Kate is into her aforementioned script a few days. Don’t ask me how many; I’ve already lost count.
We’ve forgotten a few doses. All but the first have required two people: one holding her down and the other forcing medicine down her throat. This method has a roughly 50% success rate at getting more than 75% of the dose down. Never is the dose complete. She always manages to spit, push, or drool some of it out. I have become expert at removing pink stains.
This is exactly why I swore off antibiotics when Will was her age. I can’t imagine that my experience is a-typical. I’m a good parent. I’m pretty on-top of things. And I’m savvy enough to try lots of angles at medicine-giving. Maybe the ability to give a child resisting medicine is a skill… but WHERE would any parent learn it, except with their child?
I know so many parents whose kids don’t even take Amoxicillin anymore because it does nothing for the child. Is this because all of these kids have been given it like Kate… in partial doses with occasional misses? Giving the drug the perfect opportunity to be rendered useless and creating a stronger, more efficient and persistent bacteria in the process?? Even if a parent can give a med now… could they during the first couple of times the antibiotic was prescribed? Bacteria doesn’t even cause ear infection pain… so why be in such a hurry to use a drug to get rid of something that is going to go away on it’s own in less than a day later?? I need to understand these details. I really, really, really need to get a better picture of this, because I grow more frustrated at myself everytime I have to hold my screaming child down and hold her nose to force her to swallow something I not only doubt she needs, but strongly feel will threaten her health later. (Not to mention undermine the health of world, but that’s another issue… it’s not like I’m not trying to be dramatic or anything.)
I can remember working with physicians in a nutritional outreach program in India, trying to figure out why they were reporting no success. It took about 4 seconds to figure it out. I asked folks (the actual people in the community, not the physicians) how they used their vitamins. They don’t. They throw them out. Tonics were the name of the game there… everyone wants a tonic. It’s the vogue treatment of choice, not unlike the power of pills here. Give out whatever you want, but if it’s not fully understood and appreciated… no one is going to follow the plan. One physician got it and changed the way he approached the use of the pills, explaining in more detail what they were and how they worked — and offering suggestions for ways to crush up and create tonics with the medicine. I think that the experience highlights how people tend to seek something specific from physicians, the same way we might “shop” for a particular item, and throw out whatever is not part of our expectations. So, maybe if we go to a physician seeking a prescription and don’t get one, that we feel it’s not worth the cost of admission. Perhaps telling the parent of a child with an ear infection to just treat with Tylenol and hot compresses would seem like a step back in medicine after so many years of antibiotic treatment. Even though the previous practice was inappropriate and we know that now, providing LESS medicine at an appointment strikes the patient as poor medicine, so physicians comply with what patients want simply to keep them coming in. It is a business, after all.
I question the efficacy of this drug and its current use on my child and I’m ticked off that I didn’t pursue the issue further. I’m not trying to challenge the doctor — I am not a physician and respect that specialized knowledge — but I have the capacity to understand the rationale for the treatment choice. And ultimately, that’s all I want to know. What is the rationale and does it make sense? Is it based on evidence-based care, or a social expectation? If I can’t make this kind of a stand, then how can good medicine ever be fully evaluated by patients?
Meanwhile, would it be better off to just stop the drug completely? Is it worse to stop midway through a poorly administered dosing schedule, or continue on with missed and partial doses until the 10 days are up? Either way, it’s not good… but which is more harmful?
jenny | 01-Apr-08 at 5:31 am | Permalink
have you tried mixing the amoxicillin into something she will eat or drink, like the filling in Oreo cookies?
I hate to compare kids to pets, but wow, what you wrote reminded me of the twice-yearly chore of giving my cat amoxy for his bladder infections. at least with a cat you can swaddle it in a towel and pry open its jaws to squirt the stuff down its throat – and not have to worry about psych damage (or someone calling CPS).
Cold Spaghetti | 01-Apr-08 at 6:30 am | Permalink
We have a long history of trying every food or drink substance available on the Western Hemisphere for hiding medicine. This was required with Will, who was so good at fighting off drugs that he could literally hold his breath until he was blue in order to spit out drugs… so holding his nose to force him to swallow was not an option. We had a moment when we actually thought we had injured him (this was the actual moment I looked at myself and the situation in full scope and went, WTF?? This is bullshit!) Now we can reason with him so it’s not so big of a deal.
Kate doesn’t like treats… won’t touch chocolate, doesn’t drink milk, etc., so the “special something” angle means nothing to her. Peach oatmeal works for a few bites, but she can tell the taste and then rejects it. Same with yogurt.
We’ve found that the food methods aren’t effective with our kids. They can smell or taste it the difference. And even if we can hide it, they don’t finish the food or drink — or do they eat it and make the usual mess — which means they aren’t getting the dose anyway.
When Will was toddler, I said that if he became seriously ill and needed regular medicines to stay alive, we’d have to bring him to the hospital for every single dose via injection… it’d be the only way. I feel that way now about Kate.
The bottom line is that feeding ANY toddler ANYTHING can be trying sometimes. So when it becomes something that you feel they MUST have, the battle is even greater. I guess my point is that I’m thinking that ALL families go through this… so from a public health perspective, this doesn’t work.
Holding down the cat and forcing pills down his throat is way easier!!
Andrew Kottenstette | 01-Apr-08 at 10:00 am | Permalink
The thing about yoghurt is scary, because after her anti-biotics course is done that’s one of the best ways to get good bacteria back into her.
Young as she is one would think peer pressure would work! You know, a game. If she felt like her participation was important she would want to do a thing. She wouldn’t want to feel left out if the whole family was doing it and having fun and laughing. I know it’s trickery and all that. My experience is that stubborn kids only do something they decide is their idea, and sometimes almost a thing to show off and get attention for. It’s more pull than push…with psychology.
Other than that one would wonder if honey would work, sticky and awkward as it seems. It’s an anti-biotic. My dad bought some Manuka honey that cleared up a weird thing he had on his arms for years!
chrissie | 01-Apr-08 at 10:28 am | Permalink
I am so with you on the over-prescribing of meds thing. Its a serious issue in mental health, IMO, as patients now expect their psychiatrists to a) diagnose them with something and b) give them a medication to fix it.
Sydney is the same way with meds–luckily we haven’t had that many opportunities to have to administer them to her. What I’ve started doing is having her give me MY medicine (usually a Tums or occasionally an Ibuprofen or something) and watch me take it, swallow it, and talk about feeling better. This seems to have alleviated some of the resistance.
Head Lima Bean | 01-Apr-08 at 10:38 am | Permalink
we cried uncle after 2 days of trying amox. we were all much happier because of it and the next time they tried to give it to us i refused and we finally found a solution that worked for our family. good luck…and hugs (and seriously PLEASE post your stain fighting regime…we’re big oxyclean spray users here but if there’s another miracle wonder out there i’d love ot know!)
Poists | 01-Apr-08 at 11:01 am | Permalink
Okay, so my pharmacy hat is going on…You are right about the fact kids are resistant to the drug due to over prescribing BUT also kids get resistant due to the fact the course of meds is stopped halfway!
PLEASE TRY TO FINISH THE COURSE.
I agree 100% that unless proven bacterial (which some ears do get) that drugs are unnecessary. Have you asked about the Similasan ear drops?
As for drug recommendations to cut down on the length of torture to both parent and child, please if your ped is pushing drugs and almost demanding you give them ask about the following:
1. Zithromax 3 day
2. Rocephin injection
3. What are powdered options? I believe that some cillians are suspension products which means they are in a powder form (most likely not as icky tasting) prior to being “suspended” in water or some other similar solution to make them liquid.
Emily | 01-Apr-08 at 12:23 pm | Permalink
I’m pretty sure my mom (the RN who is also hesitant about overuse of antibiotics) would want me to pass on that ending an antibiotic treatment early is worse than a couple missed/spit out doses (although getting all the doses is most ideal). Since you’ve already started it, I would suggest finishing the treatment… Good luck! :o)
Leigh C. | 01-Apr-08 at 4:51 pm | Permalink
It IS horrific, trying to give these kids their drugs for their ear infections – and some kids are more receptive to taking it than others. My brother at this age, and a little older as his ear problems progressed, then finally ended, took to calling the amox “Pink Panther” medicine, and my parents reinforced that, which helped him become more comfortable with the idea of taking it.
The peer pressure thing could work, if Kate looks to Will for her cues. Once the treatment has started, it’s better to finish it as best you can, though. I’m sorry she isn’t more receptive – and I wish there were another way to administer this to kids who absolutely refuse to take it. One would think there were enough instances of this happening for the pharmaceutical companies to develop something else…
elisa | 02-Apr-08 at 3:11 pm | Permalink
i agree with the above comments…. i think now that you’ve started you should finish but i’m a little confused with the diagnosis of acute otitis media to begin with because if you read the AAP/AAFP guidelines the diagnosis requires an acute onset of symptoms and it never seems kate ever even had symptoms. here is the definition provided in the guidelines: three components: 1) a history of acute onset of signs and symptoms; 2) the presence of middle-ear effusion; and 3) signs and symptoms of middle-ear inflammation. anyway, i don’t know if this helps you at all but i think i would continue with your limited use of antibiotics in the future and not treat if she’s not acting like she has an ear infection. good luck!!
Leigh C. | 02-Apr-08 at 5:49 pm | Permalink
Elisa, I NEVER had any ear infection symptoms at this age or even a little older. The only way my mother even figured out that something was wrong with me was when I would get in the car and start throwing up once it was in motion. First time it happened, she thought it was bad motion sickness, until she finally got disgusted and drove me straight to the doctor’s office and demanded I be seen right then and there.
“She has an ear infection,” my mom was told.
She was surprised. “But there were no symptoms!”
“Sometimes there are hardly any.”
I was one of those. It’s not too far-fetched. It’s also why I’m sort of glad that my son’s ear infections have been accompanied by a fever, because at least there’s a SIGN…
Cold Spaghetti | 02-Apr-08 at 8:21 pm | Permalink
Elisa: Thanks for listing the requirements. It means a lot to hear it from a physician. I didn’t want to question the pediatrician on her Dx and had the same thought. My guess was that she was going on my answer to the question: “How is everything… eating, sleeping…?” And I answered, “Okay. She eats well but doesn’t really sleep soundly through the night, she wakes up a lot.”
Granted, she may be waking from ear pain. But I doubt it, since she wakes up all the time irregardless of health (we actually think that she has gas pain at night, since she usually settles down after a few good toots… it’s sort of funny, if you can look at it without seeing how darn tired we are in the meantime!) The doc didn’t ask for specifics, and I thought that maybe I was wrong and maybe she really was having symptoms.
No fever, though, I’m sure… and to me, fever with runny thick nose is usually when I start to think ‘ear infection.’ Will’s major ear infection symptom was that he would be incredibly cranky and difficult. I’m usually pretty good at predicting when the kids have them and treat with Motrin or Tylenol and compresses for pain. We were at the appointment for a re-check because she had had fluid in the OTHER ear during a routine appointment.
The kids have both had several ear infections that we have not treated with antibiotic.
I feel like a tread a delicate line between wanting to be seen as a good parent and patient… and wanting to be given all of the information and choices to make a decision that I feel good about without sounding like I’m challenging medical advice.