Every new parent knows how scary it is to watch their little one spike a fever and develop signs of illness. When your baby is so small and helpless, even the most minor of symptoms can seem like a very big deal. So it’s no wonder that so many parents are quick to reach for the phone and ask their child’s pediatrician for antibiotics to help get them well.
But new research warns against opting for medication too quickly.
In a study published in the journal Mayo Clinic Proceedings, researchers looked at 14,572 children born in Olmsted County, Minn., between 2003 and 2011. Of the children being observed, 70 percent had received at least one antibiotic prescription (primarily for respiratory or ear infections) during their first two years of life.
The findings were concerning, with researchers noting this early antibiotic use was later associated with a greater risk of developing childhood-onset asthma, respiratory allergies, eczema, celiac disease, obesity and attention deficit hyperactivity disorder.
The association between early antibiotic use and the development of chronic conditions became stronger the more rounds of antibiotics a child had been given.
But what do these findings mean, exactly? And how should they impact the decisions parents make from this point forward when their little ones become sick?
Understanding the Association
Martin Blaser, M.D., co-author of the latest report, serves as director of the Center for Advanced Biotechnology and Medicine at Rutgers and Henry Rutgers Chair of the Human Microbiome.
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He said that the key to understanding the most recent findings starts with what we’ve learned about the importance of the microbiome (the microbes that live in and on us) over the last 15 years.
“The microbiome is largely inherited from mom and develops its new form in babies,” Blaser explained, noting that the first 3 years of life are crucial to healthy development. “That also is the period of life when babies are developing their immunity, metabolism, and cognition. This is the critical time, and we have shown experimentally in mice that even a transient perturbing of the microbiome can have long-lasting metabolic and immunological effects.”
Researchers hypothesized the impact early antibiotic exposure has on the development of this microbiome can cause enough harm to increase the risk of developing a chronic condition later in life.
But Daniel Ganjian, MD, pediatrician at Providence Saint John’s Health Center in Santa Monica, said it’s important to not jump to conclusions too quickly.
“Association is not causation,” Ganjian explained. “The title [of the latest report] says it is associated, but it does not mean it causes those conditions.”
He said it is possible, at least, that these conditions affect the immune system and predispose young children to getting bacterial infections more easily.
Meaning there is still plenty for further research to explore.
The Association With Younger Children
The latest research specifically notes this association in children given antibiotics prior to the age of 2, even though researchers followed study participants for eight years. So why wasn’t a similar association identified for children given antibiotics at age 3 or 4?
“This is because the first 3 years are the most crucial, and in fact, the first year is most crucial of that, and the first 6 months even more crucial,” Blaser said in explaining the healthy development of the microbiome.
“Interestingly, for a number of the diseases we studied, antibiotic exposure in the earliest period was associated with the greatest risk of the later development of disease—as we had hypothesized.”
Still, he was quick to point out (like Ganjian) that the results only point to an association (correlation), not causation.
“It is very difficult to show causality in studies of humans,” Blaser explained. “That is why we do experiments in animals—and a large number of studies (including ones from my lab) provide evidence of causal relationships.”
He said the results in this study were not unexpected, but did produce two interesting new points for further research to explore.
“Although the effects were age-related, and related to the number of antibiotic courses, and for some diseases (like asthma) related to all three of the major antibiotic classes—the use of cephalosporins had the strongest associations with many of the diseases—this had not been reported before and looks consistent within the study.”
Blaser explained that the use of cephalosporins, a type of antibiotic, in children was relatively uncommon until 25 or 30 years ago, when they started to be used because they did not have to be dosed as often—every 12 hours or once a day, as opposed to multiple times a day like other, more popular, antibiotics.
Cephalosporins also became more common as more children were diagnosed with penicillin allergies.
“This study raises a red flag about this practice,” Blaser said.
The second point he wants parents and pediatricians to take note of with this research is the fact that all of the findings were straightforward, except for autism.
“In net, there is no significant association of antibiotic use and the development of autism,” he explained. “But in girls, we find opposite trends between penicillin and cephalosporins—this was unexpected! The data are consistent with the hypothesis that cephalosporins are driving autism, and that penicillin protects (similar trends are found in boys, but not as strong).”
One possible explanation for this association, he said, might be that cephalosporins are suppressing some bacteria that are protective against autism (and that penicillins might be selecting for them by inhibiting other bacteria).
“This is speculation at this point, but the findings for autism are the most interesting and potentially exciting findings,” Blaser said.
Talking to Your Child’s Pediatrician
None of this means you shouldn’t contact your child’s pediatrician if they become ill. Pediatricians and parents should always partner together in ensuring the best level of care for infants, especially.
But it does mean you may want to embark upon a conversation with your child’s pediatrician about when antibiotic use in children under the age of 2 may be most appropriate.
“The main point is that although antibiotics have critical benefit for seriously ill children, they are being widely used for children who only have mild (and self-limiting) infections,” Blaser said.
He pointed to the fact that doctors in Sweden have been found to prescribe just 40 percent of the antibiotics doctors in the United States are prescribing.
“Parents need to understand that antibiotics are not only a ‘quick fix,’ but that they carry risk of important diseases later in childhood—as our work implies,” Blaser explained, adding that several other studies have shown this same association for individual diseases, with this being the first to review the association with 10 diseases in the same study.
“Rather than demanding that their kids get an antibiotics, they need to ask their doctor or other practitioner to carefully examine their child and determine whether or not an antibiotic is really needed,” Blaser said. “Their question should be—Is this so serious that an antibiotic must be given, or can we wait and see how the child is doing (as is more of the practice in Sweden)?”
Ganjian agrees, explaining that doctors must be efficacious in identifying viral versus bacterial causes of illnesses and only prescribe antibiotics for the latter.
“But if a child is very sick with a bacterial infection, we should treat the child with antibiotics before it progresses and gets worse.”
What he doesn’t want to see is parents avoiding antibiotic use when that may be exactly what is necessary to help a child get well.
Th most important thing, he said, is having an open line of communication with your child’s pediatrician.
“Find a pediatrician that does not always rush to prescribe medications,” Ganjian suggested. Medications should be a second-line intervention when first-line remedies do not work or if the child is too sick to try home remedies.”
As far as what home remedies you might try, he further suggested discussing this with your child’s pediatrician.
“You can ask the pediatrician if you can try some natural remedies like honey (for children over 12months old), nasal saline, and vaporizer. Or you can ask if you can wait a few days before deciding whether the child can fight the infection without medications,” he said.
But if there is no improvement, you may need to start antibiotics immediately, especially if your child is getting worse.