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Pro/Antibiotics

Jan31

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Advice Smackdown ArchivesDearest Amalah–

First off, congratulations on 3 boys! Forget saving for college…you better start padding your grocery fund for the coming years!

Okay, my question is medically related…sort of. My daughter, who just turned 1 last week, also just came down with her first ear infection to celebrate (complete with a late night trip to the ER when her temperature spiked to 104.6 WITH Motrin…yeah, saddest thing ever). Anyways, since she’s one now, she has been prescribed Amoxicillin twice a day for TEN DAYS. This is probably normal. I don’t know, I’m a first time mom, but that just seems crazy to me.

Anyways, I’m not a huge fan of antibiotics, but I will follow the instructions because I want my baby to be better. My question is if you had any tips for what you do with your kids when they are on antibiotics to prevent some of the nasty side effects. I know when we are on antibiotics, my husband and I eat kefir to try to replace the good bacteria in our bellies. Should we do the same with her? Any other tricks you try?

Please let me know. And soon would be great. Thanks Amalah!

ERB

Ugh, YES. THIS. Welcome to the wonderful world of antibiotics. Yes, essential and civilization-saving and all that, but also one of the LEAST FUN THINGS you as a parent will ever reluctantly force down your child’s throat.

My kids have — collectively — only been on antibiotics a very small handful of times. When I was a child, I was given them pretty excessively for every minor ear infection ever. I think I was on antibiotics for MONTHS at a time for a good two years, because that’s just what you did back then when kids were even mildly ill. I eventually had tubes put in my ears, which solved the chronic infection problem, but not before I was left with a host of permanent side effects (tooth discoloration, a good DOZEN prescription drug allergies that I have never outgrown). On the plus side, I’m pretty good at figuring out how to treat a ton of mild illnesses without the help of antibiotics, because they’ve simply been off the table for me since childhood.

My pediatrician usually sends us home from a sick visit with a prescription but with the caveat to “wait and see” and give it another night or two to see if we can’t weather the illness without the meds. And we usually can, but occasionally, sure. What we thought a mild ear infection turned out to be a pretty bad double infection, or Ezra managed to spectacularly injure himself and antibiotics were prescribed as a preventive measure. Fun!

The good news is that — for us, anyway — the first round of antibiotics is always the worst, in terms of side effects. So just because you’re beyond horrified at what the Amoxicillin is doing to your poor baby girl right now, rest assured that it likely won’t be THAT BAD again should she ever need them again in the future. I don’t know if it’s an age or exposure thing, but I do know that Noah on antibiotics at age four is NOTHING like Noah on antibiotics at age one.

In the meantime, how to offset the side effects? Obviously, yes, probiotics are a HUGE HELP when you’re dealing with an upset stomach or hideous diaper rash from antibiotics. I still remember those diapers. Oh my God. Somebody hold me.

Kefir is a great start, or any kind of yogurt really, but we always bust out the pure, powdered probiotics and dilute them in whatever liquid the kid will accept. Kids sometimes get a little extra picky and lethargic about food and drink when they’re not feeling well, so I find it’s best not to count on them accepting yogurt smoothies or probiotic-boosted oatmeals right when they really could use them. Going with a powder gives you a bit more flexibility when faced with a cranky toddler who will only drink That One Kind of Apple Juice. You can even mix the powder into foods, like pudding, applesauce, ICE CREAM, whatever it takes. Whole Foods sells several kids’ formulas — you keep ‘em in the fridge, and they’re handy for whenever you suspect some tummy problems emerging, or a yeast-based diaper rash, or just as a daily boost for their morning milk.

If you can’t find the kids’ powders and don’t have time to go hunting for them, MOST pharmacies and drug stores now stock some kind of probiotic supplement. Find one in capsule form and just open the capsule and dump the powdered contents into her drink or cereal or whatever. Don’t stress about the dosage — one adult-sized capsule is still a very reasonable amount that isn’t going to hurt her or anything. And if she’ll drink yogurt-based smoothies or eat it straight from the container, by all means go for that too. Her body will find the balance, eventually.

One last thing, just because I know this ALWAYS comes up when we’re talking kids and diarrhea: Note that the BRAT diet (Bananas, Rice, Applesauce & Toast) is NOT RECOMMENDED for small children, at least not for more than 24 hours or so. I know, I know! We all grew up with it and my mom still swears by it and I KNOW, OKAY. But: the American Academy of Pediatrics says that while those “binding” type of foods can certainly be ADDED to a child’s diet, they should absolutely NOT replace the child’s normal line-up of foods. BRAT is too nutritionally incomplete (even most adults are now advised to resume eating as normal a diet as possible when faced with a stomach bug), and your child needs to keep her energy level up and her immune system in gear, and a diet of white rice and bananas alone aren’t going to help any. So feed her “the usual” meals without fear, try some popsicles, and put butter and jelly on the toast, if that’s what she’ll eat. Binding foods are great, definitely, but keeping a child on a restricted diet for say, a full 10-day course of antibiotics, is not such a great idea.

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If there is a question you would like answered by Amalah on the Advice Smackdown, please submit it to amyadvice@gmail.com.

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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18 Responses to “Pro/Antibiotics”

  1. NinaN Jan 31 at 11:56 am Reply Reply

    We just went through this, same drugs and nasty ear infection. Only it was in our not quite 3 months old baby!!!! What worked awesome for our poor little guy are the BioGaia probiotic drops. So simple. Just a few drops on your nipple, or a soother or a bottle or right into the mouth. Or you could add it to whatever they will eat! The only downside is that they can be hard to find. I guess since they need to be refridgerated, not every pharmacy will carry them. But totally worth hunting them down!

  2. Olivia Jan 31 at 12:08 pm Reply Reply

    Huh, my toddler is currently taking amoxicillan for the second time in her life and I have yet to see any of these side effects. Maybe it’s because she likes yogurt a lot. This is also the first time I’ve heard of the BRAT diet. It sounds dreadful, no wonder it’s not recommended.

  3. Ally Jan 31 at 12:19 pm Reply Reply

    The first time my son had to take antibiotics was last spring for Lyme Disease. He had to take 3 weeks worth and it actually wasn’t bad. We gave him lots of yogurt and he was sad when we stopped the medicine (he loved taking it). 

  4. Crabby Apple Seed Jan 31 at 12:43 pm Reply Reply

    Also: avoid fruit juice during episodes of diarrhea. (really, avoid fruit juice as much as possible, it’s baby candy, but that’s another rant for another day.) So many sources are unclear on this and recommend “clear liquids” for kids with diarrhea, but juice is HORRIBLE for diarrhea and will make it worse. Unfortunately, since a lot of kids will become temporarily lactose-intolerant following a GI-related illness, that pretty significantly curtails your choices, but stick with water/pedialyte/gatorade as much as possible. fruit juice = more diarrhea.

  5. tami Jan 31 at 12:49 pm Reply Reply

    i have to second the call for probiotics powder. that stuff has been great! we are on our second round of antibiotics for an ear infection and our little one’s poop is so nice and firm when she takes the probiotics. we just put it in her last bottle of the night. good luck!

  6. Bridget Jan 31 at 12:49 pm Reply Reply

    My diarrhea recommendation #1 is Rice Milk – that stuff helped my son tremendously last time.
    Also, if your LO is having trouble with the flavor of the antibiotics, try another flavor. I could not for the life of me get my son to take his grape flavored antibiotics, but watermelon? That’s like a treat to him. It seems obvious, but it wasn’t to me!

  7. Karen Jan 31 at 12:53 pm Reply Reply

    I’m in the same camp “this is not a big deal” camp with Olivia and Ally. My 17 month old just took her second round of Amox. for ear infection that accompanied a cold (one each winter). She does eat regular yogurt every day and we had zero side effects and she LOVED taking the yummy pink stuff. She would come running when we said “time for medicine” and suck it straight out of the dropper. The first time around she had a mild yeast infection in her diaper area but that cleared up in a day with miconazole. 10 days may seem long because the symptoms clear up quickly but make sure you stick with it for 10 days, this isn’t just some willy nilly figure pulled out of the sky. Discontinuing antibiotics too early increases bacterial resistance and if you think amoxicilllan is bad, how will you feel when the only thing still effective against bacteria for your 1 year old is Cipro?

  8. BB Jan 31 at 1:57 pm Reply Reply

    Oh my GOD those diapers from the antibiotics. One minute everything is fine and I swear, 10 minutes after they take the meds their backside looks like hamburger. SO awful. My daycare provider gave me a tip the first time this happened to my son. The rash can often be a yeast infection brought on by the antibiotics. (Yes boys can get those too.) She told me to make a paste of equal parts Monistat cream, Desitin, and Malox and just slather it all over the rash. Let it air dry if you can. I thought this sounded a little weird so I checked with the pharmacist. Sure enough, this is exactly what the prescribed diaper creme your doctor will order contains. And it worked!

    I’ve also had great luck grinding up rolled oats in the blender and chucking a handful of those into the bath along with some cornstarch for them to soak in. Very soothing to the skin and easy on the wallet.

    Good luck!

  9. JCF Jan 31 at 2:11 pm Reply Reply

    Thanks for the powdered probiotic tip–I’ll keep that in mind next time they’re not eating so well. We’ve been lucky (knock on wood) so far that only one of our three kids has EVER needed an antibiotic. Unfortunately, when our daughter took amoxicillin for an ear infection, she had a nasty allergic reaction–itchy, bumpy hives all over her body. It has made me kind of nervous for the next time she needs to take something.

    Our pediatrician, who has kind of a natural bent, now recommends steeping garlic in olive oil and putting drops in her ears several times a day at the first sign of ear pain. We’ve done that a few times now, and it has never yet developed into a full-blown ear infection.

  10. Diana Jan 31 at 2:24 pm Reply Reply

    FYI – if your kid (like mine) doesn’t like yogurt – Trader Joe’s has probiotic whole wheat crackers

  11. Julie Jan 31 at 3:32 pm Reply Reply

    Yeah, 10 days to 2 weeks is the standard recommended course for most anitbiotics. Definitely stick with it for the full course, or you run an increased risk of anitbiotic resistant bacteria cropping up.

    Current recommendations are to “wait and see” for ear infections over 2 years old, so at least the “anitbiotics first” time period won’t last too much longer. But it is frustrating. My son had as bunch of ear infections when he was between 6 months and a year old – they were never symptomatic, but would show up at his routine checkups. One refused to go away and he had to be on antibiotics for a month!

    For us, preventative use of diaper cream helped to keep the rash under control, and we added the powdered probiotics to his baby food or daycare bottles. (We were nursing, so he didn’t get bottles at home – I’d try mixing it with some water in a bottle, but he never drank much that way.)

    Also, if she’s still nursing, encourage it. All sort of good things in breastmilk to help keep her hydrated, keep her electrolytes balanced, and encourage the good bacteria growth.

  12. Chaya Jan 31 at 5:23 pm Reply Reply

    Nothing much to add on the antibiotics, thankfully my kids seem to do fine with amoxicillin, but the yogurt and such certainly helps.  
    As far as the yeast diaper rashes, I am no expert, but oats and cornstarch as recommended by a poster above, I always thought were NOT a good idea, b\c the yeast can essentially feed off of the sugars in those things.  Would love an actual medical professional to chime in (despite a dr. recently asking me if i have a medical background, I am “just” a mom!)

  13. Liz Jan 31 at 5:38 pm Reply Reply

    I believe that antibiotics can destroy probiotics if they are taken concurrently so be sure to continue taking the probiotics for a week or 2 after the antibiotics are done.

    I 2nd the suggestion for applying Monistat cream externally for a yeasty diaper rash. For boys or girls.

    I would look for ‘live and active cultures’ on your yogurt and avoid those neon blue yogurts full of sugar. They are not quite the same!

  14. wallydraigle Jan 31 at 10:16 pm Reply Reply

    My almost-one-year-old just had a sinus/ear infection. They started her on amoxicillin, which wasn’t working, so she was upgraded to cefdinir. The best part? This was in the midst of a cross-country move. One day spent at a friend’s house while the movers packed our belongs, one day spent in our cold, empty house while the movers packed the truck, one two-hour drive to Chicago, one night’s stay in a hotel room, one plane flight, and one week more in another hotel. I was ready to sell my children by the end, and they weren’t even that difficult. Anyhow, shovel yogurt into her like it’s candy. And make sure it has live and active cultures. Many flavored yogurts do not, or so I’ve read. We are lucky; our daughter likes plain yogurt and will eat it like candy. That simplifies things. And then we gave her probiotics, too. I kept giving them to her for days after we were done with the antibiotics because it took a while for her system to get up and running again. But my, what a miserable two weeks that was. Oh, and slather her up with diaper rash cream at every single diaper change–preferably the kind that makes stuff just slide off her skin when you wipe. A&D ointment is great for this.

  15. Lisa M Feb 01 at 1:51 pm Reply Reply

    Just another tip, you can also add that probiotic powder to the diaper cream and put it right on their poor little bums. I started doing this when we had a really nasty case of thrush while breastfeeding. I was putting probiotics on everything! (and taking them, and eating yogurt….)

    But it worked so well, I resorted to it anytime either boy was on an antibiotic. Plus, even think it actually works better than monistat (which is really just an anti-fungal, where as the probiotic consumes the excess yeast).

    And definitely finish all 10 days of the amoxicillin! Super important.

  16. Kathleen Feb 03 at 12:54 am Reply Reply

    Thoughts from a microbiologist- 
    Amalah is probably right, one adult dose of probiotics is most likely fine (depends on what you buy – they are so unregulated), but that’s not one every hour, please keep it to a reasonable amount. I’ve heard horrid stories from hospital epidemiologists of perfectly well-meaning parents dosing their children to high heaven with probiotics until they got blood infections ***of the probiotic bacteria***.

    Also, not sure about the probiotic diaper cream – most of the bacteria in probiotics are Lactobacillus and Bifidobacteria, which don’t normally live on your skin, and thus don’t help defend you from yeast (and could cause issues if they did take up residence on your skin, not sure there…):
    http://www.textbookofbacteriology.net/normalflora.html
    The scientific literature is pretty much on the side of little to no effect for probiotics applied to the skin, even using normal skin bacteria.

    And the bacteria are much smaller than the yeast – they’re not going to eat the yeast, they just make their own home on your skin and make it harder for the yeast to live there (or bad bacteria to live in your gut). As a mom who used waaaaay more antibiotics that first year despite doing everything I could to fight it? Antifungals all the way.

  17. maggie Feb 08 at 10:29 am Reply Reply

    Didn’t see this one mentioned: for the horrendous diaper rash caused by yeast, get some Athlete’s foot cream (clotrimazole) which is an anti-fungal and just rub a little on the affected area. It works wonders! It is like a miracle. My babies had the WORST rashes and once my doctor recommended this, we were so grateful.

  18. Della Feb 21 at 4:45 pm Reply Reply

    Hoo boy. We’ve had yeast infections. We’ve had diarrhea. We’ve had regular diaper rash plus yeast infections compounded with diarrhea. We had one generalist (non pediatrician) doctor give us the spectacularly bad suggestion of throwing some hydrocortisone cream on that last rash… Result? Blood where the skin used to be, across the entire bottom, front to back, side to side. (Some steroids thin the skin, and the acid of the pee and poop plus friction from the diaper literally rubbed his skin off.) See a pediatrician for baby problems!

    More recently, there was the ear infection antibiotics started the day before the violent stomach flu which equaled 10 days of diarrhea. And a child who became afraid to poop.

    So I speak from experience. In general:

    1) Always have an OTC antifungal on hand in case a yeast infection develops. Clotrimazole has worked for us; we also had gyna-lotrimin suggested.
    2) The BRAT diet doesn’t give you balanced nutrition, but it’s not going to make your kid malnourished in a single day. If you have bad diarrhea for more than 24 hours, try BRAT for the next 24 hours. If that doesn’t fix it, your kid has had diarrhea for 48 hours straight and probably needs to see the doc anyway.

    If your kid gets diarrhea while taking an antibiotic:
    3) WRITE THAT DOWN somewhere where you can find it again and compare notes with yourself whenever they take any antibiotics again. ESPECIALLY if it’s very drastic diarrhea (not like, “two yucky diapers and then they’re okay” kind of thing). Apparently, it happened to our son twice with the same antibiotic, but since it had been over a year since he’d had that kind, I didn’t make the connection. Luckily, the doctor did. He’s not technically allergic to that one, but since it wreaked such havoc on his digestive tract, the doctor counseled us to never give it to him again.
    4) Diarrhea = no juice. Just don’t. Offer increased water. Increase fiber (for bigger kids, try Frosted Mini Wheats or Cream of Wheat). Offer cheese and bananas.

    And on the other side of things,
    5) Constipation = avoid dairy products, including yogurt – just mix some probiotics into something else. Offer increased water. Increase wet-fruit intake (if it drips when you bite it, it’s good – peaches, pears, plums, grapes, etc; NOT BANANAS, they plug you up).

    Finally, our pediatrician kept telling us to try Culturelle brand kids’ probiotics. It’s flipping expensive. Like, $25 a box. I was like, no way! I’ll buy the adult capsules and open them up and pour that in their food. Well, the problem with those adult capsules is the texture. It’s fine in applesauce, say, but not in some foods. It doesn’t dissolve. When we had the horrible, horrible diarrhea, I was at CVS and they had the Culturelle on BOGO. I’m really glad I spent the money. That stuff is very fine, so it doesn’t add gritty texture, PLUS it dissolves – you can put it in ANY food or even in a drink.. It ended up being worth it after over a year of digging my heels in. I don’t know what other brands are out there, but that one was definitely worth it.

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