A Letter to my Younger Self, on the Eve of my 40th Birthday

screen-shot-2017-02-15-at-6-52-59-pm

Dear Heidi,

First off, let’s get one thing straight. Forty years old is very, very young. Really, it is. You won’t believe how young 40 is.

Now that we have that basic truth out of the way, let me tell you some things I wish you had known a little earlier in life.

Pinot noir and gouda are both excellent.

Laugh more. Don’t take everything so seriously.

Getting pregnant and having a baby is a miracle. Never take it for granted.

Eat a little dark chocolate most days. It is delicious and is also apparently good for you. Win, win. Don’t eat very many other sweets. You don’t like them much anyway.

Trust your gut.

Being a mom is the most amazing thing you’ll ever do. Hands down. Cliche, but true. And the kid– wow. Just wait til you meet him.

There will be a day when you think coffee tastes better without cream and sugar. Crazy, I know.

You can’t go home again. Or, maybe you can, but it is a very long and winding road.

You’re wearing the wrong bra size (along with the majority of women). Go get fitted and spend some money on high-quality bras. Totally worth it.

Most people are so busy worrying about their own lives that they are not paying much attention to you. Don’t worry so much about what people think.

Wear sunscreen and sunglasses.

Primary care for vulnerable kids is not the most glamorous part of medicine. No matter. Do not doubt your decision. This is your calling.

Lift some weights. You’ll love it. I’m not kidding.

You’ll make mistakes- in medicine and in life. Try your best to learn from them and move on. Don’t beat yourself up. You are still not very good at this.

Be kind. Be yourself. Love deeply. Let the rest fall away.

The Upstander: How They Stand Up to Bullying

The following post was written by guest author, Dr. Shelagh Dunn.

Although I didn’t know it at the time, I’m pretty sure I chose the research topic of my doctoral dissertation for personal reasons. I studied upstanders to bullying by interviewing middle school students who stood up to bullying in their schools. I thought I might someday be helping teachers and schools to lessen bullying. But it turns out that the students I was studying were my teachers. I learned so much about how to be an effective citizen and a decent human being from these student upstanders. You see, I used to see violence in the news and feel horror and pain but not know what to do about it. These students knew these feelings too but they also possessed a wisdom and resolve that I’m still only learning about. I’d like to share some of what I’ve learned with you. We need their knowledge now more than ever.

Why am I talking about bullying right now? Well, it’s common to think of bullying in schools as “kids being kids” or to say “kids can be so cruel” and dismiss the cruelty of bullying as something that children grow out of. I don’t see it this way at all. What I’ve come to learn is that bullying is a microcosm of our society. Children are using their eyes and ears to absorb the world around them and they act it out with one another at school. It is not surprising to hear that right now there are increasing reports of bullying in schools targeting race, faith, and gender, when these very things are being targeted by politicians in the media.

But here’s the thing, stopping bullying is hard, in part because being an upstander is hard. As adults, we do not have this figured out. Most of us don’t know what to do when we witness violence, discrimination or hate, and even if we know what to do, we sometimes don’t do it. In the 1950’s a psychologist named Asch found that when a person is shown lines of obviously different lengths and asked to tell which line is the shortest, they can easily do so… unless they are in a room of people purposefully giving the wrong answer. In these cases, most people will give in and give the same answer as the group even when they know it is wrong. It’s just too hard to be the only one in a group saying something different. There is also another phenomenon acting against us called the “bystander effect” which shows that people will not come to the aid of someone in need as often if there are others around, because we believe that someone else will help. All of this means that there are incredible social forces acting on us to prevent us from intervening when we witness something like bullying, discrimination, or hate-fuelled behavior. We don’t want to be different, we think someone else will do it. Add in the threat of social and physical harm that can come with taking this stuff on and it becomes a very special and unique quality to be an upstander.

So how are some people able to be upstanders? Here’s what the students I interviewed had to say. They all told me that they had been bullied themselves at least once before and had a strong sense of empathy for others being bullied. They all told me that they knew bullying was wrong and they had to do something about it. They all told me that they didn’t care so much about what other students thought of them, they were not afraid to be different. Most of them used specific tactics to intervene using the means that they had available. Most of them took on what I realized was the identity of an upstander – it wasn’t just something they did, it was something they were. It became a part of their moral character to do the right thing even when it’s hard.

We can learn to adopt these qualities and teach them to our kids. Empathy. Resolve. Being unafraid to be different. There are strategies and places to start. As we practice using our empathy, using our voice, and listening to our own sense of right and wrong, even when everyone else around us is silent, here are a very specific set of instructions from these students to their peers and teachers, reprinted here for you to think about.

screen-shot-2017-02-04-at-4-09-11-pm

If you think these instructions might help a school deal with bullying, please try them out. But here is my real challenge to you. If bullying is the microcosm, then we adults live in the macrocosm. Look at the list of actions above. Pick one. Do it today. Sleep. Repeat. Your children are watching.

“In the end, we will remember not the words of our enemies but the silence of our friends.” – Dr. Martin Luther King Jr.

Dr. Shelagh Dunn is a Registered Psychologist in Edmonton, Alberta, Canada. She has a private practice in counselling psychology, with an interest in positive psychology and the health benefits of creating social change.

10 Things I’m Doing Right Now

 

screen-shot-2017-01-29-at-9-08-21-am

Credit: David Sipress, The New Yorker

 

I’ve seen this graphic shared a number of times recently and I think it is something many are feeling these days. I know I am. I certainly do not have all of the answers (by any stretch) but here are 10 things I’m doing right now to try to find balance and peace.

1. Reach out to one friend or family member each day. Whether via text, email, call, or in-person, it feels like an important time to maintain our existing personal connections and build new ones.

2. Meditate 10 minutes (minimum) each day.

3. Place boundaries on social media. Now, more than ever, I need to control my media consumption instead of it controlling me. Giving my phone an early bedtime was the first (very effective) step.

4. Stay informed but carefully choose my sources. Facebook will not be my primary news source.

5. Place one call to a legislator each day. It is hard to know whether this will make a difference. But I do know one thing that will definitely not make an impact- doing nothing.

6. Read a little each day. If it is fiction, so much the better. Write a little each day. Whatever comes to me; and however short- not for any particular reason except that it makes me a better person.

7. Continue to get to know my Dallas community. Serve others locally as often as I can.

8. Dig deep into my roles as mother and pediatrician. Our children need us to be fully present with them; to support, guide, explain, and above all, to listen.

9. Practice and share self-care and wellness strategies. For me these include daily exercise, prioritizing sleep, and good nutrition.

10. Double down on radical love and kindness. There is no other way.

Healthy, Kid-Approved Meals and Snacks

screen-shot-2017-01-08-at-8-46-28-amWe do a fairly good job of eating healthy at our house, particularly for dinner, but we have recently been in a rut with healthy options that my 6-year-old will actually eat for breakfast, lunch, and after school snacks. He’s also at the age where he likes to get involved in food choices and (occasionally) food preparation.

So, to mix things up a bit I crowd-sourced for new ideas this week (and boy did folks come through with some great ideas)! My plan for 2017 is to have this chart up on the fridge and involve my son in meal planning. Each Saturday before grocery shopping he can pick two items from each category and I’ll make sure we have the ingredients on hand for the following week. During my usual Sunday meal prep, I’m going to try to involve him in getting his own BF/lunch/snacks ready for the week.

Additional helpful resources:

Super Snacks for Super Kids by Sarah Fox MD and Julie Stephenson

Emi Ponce de Souza

This is a living document so if you have more ideas or helpful resources, please share in the comments. The first PDF includes our ideas, the second is left blank for your family’s imagination. I’ll let you know how it goes!

Kid-Approved Breakfast, Lunch, and Snacks PDF: kidapprovedbls

Kid-Approved Breakfast, Lunch, and Snacks (blank) PDF: blankbls

A Return to Cooking

FullSizeRender-2Over the last six months I have placed serious, focused attention on taking better care of myself. A huge part of this has been a long-needed return to daily exercise. More on this in future posts, but today my focus is on nutrition and, more specifically, cooking meals at home.

My love of cooking is long-standing. I was blessed with two grandmothers who could prepare delicious feasts, almost magically, for large family gatherings. Only now do I appreciate what an undertaking each of those meals was for them. What a true expression of love. I have parents who, despite both working outside of the home, managed to prepare a home-cooked meal for our family almost every night. My mom– her famous lasagna or hamburger pie; my dad his skillet experiments (or hot dogs and peas :). Only now do I understand the effort and planning that required, day-in and day-out.

My own interest in cooking and baking started in middle school. A friend and I baked cookies and planned a future baking company. Another friend and I prepared a “cooking show” video outlining the process needed to create lefse (a traditional Norwegian staple).

In high school I asked my Grandma K to write down some of her famous recipes so that I could attempt to recreate them. In usual fashion, she outdid herself — I have a now treasured collection of recipes in her own handwriting. Little did I know then how much I would one day miss her — both her unconditional love and the food that channeled it.

College is a blur, but I didn’t cook much. The dorms weren’t great for cooking, nor the cafeteria for my waistline, but I wouldn’t trade the meals shared there with great friends for anything.

Contrary to expectations, medical school actually brought cooking back to me. A dear friend and I shared an apartment all four years. From her I learned about the art of vegetarian cooking and the wonder that is Indian food.

No, it was not medical school that led me to lose my love of cooking. Residency earns that distinction. 30 hour shifts followed by microwave popcorn and sleep. More take-out than I care to remember. The joy of cooking was gone. It felt more like a chore for which I simply could not muster up the energy.

Slowly, but surely, my love of cooking has found its way back over the last eight years. First, out of love for my child, I experimented with home-made baby food and simple healthy meals as he grew. I started to favor Trader Joe’s over take-out.

But, I must admit that it was not until the last few months that cooking has again become something I look forward to instead of a simple necessity. For this, I credit my fabulous wellness group, growing concern about the ingredients in processed foods, and an ever increasing desire to serve as a role-model for my son. We grow simple plants like tomatoes and herbs in the hopes that he will begin to appreciate where food comes from. I experiment with a variety of ingredients in order to expand his palate and help him learn that healthy food can be delicious. And, I involve him in the food preparation, with the goal that he grows into a man who is comfortable in the kitchen.

I now spend a couple of hours each weekend planning and prepping our meals for the week. This past Sunday I was once again reminded that following a well-written recipe can be an almost meditative process— a peaceful way to start the week or end the day. I felt the warmth and satisfaction of a dish that turned out better than expected. The joy of knowing that we were placing delicious and healthy food into our bodies.

I may not be preparing a feast for twenty guests. Still, I think my Grandmas would be proud.

Digital Sabbath

Webster’s defines mindfulness as “the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis.”

With the aim of increasing mindfulness, this week I did something I have not done in a very long time— I completely unplugged for 36 hours. No computer. No phone. No internet connection. It was a complete digital sabbath and it was amazing.

It probably helped that I took this digital sabbath while staying in a cabin overlooking a beautiful bluff and surrounded by trees, but I came away from the experience more fully relaxed and with more mental clarity than I have had in a long time. My attention span feels longer. I am more fully engaged with my son when he’s talking to me. That nagging urge to check my phone, which often causes me to feel irritated with myself, is gone. I can be present and mindful about whatever I’m doing right now. The rest can wait. Not surprisingly, given the strength of the mind-body connection, I also feel more physically energized and ready to tackle my fitness goals in the coming weeks.

Given all of these benefits, I am more committed than ever to the two digital sabbath days per month that I have promised myself as part of our family media plan.

How are you cultivating mindfulness?

10288787_10153965199992889_700700251153272589_n

Making a Family Media Use Plan

IMG_2557I have long thought about the importance of being mindful regarding our son’s media use. We have verbalized daily time limits that we try to stick to and I monitor content of his screen time fairly closely. This does not mean we are perfect or that we don’t have setbacks. Over the holidays we strayed fairly far from our from our usual limits and have not quite gotten back to where we should be.  I’m taking a piece of my own advice and writing down a family media plan. Here are the important elements:

  • Quantity: It is important for families to think about how much screen time they consider reasonable for their children. The American Academy of Pediatrics has long recommended no screen time for children under two and a maximum of two hours for all other children, but has recently acknowledged that this is not the reality for most families. Data from Common Sense Media (2013) tells us that kids between 8-10 years old have an average of 8 hours of media exposure per day, and teenagers have in excess of a whopping 11 hours per day of screen time. This is more than time spent sleeping or time in school! Clearly, we need to get a handle on this stuff. Why are limits important? Excess screen time has been associated with problems like obesity, disordered sleep, and behavior problems. Perhaps most importantly, any time spent in front of a screen is less time spent interacting as a family. It is helpful to set “device curfews” and to keep all devices and screens out of bedrooms.

 

  • Quality: More and more, we are learning that it is not only the quantity of screen time that matters, but also the quality. Our family is pretty good in this regard. I use Common Sense Media as a guide to gauge the appropriateness of any videos or apps my son is viewing. Any program with adult content is off-limits. For any shows that are borderline, we watch together to provide context and share any teachable moments. Recent data suggests that certain “pro-social” media can be beneficial in teaching empathy, respect for other cultures, and in sending anti-bullying messages. Researchers are also exploring how interactive media, such as iPad use, may influence kids in different ways than more passive media exposure. More to come certainly, and it is well worth our time as parents to stay abreast of developments.

 

  • Role-modeling: An essential component of any family media use plan is to address parents’ media use and set limits for ourselves as well as our kids. This is important from a role-modeling perspective, but it is also important from a relationship perspective. A recent small study observed 55 parents’ behavior with their children while eating together at a restaurant. 40 of the 55 parents looked at a device during the meal. Researchers found that the more immersed a parent was with their device, the more harshly they responded to their children, even if the child’s request was simply asking for help with their food. My own personal goal is to stay off devices between the time I get home from work and the time my son is asleep. I don’t always succeed, but I’m recommitting to it in writing here. My son knows he can hold me accountable. Kids are much more likely to buy in to a media plan if they see that their parents have to follow the rules as well.

 

  • Safety: All media use plans should address safety. Do whatever you need to in order to refrain from using your phone while driving. For many of us this means placing the phone out of our reach. There are also now apps that make it impossible to text and drive. Consider installing one if the pull of the phone is just too great. For those with older children, being thoughtful about when they are allowed to enter the social media world is highly important. Having conversations about cyberbullying and being a good digital citizen are essential. For more information on these topics, take a look at the American Academy of Pediatrics’ excellent resource, SafetyNet.

How this looks for our family:

Quantity: We have a limit of 30 minutes of screen time for my son on weekdays. I’d rather this was zero, but frankly I really enjoy relaxing together on the couch after dinner, so I’m staying realistic on this for now. He has a two hour max on the weekends. These limits seem realistic, but require discipline. I am going to set more timers to avoid some of the “just a few more minutes” that easily turn into an extra hour on weekend mornings.

Quality: We will continue to use Common Sense Media to gauge appropriateness and to co-view with our son whenever possible. I will explore more interactive, educational apps and games and try to decrease the percentage of my son’s screen time that is passive viewing.

Role-modeling: Perhaps the most challenging section, but here goes. I’ve installed the “moment” app on my phone that lets me know how much time I’m spending looking at my phone each day. It also counts the number of times I pick it up. This has been eye-opening. I’m using this tool to help me stay under a total time goal per day. I’m also pledging to stay off my phone from the time I get home until the time my son is asleep, and he knows this and will help keep me accountable. I’m going to take a “digital sabbath” twice a month- two days a month when I am completely off-line. I will turn off all devices at least 30 minutes before my desired sleep time (this should probably be an hour, and I’ll work towards that by the end of the year).

Safety: Intentional, continued commitment to no texting or looking at the phone while driving. No excuses. No exceptions. For me, this means always remembering to set my audio book or music selection prior to starting out.

Do you have a family media use plan?

Forward

IMG_1756In lieu of more traditional resolutions, I have started the last few years by setting intentions. I find that choosing a word or two helps me to refocus on these intentions whenever I get bogged down in the day-to-day as the year progresses. 2015’s word was gratitude and I’ll tell you what, I’m keeping that one. Ending each day talking with my son about what we are each grateful for has become a very meaningful habit.

The word I’m choosing as a theme of sorts for 2016 is forward. Perhaps it appeals to me in part as the motto of my home state; and it also accurately represents where I’m at in many facets of my life right now.

I don’t mean forward in a “let’s rush and get this over” kind of way. In fact, most days I’d like to slow things down a bit. No, I mean forward progress. I mean a commitment to taking baby steps each day that slowly move the ball down the field in different areas of my life. A mindful, grateful movement towards more meaning, more joy, more organization. It is all too easy to go through the motions of the busy days. I sometimes get mired in the details and lose sight of my overall direction. Forest and trees and all of that. It’s easy to feel a bit stuck.

This year I’m shaking that off. I pledge to work on balancing gratitude for all that is with hope for all that can be. And, it won’t just be ethereal hope. I’m backing up that hope with a few concrete actions to get things moving.

  • Work: My work can be fairly intense. It is also exceptionally meaningful, and for that I am grateful. This year I am going to make a few concrete changes that I hope will keep me effective, but improve my ability to set boundaries, stress less, and focus more energy on forward progress in a few specific goals. In order to do this I’m tinkering with a new approach to the all-consuming beast that is work email and an overhaul of my (endless) to-do lists. I’ll let you know how it goes.
  • Home: By leaving more of work at work, I’m aiming to lean in at home by focusing on small, daily joys. I’ll work on keeping the time I have with my family mindful and positive. I’m hoping for forward movement in our ability to stick to daily screen time limits (for all of us!) in order to make more time for things like puzzles and games and legos and soccer and the park. These are the moments that my son invariably recalls as the “best part of the day” when we reflect at bedtime (well, that and Pokemon as of late). And we will continue our cherished bedtime reading.
  • Self: Over the past six months I made huge forward strides in taking care of myself. I kicked out the self-talk that told me I didn’t have time to exercise, decided I couldn’t afford NOT to exercise, and am now working out six days a week. This one change has brought with it the energy and focus that has inspired a completely new outlook and, indeed, inspired my choice of word this year. I managed to convince myself that sustainable change is possible when it comes to taking care of myself and there is no going back. If this change is possible so are others. More about this in future posts, but I am eternally grateful to Renee Paro and the other fabulous women in our wellness group who helped to set me on this path. I’ll be building on this with continued forward progress in physical fitness and work on mindset via daily reading and writing (even if it’s just ten minutes).

It all sounds a bit audacious written here. So be it. As they say in Texas, go big or go home. And so, here I go. Onward and upward. In kindness, in gratitude, in respect for all living beings. Forward.

What’s your word for this year?

My Favorite Books of 2015

As I did last year, I’m ending 2015 reflecting on all of the wonderful books I read this past year and I again feel sincere gratitude for all of the richness that reading has brought into my life- wonder, laughter, learning- it all can’t really be expressed. Reading has also brought many wonderful moments with my son and has sparked such interesting conversations. This is also the first year that my son can read to me– which brings an entirely new level of amazement and joy as a parent.

Here are a few of my most meaningful reads of 2015.

Screen Shot 2015-12-31 at 11.01.04 AM

Middlemarch by George Eliot: I am not sure how I missed this gem until now. It did not cross my path during high school or undergraduate studies, but my goodness am I pleased that I picked it up. It is simply wonderful. This book is a time investment but is absolutely worth it. Its pages contain complex, well-developed characters whose lives intertwine in interesting and unexpected ways. It is at turns funny, tragic, dark, uplifting. Eliot’s writing is smart and beautiful. What most rings true, even today, is her message of the importance of everyday kindnesses and the impact of each life (even those uncelebrated) on the way the world unfolds. Middlemarch is definitely, and unexpectedly, among my top 10 favorite books.

Screen Shot 2015-12-31 at 11.13.09 AM

The Ramona series by Beverly Cleary:  Unlike Middlemarch, this was a return to familiar, beloved territory. I remembered the Ramona series as one of the favorites of my youth. This time, my son and I set off on reading them aloud together. I find Cleary’s series about spunky Ramona and her family perhaps even more meaningful as a parent. We are through the first 4 in the series, and so far I think Ramona the Pest might be my son’s favorite (he definitely identified as a fellow 5-year-old starting kindergarten). My own favorite this time around might be “Ramona and Her Father“, with its themes of a family sticking together through hard times and a child dealing with not always being able to get what she wants. All are wonderful, though, and have sparked really cool bedtime conversations.

Screen Shot 2015-12-31 at 11.22.01 AM

All the Light We Cannot See by Anthony Doerr: Written with exquisite attention to detail and obvious care in the choice and placement of each and every word, this book rose above most others for me this year. The characters are so well developed and vividly described that the reader comes to care deeply about them. Doerr somehow managed to illuminate a part of World War II that I had not carefully considered before, despite reading a number of books on the subject. My only (small) criticism is that I wonder if he should have ended the book sooner, leaving us with the characters as they were at the end of the war. Regardless, a unique and wonderful read.

Screen Shot 2015-12-31 at 2.24.35 PM

Wonder by R.J. Palacio: As someone who cares for many kids who are unique or different in some way, this book really spoke to me. Palacio weaves lessons on kindness and celebration of differences into the story of one very unique boy’s life. I love that the story is told not only from the point of view of the main character, but also touches on the impact for his parents and sibling, perspectives that are sometimes lost when there is a child with special needs, in my experience. My bet is that reading this book would send a much more powerful anti-bullying message to kids than almost any lecture on the topic, and I hope that all middle schoolers and their parents will read Wonder at some point.

Screen Shot 2015-12-31 at 2.36.04 PM

Gumption: Relighting the Torch of Freedom with America’s Gutsiest Troublemakers by Nick Offerman: As a big fan of the television show “Parks and Recreation” I decided to read all of the recent books authored by its cast members. I was quite surprised that Offerman’s offering (sorry, couldn’t resist) rose to the top for me (although I did really like Poehler’s “Yes, Please” and may go back and read it again now that I’ve finished the TV series). Gumption was a very enjoyable read (and lots of fun as an audio book read by the author). The book is made up of short biographies of 21 Americans mixed with Offerman’s own take on living a meaningful life. My only criticism is that he could have EASILY found a few more women to include (although he does admit this shortcoming). My takeaways from Offerman for living a life of gumption:
-Spend time engaged in hard work that is meaningful to you.
-Be kind.
-Read a lot of books.
-Get outside.
-Make stuff.
-Take time away from technology.
-Follow your dreams and remain hopeful even when the going gets tough.
-Laugh every day and don’t take yourself too seriously.

Pretty decent message, I’d say.

I read a lot of other great books this year. Three that could have easily been above are, “A Monster Calls” by Patrick Ness, “Congratulations By The Way: Some Thoughts on Kindness” by George Saunders and “The Little Prince” by Antoine de Saint-Exupéry, which I had (shockingly, I know) never read before, and I’m glad to have that remedied.

What were your favorite books this year? I’d love to get some suggestions for 2016. I’m upping the ante for myself again this year with an audacious Reading Challenge over at Goodreads. Want to join me?

 

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