Stop Killing the Good Guys! Protect Your Child’s Microbiome from Antibiotic Overuse


There’s no doubt that antibiotics are a good thing. They save lives every day. We can, in part, attribute our longer lifespans, reduction in infant mortality and childhood deaths from life-threatening infections, and the near elimination of childbirth-related maternal deaths from infections in hospitals to antibiotics. As a medical doctor I am grateful to be able to prescribe them for serious bacterial and other appropriate infections, for example Lyme disease.

As with many things, however, more is not always better. And this is certainly the case with antibiotics.

The average child in the United States will receive between and 10 and 20 courses of antibiotics by the time he or she is 18 years old. We are so accustomed to antibiotics being prescribed for childhood illnesses that we assume that they are as safe as they are common.

 

But this is far from the truth. We are now learning the hard way that the common overuse of antibiotics, both as medicines and in our foods (they are given to cattle and poultry to keep them “healthy” until they are slaughtered for food; antibiotics also promote growth in these animals by the same mechanisms that their chronic use increases the risk of obesity in humans) is responsible for two major health problems: global antibiotic resistance to serious infections, and damage to the human microbiome.

This growing awareness that antibiotic overuse is dangerous for both public and personal health requires us to drastically and immediately rethink and adjust our antibiotic use. In doing so we can prevent our children from developing life-long chronic illnesses associated with microbiome damage, some of which rival the seriousness of the bacterial infections that used to threaten them, and we can reduce the major global threat of antibiotic resistance we all face.

Antibiotics, Your Child’s Microbiome, and Chronic Disease

Antibiotics kill bacteria. The problem is that they not only kill off the bad guys (and as you’ll see below, because of antibiotic resistance, they are doing this less effectively!); they kill off the good ones, too. When we give antibiotics to children at a young age or frequently enough, some of the good guys may never fully recover. These good gut flora, and their composite, our microbiome, are essential for more functions that protect and support our health than we’d ever imagined until recently. We now know that microbiome damage directly and significantly increases the risks of our children developing long-term health problems including: food, environmental, and seasonal allergies, eczema, asthma, ulcerative colitis, Crohn’s disease, obesity (even when they’re not over-eating), diabetes, and cardiovascular disease.

Antibiotics are given to between 30 and 50% of all women during pregnancy or labor. Mom’s exposure to antibiotics perinatally also negatively affects the breast milk microbiome, which is part of what is supposed to help colonize baby’s gut with beneficial flora. Additionally, 34% of babies are born by cesarean. These babies miss out on the important inoculation their gut flora is meant to receive through natural exposure to mom’s vaginal flora, thus compounding the problem. Our babies thus begin their antibiotic exposure even before birth, and as a result damage to their formative microbial populations begins before they’ve had a chance to establish their optimal gut flora. If your baby was born by cesarean section, or if you did need to have antibiotics in labor, no need to be worried ! Start your baby on a probiotic in the day or so after birth. Klaire makes a product called Therbiotic Infant which is a powder that can be mixed with a tiny amount of breast milk and then be given by eyedropper alongside the breast. Data has shown that while we can’t necessary restore the native flora baby might have had, we can prevent eczema, allergies, and asthma with early probiotic treatment.

By age 24 months, 69% of children in the US have received at least one systemic antibiotic course, though the average is 2.3 courses for ear infections, bronchitis, sore throat, and other common childhood illnesses. Yet according to the Centers for Disease Control, and other official reports, at least 50% and as many as 70% of the antibiotics prescribed for children for these and other symptoms/conditions are unnecessary and inappropriate.

Reactions to antibiotics are responsible for at least 140,000 hospital visits annually in the US. One in every five emergency department visits due to a medication reaction is due to antibiotics, and in kids under 18 years old they are the most common cause of drug reactions. When a child takes an antibiotic that is not needed, not only is she or he getting no benefit; she or he is exposed to all the risks of harm and the use of that medication adds to antibiotic resistance.

Why are antibiotics overprescribed? There are 4 main reasons:

  1. Doctors think that parents expect an antibiotic prescription when they bring their child in for a sick visit – and many do – leading to 50-70% of the antibiotics that are prescribed.
  2. Doctors are afraid to get sued should an infection that they didn’t treat with an antibiotic turn out to be more serious than anticipated.
  3. Doctors don’t feel that they have time to explain the problems with antibiotics to parents in the time allocated for a child’s sick visit, whereas it is quick and easy to prescribe an antibiotic.
  4. Doctors aren’t knowledgeable about alternatives to antibiotics and want to prescribe something they think will help.

The Centers for Disease Control and Prevention (CDC) has been on a several decade-long campaign to get physicians to reduce their antibiotic overprescribing. While there has been about a 20% decrease in antibiotic prescribing over the past 20 years as a result, the rates of overprescribing remain shockingly high, according to the CDC and other researchers.

Antibiotic Resistance: A Global Health Threat

We are in the midst of a global health crisis — antibiotic resistance, which is a direct result over the overprescribing and inappropriate prescribing of antibiotics, and the overuse of antibiotics in the meat industry.

Antibiotic resistance is not something that develops just in the individual – that is, it’s not just that you become resistant to that antibiotic – it means that the bacteria themselves have learned to outwit the antibiotic so that the antibiotic is no longer effective in treating anyone who is infected with the resistant strain.

 

Each year in the US alone over 2 million Americans acquire serious infections with bacteria that are now resistant to some or all of the antibiotics that we have to treat those organisms, and at least 23,000 people die each year as a result of antibiotic resistance. Global leaders in public health have declared that these “nightmare bacteria” pose a catastrophic threat to every person in the world!

5 Steps for Preventing Antibiotic Overuse In Your Child

  1. Promote HEALTH in your children: Preventing recurrent upper respiratory infections including coughs, colds, ear infections, and sore throats is an important and logical step you can take to prevent antibiotic overuse. Less need for them = less use of them! A healthy diet of natural foods with plenty of good quality protein, good quality fats, plenty of fresh vegetables, and low sugar, reduction of chronic stress, playing outside and getting dirty to get exposure to natural probiotics in the soil, and regular handwashing with soap and water (don’t use antibacterial soaps – these also contribute to antibiotic resistance), along with a multivitamin that contains adequate iron, vitamin D, essential fats, and zinc, all support optimal immunity. The gut can also be nourished and the microflora supported with a probiotic such as Therbiotic Infant and Therbiotic Children’s Chewable.
  2. Choose organic for your meats and dairy: While it may not be feasible for you to serve your family an entirely organic diet for economic reasons, at least use only antibiotic- free meats and poultry, and organic dairy. These are where the heavy antibiotic exposures come from in the diet – so it’s where you can make your money count most toward reducing antibiotic exposures.
  3. Know Your Options – Get Smart: The CDC has a website called Get Smart that is dedicated to preventing antibiotic resistance through preventing antibiotic overuse. You can find information on the primary infections for which antibiotics are overused, how to know when your child really does need an antibiotic, and how to avoid unnecessary use. Included is also information on comfort measures and medical alternatives for common symptoms ranging from cough and sore throat, to fever and ear infections. I don’t necessarily agree with all of the CDC’s alternative treatment recommendations, particularly the liberal use of Tylenol and ibuprofen, which have their own potentially serious side-effects, but the overall information is very useful and also provides solid information to bring to your child’s doctor’s appointment to share with the pediatrician in case there is disagreement over whether the antibiotic is necessary and appropriate.
  4. Know Your Rights: Doctors are not infallible nor are we omniscient. And not all doctors are aware of the importance of avoiding antibiotic overprescribing, so some may may insist on the prescription in spite of the CDC’s guidelines. If you cannot reach agreement with your pediatrician, you have the right to seek another opinion or to change doctors. You should not be coerced into giving unnecessary antibiotics to your  child. If your pediatrician is, however, insistent, find out why – she may have a different perspective on your child’s symptoms and of course the CDC guidelines are just that – clinical judgment is also important.
  5. Use natural treatments for the symptoms of common childhood illnesses whenever possible. Below are links to the blogs I have so far on treating common children’s health conditions. You will also be able to access my new E-Book, Herbal Medicines for Kids: Taking Charge of Your Child’s Health…Naturally, in the next few weeks, so keep an eye out for its publication in an upcoming email. My book, Naturally Healthy Babies and Children has been a well-loved guide for many families over the past 20 years, helping them to avoid unnecessary antibiotics for their kids. Also I will publish many more blogs on preventing and treating common illnesses in kids, with an upcoming blog on healing children’s gut and microbiome.

6 Sure Fire Tips for Preventing Kids’ Ear Infections Naturally

Natural Remedies for Kid’s Ear Infections

Sore Throat: Do You (or Your Kids) Need an Antibiotic? + Some Natural Sore Throat Treatments

6 Ways to Avoid Unnecessary Antibiotics & Why You Should

7 Natural Cold Busters (in this blog, modify the zinc dose for kids to be 5-10 mg for children 2-7 years old, 10-20 mg for children 8-12 years old, and 20-40 mg for children over 12 years old).

Protecting your child from antibiotic overuse is not just a matter or personal health. It’s an important contribution you can make toward resolving a pressing public health matter. Please share this article widely and join me in keeping our kids healthy and pharma-free whenever possible! 

With love,

AJR-Sig

 

 

 

 

 

P.S. I’ve got a gift for you!!! Get my FREE Ebook, Herbal Medicines for Kids. To receive your copy, click here. In one easy step it will be delivered to your inbox.

 

Bailey LC et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr 2014 Sep 29

Blaser, M. Stop the killing of beneficial bacteria. Nature. Vol 476, 393-94. Aug. 2011.

CDC. Antibiotic Resistance Threats in the United States, 2013. US Dept of Health and Human Services, Centers for Disease Control and Prevention.

Dooling KL et al. Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997–2010. JAMA Pediatr 2014 Sep 29

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Corrie

Hi Aviva, Thanks for the info. One question: Can you recommend a good multi-vitamin for children? Thanks, Corrie

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    aviva

    Hi Corrie For fish oils I use Nordic Naturals. For a general multi, Rainbow Light is a good company and readily available at places like Whole Foods and online. Professional products I use include Junior Nutrients and Pure Pals by Pure Encapsulations, and VitaSpectrum by Klaire. Also depends on whether a kiddo can swallow caps, prefers a chewie, or will take a powder in a shake. The above options cover all of those bases. Food is still always the best primary source of nutrition for kids. :) Aviva

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amber

Thanks - great article. Do you mind if I print and give to patients and their families as a patient handout? Love your stuff….

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Elise Holcombe

This is a great article. Thank you so much. Im having oral surgery soon which will include some skin grafts; the surgeon wants me to take a course of antibiotics. I am reluctant do to this. Its a short course, 10 days, but I am wondering if I should just not take them. I did mention to the dr. I didnt want to take them and he told me that an infection could prevent the graft from "taking". I definitely dont want to jeopardize that, but Im still not convinced. I would appreciate your thoughts.

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Amber

Do you have any recommendations for treating sinus infections in small children without the use of antibiotics? Both of my boys have had issues with sinus infections and of course I give in and give them antibiotics because I have no idea how to treat and of course the Pediatrician only recommends antibiotics. Also, the last time my son had an ear infection I used the garlic mullein oil to treat instead of the antibiotics his ped perscribed and it worked great! Thanks for that suggestion.

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Claire Graham Kellerman

Healing pneumonia and acute bronchitis can be done without anti-biotics. I proved it this year! :) My doctor said she was so scared I would not take anti-biotics. She was right. Then she said I healed in the same length of time a person taking anti-biotics would take to heal. It took my sincere dedication to natural remedies: vitamin D, Paul Stamets' natural-anti-biotic-mushroom spray, Maui's Alive & Well's Pain Power (anti-inflammatory capsules), polycodon & L.A.'s Jing Herbs' Polycodon & Frittillary chinese herbs to clear my lungs from deep down, hot water with ginger, and lemon, and tea with honey, lots of garlic, and organic foods, green juices, CALM by Peter Gillham Magnesium powder every night in hot water before bed (cheapest source: vitacost.com, size: 16 oz.), and rest, like a mushroom growing on a log-couch-time! 5 movies every day, was great for studying good storytelling. I had to surrender to my body's needs for rest!!! Rest and walks to build strength after lungs were clear. It was quite a journey, but I thank all the healers who have encouraged me to protect THE GOOD GUYS!!! The beneficial bacteria are the foundation of immune health and strength. I got sick from the plane ride from L.A. home to Maui, Hawaii. Now, I am all better! Thank God for the intelligence of our bodies and the grace of listening to it.

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Lourdes

You keep saying "doctor's" with the apostrophe instead of "doctors" and it makes an excellent article seem ignorant. I'm not even wanting to share as is because it is embarrassing. Please correct your grammar and proofread/edit the next time.

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    tracy

    Sorry about that, Lourdes. We do proofread everything that gets published, but we did miss those errors. They have been corrected. Thanks for the tip!

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Autumn

Should babies receive probiotics continuously or just after exposure to antibiotics from birth and if exposed while mom is breastfeeding?

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    aviva

    Great question! If born by cesarean or there were antibiotics at birth, I recommend using them for the first 3 months. For older nursing babies, I'd say for a couple of weeks after mom completes the course is probably a good amount of time -- but there's really no hard data on this. :) Aviva

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Mary Gold

I love your stuff, thank you so much for sharing your knowledge. I hope you don't mind me sharing your work also. I love your saying "own your health, change the world."

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Kathy Kenney

What multi-vitamin do you recommend for toddlers and children as they age? TIA!

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    aviva

    For fish oils I use Nordic Naturals. For a general multi, Rainbow Light is a good company and readily available at places like Whole Foods and online. Professional products I use include Junior Nutrients and Pure Pals by Pure Encapsulations, and VitaSpectrum by Klaire. Also depends on whether a kiddo can swallow caps, prefers a chewie, or will take a powder in a shake. The above options cover all of those bases. Food is still always the best primary source of nutrition for kids. :) Aviva

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Emily

Thank you for sharing your thoughts and research on such an important topic. I was wondering what your thoughts are on treating lyme with antibiotics. My 2 year old son was bitten by a nymph deer tick and a few days later had a fever and vomitted. He got better within the day, making us think it was a stomach virus that was going around. But we were of course concerned and had the lyme titer done. The test came back negative (no surprise, it had only been a week since the bite) and a few days after my husband and I also got a stomach virus, similar to what our son seemed to have. Weighing the possible risk of lyme (especially without good evidence that it's there) with the strong and undesirable effects of antibiotics is unsettling and unclear to me. Would you prescribe antibiotics to a 2 year old after a fever for 3 weeks as a preventative or would you wait and see if any symptoms appear and retest in a few weeks?

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    aviva

    It's absolutely necessary to treat Lyme initially with antibiotics. I wouldn't necessarily prescribe them on the basis of your son's symptoms, but if the criteria were met (tick imbedded > 24 hrs) then yes, I probably would treat. I'd certain at least repeat testing periodically and if any symptoms of Lyme arose, I would treat with antibiotics. I know it's very worrisome. I hope this episode of concern passes quickly and easily for your family!

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Rian

What a perfectly timely article! I am waiting to have my first child, I'm around 40 weeks pregnant right now, and am beta strep positive and will likely have antibiotics during the course of my delivery. I was wondering if you could recommend any other brands of infant probiotics? I live in a remote region of Northern Canada and have been unable to find a Klaire Labs supplier that will ship to me here. Also, will my own diet high in probiotics and a probiotic supplement help with my infants exposure/colonization of flora during birth? Thanks so much for another great (and USEFUL!) post! Rian

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    sally

    Look into that some more.. Many people are geoup-B strep+ and give birth with no I'll affect to their baby. That happened with my third. I didn't go in until right about to birth, so no time for antibiotics (part of my plan to wait). They can just monitor baby for the next 48 hours for signs of infection. Why not wait to see if baby even needs antibiotics vs using them as a precaution?

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Lee

Dr. Romm, can you share your thoughts on the annual flu shot. Are there some natural alternatives that are effective? I also worry about a secondary infection developing especially in young children. Thank you so much.

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    aviva

    Here's an article from a doctor I work with...hope this helps. It is a very personal decision. I don't encourage it for routine use in young children unless they are at high risk -- severe asthma, immunocompromised... http://drhyman.com/blog/2012/10/23/should-i-get-the-flu-shot/

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Amie

Hi Aviva, Any suggestions on how to avoid the antibiotics if a pregnant woman is GBS+? Any research available so I can educate myself?

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    aviva

    Hi Amie, This is a really complicated and extensive subject -- so I periodically give a webinar on it. But more than I can get into in the comments. You might find some answers in the blog called Science and Sensibility...

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Aravinda

Thank you for this article. Can you also advise us on how best to facilitate the process of restoring the micro biome after having a course of antibiotics.

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    aviva

    3 ways: 1.a broad spectrum probiotic 2. a wide variety of green leafy vegetables and also fermented vegetables 3. prebiotics -- for example, larch arabinogalanctans in products that "feed" health gut flora (Yeast Balance Complex has these) and time will also usually restore the flora if the damage wasn't ongoing or severe.

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Rebekah

What is your opinion of long term antibiotic treatment of chronic Lyme disease symptoms when it is a speculative diagnosis, not meeting the criteria of positive lab results, known history of tick bite and remembered initial acute stage etc? Thanks

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    aviva

    Oy - Lyme disease is SO complicated. I do intense screening and if it seems like there is ACTIVE Lyme disease, yes, I do antibiotics - but not usually for chronic Lyme symptoms, and no long term. It's one of the tougher diagnostic and treatment situations though.

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Julia

Hi Aviva, thanks for this valuable information. My baby was born by c-section 5.5 months ago. I've sourced the Klaire infant probiotic and am about to start giving it to her. Can you please give me some guidelines on dosage? Also should I have her on the probiotics for a specific length of time before introducing solids (she is exclusively breastfed)?

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    Megan Liebmann

    Hi Julia, This is Megan from Dr. Aviva's team. If you scroll up through the comments you will see the answers to your questions! Warm wishes, Megan- Dr. Aviva Romm Nutritionist

    Reply
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