause of the fever is from a virus or bacteria, your child needs to be examined by a doctor in the emergency room as soon as possible. Blood, urine and, very likely, spinal fluid tests will need to be done in the emergency room. Possibly, your child might need to be kept in the hospital for antibiotics for at least for 48 hours. If not admitted to the hospital, your child might receive antibiotics by injection in the muscle. In such case, you would to need to bring your child to his doctor the next day to be re-examined and to receive at least one more antibiotic injection.

If your child is older than 3 months of age, it helps to look at how the child is acting overall. If your child is taking fluids and urinating adequately, those are a good signs that the infection is probably not very severe. In terms of keeping track of urine production, a good rule of thumb is as follows: in children less than 6 months of age, wet diapers every 4-5 hours is the goal. In children older than 6 months, urination every 6-8 hours is a good sign of adequate hydration.

Fever reducers, such as Tylenol or Motrin/Advil, may not completely bring high temperatures back to normal. A 1.5 to 2 degree drop in temperature one hour after fever medication is a reasonable expectation. The fever will most likely go up again after the effect of the medication wears off (usually after 4-6 hours). It’s also possible that fevers will run higher in the late afternoon and evening, since our internal temperature regulators are designed to keep our bodies colder in the morning and warmer at night. Because of this day/night variability, a higher temperature later in the day is not necessarily a sign of worsening infection.

A child with a fever who is drinking and urinating, acting more like him or herself, smiling and playing after Tylenol or Motrin/Advil is probably sick with a viral infection which should improve on its own.