Effectiveness/General Use

Do they really work or is it a mind over matter thing?

I think that there are probably some uses for oils that will be studied and proven to work. I think these will be pretty rare and only a small fraction of the claims that are currently made.

So, is it mind of matter (placebo)? Here are some of the most common uses I see for oils in kids:

Teething - It’s not even clear what symptoms teething causes …fussiness, fever, runny nose, etc have all come into question. But, if you give an oil and a symptom goes away, does that mean the oil fixed it? Not likely.

Fever - Fevers come and go during the day with illness, even without medication.

Cough/congestion - The regimens I see where children have oils placed frequently basically make it impossible to know if they do anything for these symptoms. Cough/congestion will be worse at certain times of day and better at others treatment or no.

How close are we to having actual research on the use of oils?

I still think we are quite some time away. Those that are currently doing research are often biased, are not doing high-quality studies and are using small sample sizes.

Marketing

Why are they sold through multi-level marketing (MLM)?

It’s a fast way to get a product out there and make a lot of money. Since I’ve been on social media, I’ve seen several of these types of MLM ideas crop up. The difference with these is I have some specific knowledge about the conditions they are being used for and specific concerns about how their use could harm a population of people that I care very much about. I know very little about bags and good smelling wax that can be melted with a light-bulb so I haven’t gotten involved until now.

In many ways, it protects the big company because they are not the ones out there making claims about the oils and what they can do. That falls to their independent distributors. If someone were to have a bad outcome because of their use of essential oils, who is responsible? If I prescribe a medicine that someone is allergic to, that responsibility falls squarely on my shoulders, not the makers of amoxicillin. If I prescribe the wrong medicine for a kids asthma and something bad happens, that responsibility falls to me.

Are they an increasingly popular trend or just something I was not aware of?

I’m not sure but it certainly does feel like they are gaining in popularity. Social media makes it seem that way at least.

Do you believe the claim that certain brands of oils are superior to others?

I’m sure there are differences but since we don’t even know what they do for the most part, it’s hard to answer this question.

Philosophy/Opinion

Regarding writing about essential oils: Are you mad, man?

Yes, in fact, I think I must be.

What’s the number one reason you see parents using oils instead of medicine?

In general, people are becoming less trusting of experts and organized institutions. Medicine and doctors are no different. The gap between what a doctor knows and what patients know shrinks every day. People can find out information about their conditions and know basically the treatment options that exist. People are looking to live more natural lives and most who use them feel that oils fit within that idea. When you combine these two issues, right or wrong, essential oils seem to step in the gap.

What is a good way to communicate with your doctor about your use of essential oils (for specific conditions and generally)?

I think it’s important to be honest with you doctor about your use of essential oils. As new information is uncovered it would be important for your doctor to be able to show you new research etc, especially if something shows a particular oil to be unsafe. They can only do this if they know about your use of them. Also, as doctors are prescribing medications, we need to know anything you might be on that could cause a drug interaction.

What is your take on the potential political barriers to the study of essential oils given that they are not backed by super profitable pharmaceutical companies?

Young Living is a very profitable company. They are big and profitable and will only continue to be more profitable. There is no reason that they could not start testing their own products or set up independent testing.

After your research as a pediatrician, would you use them on your children?

People will read all of this information or even do further research and come to different conclusions from me but here are two reasons I won’t:

1. I do not treat my kids with unnecessary medications. Since they are recommended for symptoms and given with the hopes of reliving those symptoms, I consider these oils to be medication.

2. I believe that, due to the lack of good studies, the use of them in children should be considered experimental at this point.

Summary

• The use of essential oils seems to be growing.
• The evidence for their use in children is slim.
• Talk with your doctor about the products you are using so that they can be aware of potential safety issues and medication interactions. 

Previous articles on this topic:

• New York Times Report: Are Essential Oils Safe For Kids?
• Essential oils and their use on children
• How safe are essential oils for children?

The Centers for Disease Control and Prevention (CDC) found that nearly half of all people who enter an urgent care center, or walk-in clinic, with symptoms of a cold or flu leave with a prescription for an antibiotic.

The study found that 46 percent of urgent care patients were prescribed antibiotics for conditions, compared with 24 percent at emergency rooms and 17 percent at medical offices.

Educating families and staff on antibiotic overuse has become a focus of Parul Martin, M.D., medical director of Cook Children’s Urgent Care Centers. She joins the national movement on this topic to improve antibiotic stewardship and has highlighted this topic of concern in her presentations for the Urgent Care Association (UCA).  Additionally, the Cook Children’s Urgent Care Quality Improvement and Research Council is collaborating with the UCA to improve antibiotic prescribing practices nationally.

“Cook Children’s proudly supports a culture of clinical excellence,” Dr. Martin said. “Our practice standards are very high. We follow the American Academy of Pediatrics guidelines and we follow evidence-based medicine across the board, including our primary care offices, our specialties, our Emergency Department and our Urgent Care Centers. Everyone is held to those same high standards. We are continually educating our providers about antibiotics and the treatment of viral illnesses. But we also have to continue to educate the families we treat about the proper use of antibiotics.”

Many families don’t want to leave a doctor’s office without an antibiotic. But Dr. Martin said it’s important that doctors explain to families that too much antibiotic use can be harmful to a child. Education is the key to reaching a long term solution to the current crisis.

“We’re a little more proactive on this issue than some of the other Urgent Care Centers or walk-in clinics you may take your children to if they are sick,” Dr. Martin said. “We don’t have the same pressures that they do to stay in business based on volume. If families aren’t prescribed an antibiotic they may go somewhere else. That’s a tough position to be in because if those clinics don’t satisfy the families, they aren’t going to stay in business. That’s part of what has led us to this antibiotic crisis we are in right now. As caregivers, we have to be unified and responsible about only giving this medication when it’s absolutely necessary.”

For viruses that cause illnesses such as the common cold, also known as an upper respiratory tract infection, antibiotics aren’t effective. Antibiotics don’t stop viruses. They only kill bacteria.

The CDC estimates 47 million unnecessary antibiotic prescriptions are written in doctor’s offices, emergency rooms and hospital-based clinics each year. Furthermore, they estimate up to one-third to one-half of antibiotic use in humans is either unnecessary or inappropriate.

Using antibiotics the wrong way can cause bacteria to grow into superbugs and this could mean a problem for your child.

“Antibiotics are drugs used to treat bacterial infections,” said Marc Mazade, M.D., a pediatrician who specializes in Infectious Diseases at Cook Children’s. “Over prescribing or using antibiotics the wrong way can lead to antibiotic-resistant infections. This means the next time your child is sick, the next infection could be much harder to treat when he or she really needs an antibiotic.”

If you are unsure if you or your child needs an antibiotic, ask your health care provider these 5 questions:

1. “Do I really need an antibiotic?”

2. “Can I get better without this antibiotic?”

3. “What side effects or drug interactions can I expect?”

4. “What side effects should I report to you?”

5. “How do you know what kind of infection I have? I understand that antibiotics won’t work for viral infections.”

Each year in the United States, at least 2 million people get serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic infections, according to the CDC.

“I think what happens sometimes is that health care providers feel pressured to give antibiotics from their patients or in a child’s case, the patient’s family,” Dr. Mazade said. “The parents feel they are doing what is right for their child, but the reality is that they may be causing long-term harm to him or her. If they overuse antibiotics, the next time children need the drug to fight off an infection, antibiotic resistance may make the antibiotic useless.”

Antibiotic resistance happens when bacteria change in a way that reduces or eliminates the ability of antibiotics to kill the bacteria.

You do not need antibiotics for:

• Colds also known as upper respiratory tract infections (URI)
• Most coughs and bronchitis
• Sore throats not caused by strep bacteria
• Runny noses, stuffy noses and nasal congestion
• Seasonal Allergies
• Most earaches
• Bug bites by themselves
• Most Diarrhea
• Most Rashes
• Uncomplicated flu infection and RSV infections

I read the paper during my lunch hour this week. It seems to be a decent study (sometimes studies aren’t that good. Remember that the next time you see an inflammatory headline and try to always read the study, or at least the fine print, for yourself!)

The researchers claim that children who are given antacids or antibiotics in the first six months of life are more prone to “allergic conditions” – like allergies, eczema, asthma, food/medicine allergies, and so on.

The study looked at over 790,000 kids in the Military Health System database from 2001 to 2013. It was a pretty big study.

What it concluded was that if a child got an antacid medication (like Ranitidine or Lansoprazole, amongst others) or an antibiotic (Amoxicillin, Augmentin, Bactrim), the kiddo had a higher chance for those problems listed above.

Antacids in the first 6 months doubled the chance of food allergy. Antibiotics doubled the chance of asthma.

The general thought is that antacid medications and antibiotics mess with our “gut biome.” Those are the living organisms in our gut that help us digest food and help our immune system to know friend from foe.

We want lots of different “good gut bugs” living in there to help us out. When you use antacids or antibiotics early in life, the theory is that this diversity is reduced.

As a mom, I asked myself, “Did those two months my son was on ranitidine cause him to have his awful cantaloupe allergy?” The guilty feelings were already sinking in.

Stop right there! Let’s not feel guilty about this. We are always learning and medicine is always changing. Let’s move forward. Yes this study seems solid, but what questions can we ask about their study methods?

Maybe we’d have more knowledge of a true connection if each individual medication was studied, instead of all of them lumped together?

Maybe kids who deal with reflux or infections as babies are just more prone to allergies and illness in general later on in life?

Are military families living in or with environmental conditions which may predispose the kiddos to allergic conditions?

I don’t know the answers to these questions. But boy, is this article making me think!

Like any “big discovery,” do we need more studies on this same topic to reduce any bias and truly know if there is a connection between these medications and allergies? Absolutely. We’ve done similar studies on animals in the past, but now it’s time to do more studies on humans.

For me, as a pediatrician, I’m going to walk through these risks with my patients a little more thoroughly.

Children with reflux suffer. I watched it happen in my own kid. Do some of them need the antacids to survive? Absolutely (some kids lose weight with reflux). Will I try to talk parents of children with more “mild” cases of reflux out of it? Probably.

Children with bacterial infections need antibiotics. Will I make sure to be certain to use the “least strong” antibiotic I can muster so as not to kill off too many of the important gut biome? Absolutely.

This article will no doubt cause some strong opinions. If, in the end, we are using less medication to treat our children’s mild infant illness, I think it will be better for everyone. I look forward to reading more research on this in the future!

WHO says the list is an effort to “guide and promote research and development of new antibiotics.”

Antibiotic resistance is growing, according to WHO, which means “we are fast running out of treatment options.”

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease at Cook Children’s, says the best way both the medical community and parents can prevent the spread of these dangerous bacteria is the judicious use of antibiotics.

Some infections in kids require antibiotics for improvement. Some strep throat, urinary tract infections and skin infections will need antibiotics to treat and prevent worsening of the symptoms.

Ear infections don’t always need antibiotics. In older children with less severe disease, a period of waiting can allow the infection to go away without treatment.

Many infections in children are caused by viruses. Colds and sore throats that aren’t strep and many other infections in children simply need a little time and TLC.

“Most viral upper respiratory tract infections start with clear runny nose, maybe fever, and maybe a cough. After a few days the nose drainage is green and then after a few more days it goes away on its own. Antibiotics are not needed for these viral illnesses. The child might have bacterial sinusitis and need antibiotics if the green runny nose lasts for over 7 to 10 or if symptoms worsen after a few days.”

Children can have severe, even life threatening, allergic reactions (even if they have taken that antibiotic before and been fine). Because these are rare, they are not a reason to avoid antibiotics when necessary but they are a reason to use caution when antibiotics are not the right treatment in the first place.

Antibiotics can also cause other side effects, most commonly diarrhea. This diarrhea can last weeks and can be quite severe. If the diarrhea is severe (especially if blood or mucous is present) your doctor might have to consider testing for C. difficile which is a potentially serious infection that can be the result of antibiotic use.

Physicians say they are seeing an increase in the number of infections caused by bacteria that do not respond to the antibiotics we have traditionally used for them.

“This requires us to use stronger antibiotics which can often cause more side effects,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “You can see why people are concerned if we continue along the same path but fast-forward 25 or 50 years. What types of bacteria would emerge? This is why we must use extreme caution.”

Dr. Whitworth adds, “Antibiotics are important and often life-saving. But each time they are used there needs to be a conscious decision made about exactly why they are indicated, what the best choice is for patient compliance, and what the risks and benefits are. They should not be used just because they are expected or requested.”

Ear pain can be caused by many different factors. Often kids just play with or point to their ears. If the child is otherwise cranky, sick or not sleeping well, parents will assume there is an ear infection. However, a study from 1998 showed that parents only identified 70 percent of their children with ear infections and when they suspected an ear infection, it was only present 50 percent of the time. (Translation-they could have just flipped a coin rather than trying to guess.)

This is why getting an antibiotic called in when your child has ear pain is a bad idea - whether it is from your doctor or from one of the new insurance nurse lines that many people are using. Every exposure to antibiotics is a potential risk for allergy or side effects. Unnecessary exposure is not worth it.

2. All ear infections have fever.

Studies are all over the place about what percentage of ear infections have fever. They generally fall between 1-2 out of 3. Regardless, that means a lot of kids with ear infections won’t have fever.

3. Having your child in the wind or under water causes ear infections.

The location of an ear infection is behind the ear drum way back in the inner ear. External exposure like wind and water don’t affect that area. Grandma will have to come up with another reason for their grandbaby to put on a hat when it is cold outside.

What are risk factors?

• Age (6 months-2 years)
• Family history
• Day care
• Not breastfeeding
• Smoke exposure
• Pacifier use (small effect)

4. You can’t go swimming if you have an ear infection.

Related to the previous myth, there is no reason to avoid swimming if you have an ear infection. Unless the ear drum has ruptured the space where the ear infection is located is walled off from the water. Don’t skip the swim party! If the child feels discomfort or pain while swimming, they can play in the shallow end or just have a snow-cone.

5. All ear infections need antibiotics.

Many children with ear infections will get better without antibiotic treatment. The latest treatment guidelines give the following advice for treating ear infections:

• Children of any age with severe pain, fever or ear drainage should receive antibiotics.
• Children 6 months-2 years with both ears infected should receive treatment.
• Children 6 months and up with 1 ear infected and with mild symptoms can be watched for 2-3 days to see if symptoms improve or worsen prior to starting antibiotics.

6. Amoxicillin is not strong enough for ear infections.

Many studies have looked to compare different antibiotic treatments for ear infections. The bottom line is this, there is nothing better at getting rid of infections than amoxicillin. Other antibiotics may work as well, but they are typically more broad spectrum - meaning they cover more different types of infections that those that typically cause ear infections. Because of this, we should reserve those antibiotics for those situations in which they are necessary. Amoxcillin is cheap, well tolerated by most kids and effective. Therefore, except in penicillin allergic patients, it should be used unless the child has been on the medication in the last 30 days.

7. If your child gets tubes, their ear infections are guaranteed to stop.

After a few ear infections, some parents are eager to move forward with placement of tubes. Tubes can be a life saver with kids who have had multiple ear infections and can prevent recurrence of ear infections, but they aren’t perfect. They are a surgical procedure and the inherent risk associated with anesthesia need to be fully explained to a parent. Continued ear infections occur in about 20 percent of children even after they have had tubes placed.

Dr. Rogers explains that there’s really not a cure for a common cold and then lets them know why she’s not giving the child an antibiotic and why no one else should either.

“I understand this mindset,” Dr. Rogers said. “You come to the doctor and you want to be treated. Parents often want an antibiotic. That’s why they are there to see me. They can’t afford to take time off when their child is running a fever and sick. They think the antibiotic will make the illness go away faster.”

But if the cold is viral, it’s simply going to run its course. The antibiotics will not have any impact on the cold at all. With something like a cold, you just have to wait it out.

The American College of Physicians and the U.S. Centers for Disease Control and Prevention agree with Dr. Rogers. They have issued new guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults.

The two organizations advice to adults is similar to Dr. Rogers’ advice to children: Use antibiotics to treat bacteria that causes the likes of strep throat and food poisoning. For common viruses like the common cold and flu, the recommendation is drink extra water and juice, use a cool mist vaporizer or saline nasal spray to relieve congestion.

“It’s not that I’m against antibiotics, but for the right reasons,” Dr. Rogers said. “Pertussis starts with cold-like symptoms, just kind of a mild cough, and after 2 weeks the cough gets much worse. In those cases, not only the patient, but the entire family, will need antibiotics, but once the patient has been infected, expect him or her to have a prolonged cough.

Other times antibiotics may be necessary with illnesses including:

•  Sinusitis or secondary bacterial infections, related to a cold.
• Certain skin conditions caused by bacterial infections, such as impetigo.
• Strep throat
• A severe ear infection

“I really do try very hard to limit my prescriptions of antibiotics for bacterial infections,” Dr. Rogers said. “If your child has an ear infection and it’s red and bulging, as a parent I would want antibiotics to help ease my child’s suffering.”

However, other caregivers aren’t as careful with their prescriptions, Dr. Rogers warns. She said this can cause the medication to not be effective or even useless when a child actually needs antibiotics. The infectious organisms adapt to the antibiotics, leaving the patient immune to the antibiotic.

Antibiotics have played a vital role in treating patients with infectious disease for 70 years, Dr. Rogers said. When prescribed the right way, antibiotics can prevent illness and even death. But when antibiotics are prescribed carelessly, they lose their effect.

“We frequently see patients who have been prescribed antibiotics at the doc-in-the-box type clinics,” Dr. Rogers said. “It sometimes seems to me that they have a mandate that everyone must walk out with a prescription. They often prescribe an antibiotic, steroid or prescription cough medicine regardless if the patient needs it or not. None of that stuff works for a cold. In fact, studies have been done that say it makes your child worse. The antihistamine thickens the secretion, so you can’t get the yucky stuff out. That’s how you get better, by getting the mucus out and resting. When we’re sick, especially children, we need lots of rest.”

Dr. Rogers’ advice is to see your Cook Children’s pediatrician. Other options include a Cook Children’s Urgent Care Center or Neighborhood Clinic. If a doctor prescribes an antibiotic, she says it’s Ok to ask if it’s the right thing to do. If the doctor says it’s bacterial or to stop an infection, then proceed.

“There’s no magic cure for the common cold,” Dr. Rogers said. “And unfortunately, too many prescriptions of antibiotics are zapping the magic out of what was once a miracle drug."

About the source

Audrey Rogers, M.D., is located at 3200 Riverfront Drive, Ste. 103, Fort Worth, TX 76107. To make an appointment with her or one of her partners, call 817-336-3800. Like her on Facebook.Dr. Rogers received her undergraduate degree from Emory University in Atlanta, Ga., her medical degree at Southwestern Medical School in Dallas, and completed her pediatrics training at Children's Hospital of Oklahoma. Her special interests are behavioral pediatrics and adolescent medicine. She became board certified in 1989.

A recent study done in the adult oncology world and published in JAMA, found that doctors had a perception that patients were demanding extra treatment and testing. Review of the patient encounters showed that doctors perceived demands that did not actually occur. Many of the requests that did occur were medically appropriate.

In pediatrics, the most common issue where this comes to a head is the desire to give children antibiotics. It can also play out in other areas as well. Another common one that comes to mind is request for further testing for diagnosis.

Fortunately, in my experience, parents are becoming more informed about what situations require antibiotics and which illnesses will pass with a little time and TLC.

The problem is that many doctors have gotten into the unfortunate habit of wanting to provide what the parents are requesting without actually asking the parent what they expect. Doctors may perceive that parents want antibiotics or further testing when, in fact, they simply want reassurance that waiting is OK. This becomes a particular problem in urgent care or retail clinics where patient satisfaction plays a bigger role in getting patients to come back and see you.

So, how can you prevent this from happening to you?

Here are five casual statements that you might use the next time you visit the doctor to help them understand your expectations:

1. I’m pretty sure I’m just over concerned. I just wanted you to check things out so I can be sure.

2. I don’t really like to give my kids medicine but I wanted your opinion about what we should do next.

3. I’m totally OK with waiting, if that’s what you think is best.

4. What would you do if it were your child?

5. Are there other things we can try first or other options?

Your doctor should not feel threatened by these statements. If antibiotics are the only right choice, they should be able to explain the reasons why that is.

But, is he allergic?

Listing medications as an allergy may not seem like a big deal, but it can have significant consequences:

1. Your doctor may have to choose “stronger” antibiotics that have more risk of side effects.
2. Your doctor may have to choose more expensive antibiotics.
3. Your doctor may have to choose antibiotics that are known to be less effective against your child’s infection.

If a medicine is listed as an allergy for your children, it will carry on with them into adulthood. When they are 30 and having to make big decision about their medical care, many will have no idea why a drug is listed as an allergy for them.

A recent study conducted in adults at the Mayo Clinic in Florida showed that, out of 384 adult patients who listed a penicillin allergy, 94 percent did not actually have an allergy after being tested. I knew it would be pretty high but, WOW!

Even if a child has a true reaction, the authors report that some people “outgrew” their allergic reaction over time. This is true no matter how severe the first reaction was.

Here are some questions to ask yourself and your doctor about possible drug allergies:

1. Was this an allergy or a side effect? There is a big difference.
2. If we are going to list this medicine as an allergy, does this mean to never try it again? Some doctors might recommend retrying an antibiotic later if the reaction was mild or possibly not truly related to the antibiotics. Some reactions are clearly allergic and the medicine should not be used again.
3. Should we have testing done (at some point) if we are unsure?

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

So let’s move on from Miley and focus on what we can learn about allergies and antibiotics. Marc Mazade, M.D., is an infectious disease specialist at Cook Children’s and here’s a quick rundown of what you should know. Hopefully this twerks, er, works for you …

1. Allergies to antibiotics often manifest as a rash, sometimes a flat rash with circles or spots, and sometimes welts (urticarial, which are large “bulls-eye looking” spots).
2. Anaphylactic shock (a severe, life-threatening reaction) is not very common with oral antibiotics, but swelling of the lips and tongue may be an early sign.
3. Some allergic-looking rashes can result from viral infections or exposure to environmental allergens. 
4. Allergic reactions to antibiotics can sometimes be very severe causing a condition called Stevens Johnson Syndrome in which the mouth, eyes, skin, and urethra can become very inflamed and are often severe enough to require treatment at burn centers.
5. Some infections can cause Stevens Johnson, too. 
6. If a parent suspects that a child is having an allergic reaction to an antibiotic or any medication, the family should notify their provider immediately and stop giving the medication until the provider can outline a course of action. 
7. In addition to treating the symptoms of the allergic reaction, an alternative antibiotic may still be needed to treat the primary infection.
8. Mild rashes without other problems may subside after stopping the antibiotic and taking some Benadryl^®.
9. A follow-up visit should be scheduled with the provider as soon as possible. 
10. More serious reactions may require a trip to the emergency room. One of the first questions that will be asked is, “What medications is your child taking?”  Parents should list all medications, even over-the-counter medications and supplements.