- Written by Mark Hancock MD MPH
- Category: Humanizing Pediatrics
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Using the Wrong Tool
In an interesting study in JAMA thousands of visits to primary care physicians were studied. Progressively through their shifts in the clinic, physicians were more likely to give antibiotics to patients for conditions that did not warrant their use. By the end of the day, patients were about 25% more likely to get unnecessary antibiotics. Typically antibiotics are given unnecessarily for infections that are caused by viruses- such as a viral bronchitis, acute sinusitis, and ear infections (for which we have far better antibiotic-free treatments). The authors commented on "decision fatigue"- a phenomenon where decision makers get tired and make "easier" decisions as their work day goes on. This is a known problem in our court system where a judge is progressively more likely to deny parole as their work day drags on.
In fact, one of my patients had a thought-provoking experience with antibiotics. She had a condition after a known viral infection where a lymph node rose up. She was initially taken in to a pediatric ER and received multiple scans and tests. Aside from serious stress, poor bedside manner- per mom the pediatrician emphasized the risk of cancer, the cost of this work up was over $1000. Clinically this patient was a well appearing child with a small swollen node- no fevers, no redness, no fluctuance (where you can feel fluid inside usually indicating an abscess). She was given first one antibiotic then another was called in 12 hours later. Fortunately the mother contacted me and we held off on these unnecessary treatments. In my new model of care I will be available to head off such events. I was able to make a home visit and reassure that in cases like this we can watch. I can not say that the pediatrician did anything wrong in this case as they were following expert consensus guidelines in treatment and work up. But I do think we should question this management pathway.
By the way the likelihood of a cancer in a child with a swollen lymph node is quite small- about 0.4%- though we should always have every diagnosis in mind. Children are especially prone to inflammatory events as their immune system responds to their environment. A humanized view of the developing child respects this process. Giving medications that can cause allergic reactions, adult obesity, shifting gut biome and diarrhea does not seem like "an easy choice" to me. It is true that "expert consensus" allows for antibiotic prescribing in a case such as this one but my preference would be to base this on clinical presentation and have close follow up. It is time that medical professionals reconsider their expert opinion about initial antibiotic use for lymphadenitis. A more reasonable approach would be to mirror the management options for ear infections where watchful waiting is a viable option in cases that are clinically reassuring.
- Written by Mark Hancock MD MPH
- Category: Humanizing Pediatrics
- Hits: 476
Natural Treatment of Otitis Media- A How To Guide
Ear infections are a very common occurrence among young children that cause parents to scramble to resolve the acutely painful symptoms. A Humanized Pediatrics asks "How can we respect the fever gesture of the child while at the same time relieve pain and suffering safely?" The incarnating "I am" is seeking through the formative childhood years to make the human body its own place. This spiritual aspect is not entirely fuzzy- it is expressed in warmth. Thus we suppress every fever at a cost to the self-piloting and future individuality of our children. I have mentioned the lack of childhood fever noted frequently in patients with cancer- and supported by scientific studies. Dr David Martin is an internationally renowned pediatric endocrinologist working out of Anthroposophic insights- he sees one of his missions as shifting our culture's views on fever to a more positive one. Check out his website here, it is a true resource for parents.
Current Antibiotic Recommendations
The current guidelines for treating children with ear infections have an emphasis in avoiding antibiotics where possible. In very young children (under 6 months, or both ears under 2 years old) or severe cases typically antibiotics are given. The other cases, non-severe in somewhat older children may be given "watchful waiting" where the child's clinical course is followed carefully and antibiotics can be started later if needed but not right way. This delay is because most ear infections are caused by viruses- these are not helped at all by antibiotics. Even bacterial infections can be totally overcome by the body's immune system if not severe. Most importantly, researchers are recognizing that antibiotic use may have far reaching effects on problems such obesity, allergy, and chronic disease. Antibiotics also have risks of immediate allergies and it is widely recognized that microbial resistance is increasing. They are a life saving tool at times but we are using them without deserved caution. It is estimated that almost half of the antibiotics given to children are for the diagnosis of acute otitis media (ear infection). Many doctors assume (sometimes correctly) that patients expect antibiotics and pain killers for everything. So let your provider know up front that you are comfortable with watchful waiting if they are- this can really help them.
It is helpful to have quick access to a competent holistic medical doctor (which is why I have set up my practice model allowing consultation at all hours for subscribers).
How To Treat Ear Infections Naturally
I have six daughters. They have all dealt with ear infections during their childhood. So far we have never needed antibiotic treatment for any of them and only once given tylenol or motrin. Even in cases where conventional medicines are necessary I hope this natural treatment guide can be of use to parents. Please note none of this is medical advice- please consult your own healthcare provider for treatment of health conditions. Some conditions mimic others and it is important to have someone with a full picture in mind to avoid complications.
The soul (astral body) lives in the airy element. This soul process is evident in speech, music, and demonstrated pathologically in typical presentations of acute asthma and hyperventilation. The soul body continuously works to make certain organs airy and to expel substance from the body. Evidence shows that if we work against the body accomplishing this process through undue use of antipyretics (like motrin or tylenol) or antibiotics we can short circuit the process and see complications or chronic cases develop. Of course eliminating the risk factors we can such as smoking in the house is essential.
This study shows that children treated for ear infection with an Anthroposophic (Humanized) natural approach had faster pain reduction and parents were more satisfied than the conventional approach.
Key Natural Remedies for Ear Infection
Onion is one of the cornerstones of natural treatment. Almost always have I been able to achieve fast alleviation of ear pain. Once I substituted garlic when we were travelling and it worked well too.
Either cut the onion in half or chop finely and warm in a some oil in a pan. Make a compress with a thin cloth or cheese cloth and make sure it is warm but not too hot. Place directly over the ear and leave in place as long as possible. Occasionally I have achieved therapeutic results with very uncooperative children by making an onion bath. Human soup!
Ear oil (made by True Botanica) is another useful remedy. One must be certain the eardrum is not ruptured (by a doctor's visual inspection). The oil is made from several healing plants. Lovage, chamomile, hops, oregano, basil, arnica, angelica, usnea, and St John's wort work together to soothe and heal the ear infection.
Lovage (Apis Levisticum, by Uriel) is a remarkable healing plant. It has a strong connection to the warm and airy elements and is a support to the soul body in ear infection. The body's inflammatory process can be supported and thus fulfilled (bringing resolution to the ear infection). The honey bee's relation to this process of inflammation is supportive and thus combined in this excellent remedy.
Black Cumin Oil is an ancient natural medicine- it was even found in King Tut's chamber! It has natural pain-killing and immune boosting properties. This remedy is excellent and of course please ask your own health care provider for proper dosing. Not recommended in pregnancy or very young infants. Typically 1/8th of a teaspoon per day of the oil is generally accepted for younger children with 1/4 teaspoon per day for older children. Please be careful with any herbal remedy- while typically quite safe in low doses black seed oil can be toxic at very high doses and due to its anti-inflammatory properties it tends to thin the blood a small amount with typical doses. I like black seed oil as it naturally helps with pain but is fever supportive- so it supports the natural healing gesture (salutogenesis) of the body.
Of course, many more remedies are used for ear infection depending on the presentation but these above are the most consistent with general use in day to day cases. Hopefully you can use this mini-guide to help direct your approach to the next ear infection.