I keep saying less is more. So often, with children, the less we do, the better. Pediatricians often pride themselves on being smart enough to know when to do…..nothing.
Take pink eye, for example. You know, the gnarly ooey-gooey, eyes-sealed-shut-yellow-crusty-“sleep”- in-the-eye that never goes away? The highly contagious infection where your child looks uber-crummy and straight-up, infectious? When it happens, you create a self-imposed lock-down-blinds-drawn-cancel-all-plans-covert-stay-home and watch a movie to hole-up the contagion. You or your child may want to hide from the world until it improves.
In my practice, pinkeye is one of the those infections that inspires me to wash my hands over and over and over again. It is really contagious. And the best thing you can do when you see a glimpse of it, anywhere, is wash.your.hands.
So you haul in to see your pediatrician. Question is, what does your doc do for your child? School is asking for a note to come back and you’re there for a quick-fix thinking, “Just give me something to make this go away. And fast.” And like always, it depends on a number of things.
Your pediatrician will want to determine if the “pink eye” is caused from a bacterial or a viral infection. Studies vary but as a general rule, up to 50% of infections can be viral. So not all need antibiotics. At a glance, it can be hard to tell. Doctors use the history they take, the other associated symptoms (runny nose, cough, fever, ear pain), and the duration of symptoms to guide them. But without a culture, sometimes it can be difficult to know if a child needs antibiotic drops. And we hate to give antibiotics when we really don’t need them. Doctors can turn to some new research to help. Today I’m introducing you to The New England Journal of Medicine’s Journal Watch. It’s a publication that lots of pediatricians read. It contains summaries of recent research articles with an expert’s take on the quality of the study.
Read this: Pink Eye: To Treat or Not To Treat (Journal Watch is providing us a little portal so you can read it for free)
The article summary is written by a pediatrician, Dr Robin Drucker. She reviews the NY study that was originally published in Archives of Pediatrics and Adolescent Medicine. See what you think.
But because I can, here’s my summary of the summary. Ways for you to do less…
4 Ways To Know Your Child Is Less Likely To Have A Bacterial Eye Infection:
- If the child is over age 6 years old.
- If it’s summer! Bacterial infections were less likely between April and November (translation, less likely to be bacterial in the summer).
- If the child only has watery discharge (not ooey-gooey yellow/green stuff).
- Child is not waking up in the AM with “eyes glued shut.”
Phew. Now you know. This may help you feel better if the pediatrician suggests not to use antibiotics. Good to know while washing your hands…
Less is more.
DrV says
Nice post, Wendy. This needs to be compiled in the great list of clinical pearls. I’m putting it in Evernote right now.
Ed Pullen says
All good clinical and epidemiologic trends, but the real problem is daycare and school policies that allow children back after a period of time, usually 24 hours, on “treatment”, read this antibiotic drops. We know if a viral infection the drops don’t make the child less contagious, but the parent “needs” the child to return to school/daycare so they can return to work. So we put the child on antibiotic drops and play the reinforce the policy. Around and around it goes.
Wendy Sue Swanson, MD says
Dr Pullen,
Agreed. Around and around it goes. I didn’t address the issue of school/day care policy and conjunctivitis in the post. But yes, if we can figure an evidence-based solution/reversal for the archaic rules of “24 hours on antibiotics before return to school” for pink eye, it may be our chance at the Nobel…