Health & Safety
Diagnosis
By Alex White, M.D.
With the cold and flu season just a few months away, here is some practical information that will help you better understand your child’s illness and what steps to take to ensure proper treatment. As always, we strongly encourage a partnership between parents and physicians to provide the most prudent care based on the most up-to-date information.
One of the most common diagnoses is Pharyngitis. This is another term for a sore throat, a condition that may result from a range of causes such as a viral infection, Strep infection and post-nasal drip. Antimicrobial therapy (antibiotics) should not be given to a child complaining of a sore throat unless Group A Streptococcal (Strep Throat) or other bacterial infections have been identified. The classic symptoms of Strep Throat are acute onset of throat pain, painful swallowing and fever. Some related symptoms include headache, swollen lymph nodes, abdominal pain or vomiting. If symptoms such as a runny nose, cough, hoarseness, conjunctivitis (Pink Eye) or diarrhea are present, this points to a viral cause of infection. Children with Strep Throat will have a red throat with white patches or exudates. The gold standard for testing Strep Throat is a rapid Strep test followed by a throat culture. The CDC (Center for Disease Control and Prevention) recommends that only when rapid Strep is positive in the doctor&
Another common diagnosis is Otitis Media. This is also known as “middle ear infection” or simply “ear infection.” Ear infections are a common illness of children of all ages. Those less than 2 years old who attend daycare are at the greatest risk. Symptoms generally include severe ear pain and fever, with and without drainage. These symptoms are often accompanied by a cough and runny nose. In infants, the first signs of infection may simply be excessive rubbing or tugging at the ears. All children with suspected ear infections should be evaluated by a physician.
The CDC recommends treatment for all acute ear infections since the majority are caused by bacteria. The most common bacteria, Streptococcus pneumoniae, accounts for 40 to 50 percent of all cases. The first-line treatment for this common ear infection is Amoxicillin. Symptoms should improve two to three days after beginning the medication. If symptoms do not improve, parents should bring their children in for re-evaluation.
However, after proper treatment, which includes both adequate dosing by the health care professional and parents properly administering the antibiotics, many children continue with a pressure-type discomfort. This is usually caused by a fluid buildup behind the ear drum and doesn’t require further treatment. These persistent effusions are present in up to 70 percent of appropriately treated children at 10 days and can linger for up to six months. A cough is a frequent symptom of the common cold and may linger after all other symptoms subside. Regardless of the duration, nonspecific cough or bronchitis rarely warrants antimicrobial treatment. The most likely cause of cough, even a productive one, is a virus. It is, however, recommended that if a child’s cough persists for more than 10 days, you should seek evaluation by a health professional. Young children, 5 years of age or older, have little risk of developing bacterial-induced cough. However, bacterial infections including mycoplasma and chlamydi
Although antibiotics are recommended for these bacterial infections, in most healthy children, infections are also self-limiting. Studies also reveal that antibiotics do not prevent or decrease the severity of bacterial complications. This implies that if a child receives antibiotic treatment early in the course of a viral
illness, it may not protect him from complications, such as middle ear infections or pneumonia. Of course, there is always an exception. If your child suffers from
asthma or a reactive airway disease, seek evaluation by a physician. However, the usual treatment will consist of control and management of the symptoms.
This article is intended to familiarize parents with some of the more common diagnoses of illnesses of their children. The need for evaluation and treatment should be left up to the judgment of the parents and the physician based on each individual’s symptoms and physical findings.