About My Two Hats

Thoughts on child health from pediatrician/mom, Dr. Heidi Roman.

Does your child really NEED those antibiotics?

From SparkyI am thrilled to have Dr. Alan Schroeder, my brilliant mentor and friend, contribute a guest post here this week. He tackles an important question that many parents face- does my child really need antibiotics for this illness- and clearly outlines why we must carefully consider the answer.

Does your child really NEED those antibiotics?

by Alan Schroeder, MD

As a pediatric intensive care physician, I am able to witness the miracles of antibiotics firsthand. Thanks to antibiotics, a child with a life-threatening infection can go from being on death’s doorstep to giving me a high-five or an ear-to-ear grin in a relatively short period of time. Antibiotics save lives, irrefutably. They can be considered one of public health’s major victories in the 20th century.

But like so many interventions in health care, there can be too much of a good thing, and antibiotics are a perfect example. In fact, just as the introduction of antibiotics can be considered a major public health victory, the escalating problem of antibiotic resistance can be considered a major public health threat. Antibiotics have been overused, and bacteria have gotten smarter as a result. Increasing numbers of potentially lethal bacteria are emerging that are tough to kill because they are resistant to so many antibiotics. The more antibiotics we use, the more these vicious bugs thrive.

What is driving antibiotic overuse? Antibiotics have been a victim of their own success. Because we have drugs that can kill bacteria, we mistakenly believe that bacterial infections always need antibiotics (they don’t). We also aren’t very good at figuring out whether a given infection is truly caused by a bacteria (most aren’t). Infections are frustrating – our children are miserable, they’re up all night, they can’t go to school, and we can’t go to work. Plus, the fact that they could get even sicker is scary. So it’s natural to want to do something – anything – to make them better, and if there’s even a chance it could be a bacterial infection, why not treat with antibiotics? From the doctor’s perspective, we want to help too. And, we want to keep our customers happy. As we hear often, it’s much easier to write a prescription for a Z-pack (a common antibiotic) than it is to take the time to explain why antibiotics can be harmful and why viruses don’t need antibiotics.

Aside from the problem of antibiotic resistance, antibiotics have other serious consequences. They can cause diarrhea and/or vomiting, and severe allergic reactions. Associations between antibiotic exposure and chronic diseases such as asthma, diabetes, and obesity are increasingly described (note that these are associations and do not prove causation). Another under-appreciated consequence of prescribing antibiotics for viral infections is that many viruses cause rashes. When that rash appears, it is often attributed to the antibiotic. This is probably why most reported antibiotic allergies are not true allergies when formally tested. Once a child is labeled as having an antibiotic allergy, it makes it much more difficult to choose an appropriate antibiotic if one is truly needed in the future, and stronger antibiotics may be prescribed.

Here are some areas where we can combat antibiotic overuse:

1.) Ear infections. First, what looks like an ear infection to one physician may look like a normal ear to another. The ear drum can be hard to see, especially in a cranky child who resists the exam, or if there’s a lot of wax. So, make sure it’s a real infection. Second, most ear infections go away on their own. In one of the largest studies on the treatment of ear infections, 80% of the children treated with antibiotics were completely better by 7 days vs 75% who received a placebo. The American Academy of Pediatrics does not recommend antibiotics for all ear infections, just severe ones. This means you don’t necessarily need to rush your child into the doctor if you think he or she has an ear infection – consider trying some pain relief first.

2.) Cough and colds. Viral upper respiratory infections are probably the most common scenario where unnecessary antibiotics are prescribed. As tempting as it seems to take antibiotics, they don’t help and may make things worse. And be aware that if you take your child to his or her doctor, the doctor may get the impression that you are there because you want a prescription, so be sure to voice your concerns about antibiotics.

3.) Strep throat. The routine use of antibiotics to treat strep throat has not necessarily been motivated by a desire to make kids feel better (they aren’t great at doing that), but rather to prevent a complication called rheumatic fever. However, rheumatic fever is much less common now, so the probability of having a serious allergic reaction to the antibiotic is substantially higher than the probability of getting rheumatic fever without the antibiotic. While there may be other reasons to treat strep throat (namely, your child can go back to school sooner), similar to ear infections, there is no need to rush your child to the doctor when he or she complains of a sore throat.

4.) Antibiotics in meat. Even if your child has never taken antibiotics, if they eat meat they’ve probably been exposed to antibiotics on multiple occasions. California has recently enacted legislation to forbid animals from being raised with antibiotics. Hopefully, other states will follow. In the meantime, it’s worth spending a few extra bucks on antibiotic-free meats (or limiting meats altogether) if you can afford it.

There are multiple efforts underway to combat antibiotic overuse.The CDC’s Get Smart about Antibiotics Week is coming up in mid-November. Similarly, working with the Lown Institute during their Right Care Action Week, we recently led an initiative to promote antibiotic stewardship, and have had nearly 300 pediatric healthcare providers sign a pledge committing to this topic. Still, 300 committed pediatric providers is not enough! We all need to work together to make sure that antibiotics are provided to the kids who really need them, but avoided in those who don’t.

Dr. Schroeder is the medical director of the Pediatric Intensive Care Unit and Chief of Inpatient Pediatric Services at Santa Clara Valley Medical Center in San Jose, California, and a clinical associate professor of pediatrics (affiliate) at the Stanford University School of Medicine. His research interests focus on identifying areas where we can “safely do less” in healthcare. Follow him on twitter @safelydoingless


Last July I left the Bay Area after living there for ten years. This summer, I returned to visit for the first time. I found myself awash in thoughts of “home”. Here I was, in a place that never truly felt like what I conceptualized as home while I lived there, and yet I felt nostalgic. The familiar streets. The old haunts. The place where I became a mom and pediatrician. The people. It’s the people. My people. The friends who became family. The people around whom you can be completely yourself without a second thought. Is that what “home” is?


Yet, home is also now Dallas. Of course it is. Home is where my husband and son are. It is where my job is. It is where, after a year, we are starting to build a community and already have dear friends. It’s just not quite as worn-in yet. Not quite as easy and comfortable. It still requires a GPS. But it’s “home”, right?


Because, deep down, in a way I didn’t fully appreciate prior to spending a decade moving around, home is also where I spent my childhood. Wisconsin. Home is where my family is. Where I grew into the person I am. Where I have lifelong friends who just know me. Where the way things are done is expected and familiar. At least that’s how I imagine it. Perhaps it is a nostalgic lens. If I lived there now would it feel the same? After all of this time, would the glove still fit?


And that’s when I start wishing for a teleporter. Because home is, of course, all of these. And while there is a twinge of envy for those who have all of these homes in one place, I wouldn’t change a thing. Each of these “homes” is now weaved together into the fabric of my life.

They say you can’t go home again. But maybe you already are.


Time Flies

A glance at the clock
as I finish the dishes
tells me it’s 7:13

So that’s it I think;
A few bedtime stories and
The sun is gone
The day is done

Just a few hours with you

Feels like a second ago
that a glance at the clock
as we ran out the door
told me it was 7:13

The hours in between:
Fast, fulfilling
Slow, missing you

The push-pull
The balance ever teetering
Until I think,

Instead of having it all
I’d settle for having it together

For just a few more hours with you

And sure it’s cliche
It’s all been said before
But not by me
At least not here

And so I’ll say it:
Time flies.

All I can do
Is hope I’m passing it well

One Word for 2015: Gratitude

Screen Shot 2015-01-17 at 8.47.30 PMAt the start of each of the last few years I’ve focused on words instead of specific resolutions and have found it much more meaningful and effective. In 2013 it was Decide, Attend, and Play. Last year I added Focus, Accept, and Sleep. This year I’m going to try something a little different. I’m going to continue to think about the good words I’ve already got and add only one more: Gratitude.

2014 brought its share of challenges and I frankly wasn’t all that sad to see it go. But, as I reflect on the year that was, I realize that I was also blessed with many great memories shared with wonderful people, and that the “bad” stuff wasn’t really as hard as it might have felt in the moment. I see now that things started to look up when I began to shift my focus and think about all that I was grateful for.

I also know that I want to raise a kind and generous son who is able to cultivate gratitude (more on this in a future post). And, I know that if I want to do this, I must model it myself.

So 2015 will be a year of daily reflection on gratitude in both abstract and more concrete ways:

  • Last November we started a bedtime routine of sharing one thing we were grateful for during the day. It has been revealing, wonderful, and at times very humorous (my son has, on more than occasion, mentioned his gratitude for lunch). We’re continuing this practice in 2015 and I’ve started a gratitude journal to keep track.
  • This year I’ll be more mindful of the amazing people in my life and more vocal in my appreciation for all they do and are. I’ll share more compliments. I’ll be better about staying in touch. I’ll do all I can to be with loved ones.
  • I’ll spend time outdoors each and every day. Wow, writing that down it sounds pretty audacious, but it’s gonna happen. Even if it’s cold (or hot) and even if it’s only 10 minutes. The beauty of the world around us never fails to improve my mood and inspire gratitude for the profound gift of life itself.

I’ll leave you with this lovely 6 minute video which pairs beautiful images with a message of gratitude and mindfulness including, “You think this is just another day in your life. It’s not just another day. It’s the one day that is given to you. Today. It is given to you. It’s a gift.”

The Cure for a Case of the Bah Humbugs

I must admit that I occasionally come down with a case of the “bah humbugs” this time of year. The etiology seems to be multi-factorial. Distance from both sides of our extended family and commercialization of the holiday season both contribute. Reading the news doesn’t help. This year, I’m particularly struck by the fact that for most of the kids I take care of the holiday season is actually a pretty difficult time of year. Whatever the cause, there are times that I just haven’t been feelin’ that holiday spirit.

Luckily, I have found a sure fire cure for this malaise. Continue reading


It’s when I’m putting my son to bed at night that I feel it most acutely. Smelling his hair. Watching him breathe. It overwhelms me. There’s a name for what I’m feeling. Vulnerable.

Absolute and total vulnerability. Vulnerability that comes from a love so profound it cannot be described. I think, no one told me about this part of parenting. But then I think that even if they had I wouldn’t have understood. Heart on my sleeve isn’t the half of it. Continue reading

Helping Young Kids Adjust to a Move

7736032314_5c69699f36_qIt’s funny, growing up I didn’t really move at all. I lived in the same house in a small midwestern town from age 2 to 18. But, since leaving home for college I’ve had my share of moves. Seventeen different abodes in now three states. I didn’t really mean to turn into a nomad, it just sort of happened. You get pretty good at paring down belongings and change of address notifications. Continue reading

Sleep, Mama, Sleep

IMG_1658When my son was an infant (and not the greatest sleeper), we’d rock and listen to lullabies. We listened to one CD so many times that many of the songs are seared into my brain. I remember one song in particular. “Sleep, baby, sleep. It is time to close your eyes.” I’d sing along, willing the words to come true. Continue reading