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Dr. Bob's Mailbag 01/28/2008 

This column originally ran in the St. Louis Post-Dispatch on Jan. 28, 2008.

Modern antibiotics are a wonderful tool for fighting infection.  The last century has been a time of impressive growth in research and the beneficial use of antibiotics to treat illnesses that affect adults and children.

Unfortunately, however, antibiotics can also be misused.  Some people stop taking antibiotic medications once they begin feeling better.  This can lead to a recurrence of the illness and over time can lead to development of antibiotic-resistant infections, which are much more difficult to treat effectively.

            Another problem with antibiotics is that they are frequently prescribed inappropriately.  For instance, a study by Harvard Medical School found that more than half (53%) of children with sore throats are prescribed antibiotics by their physicians. In truth, only about 35% of children with sore throats have strep throat, which is the only common cause of sore throat for which antibiotics are considered effective. Children whose sore throats are caused by viruses will see little or no benefit from using antibiotics.

            Symptoms of strep throat include sudden onset of high fever, very sore throat, tender glands in the front of the throat, belly pain or vomiting.  Your pediatrician should conduct a rapid strep test before antibiotics are prescribed.

            An appropriate use of antibiotics is in treating urinary tract infections, which about 5% of children will experience by age 6 years.  But there is trouble there as well.  The American Academy of Pediatrics advises that ongoing, daily use of antibiotics to treat and prevent urinary tract infections is not effective and can even bring on antibiotic-resistant infections.

            Older children with urinary tract infections usually will complain of pain while urinating.  Symptoms in younger children are more subtle, but may include fever, vomiting or general discomfort.  Parents who suspect a urinary tract infection should consult their pediatrician to see whether their child should be tested and whether antibiotics are required for the child’s illness.

 

Dear Dr. Bob:

Like a lot of young people, my teen-age son likes to walk around listening to music on his iPod.  I worry about his hearing from using those little “ear bud” earphones, because I can hear the music from several feet away.  Is this damaging his hearing, and what can I say to him to get him to understand that he has to turn down the volume?

 

Music is now available everywhere, from cell phones to the ever-popular iPods you mentioned, but the combination of loud volumes with earphones that fit inside your child’s ears creates a dangerous mix – one that can damage his or her hearing.

Our inner ears have tiny hair cells that convert sound vibrations into nerve impulses that are sent to our brains. That is how we hear. When those hair cells are harmed by excessive sound pressure, hearing loss occurs.

 “A lot of times, people turn up their music to drown out the lawnmower or other outside noises,” says Kathleen Geier, lead audiologist at SSM Cardinal Glennon Children’s Medical Center. “If you can’t hear what is going on around you, then not only does it pose a safety concern, but also the volume can damage your hearing.”

In fact, some of the things we do for fun as families are dangerously noisy. Geier said ear plugs could help to diminish most of the hearing loss she sees as a result of watching auto racing, going hunting or even mowing the lawn.

iPods play music at up to 115 decibels, which is louder than a lawnmower, firecrackers, or a jackhammer. But it’s not just about volume – higher-pitched sounds are more intense. It also matters how long you are listening to something at a certain volume.

“You only have to listen to your iPod for five minutes each day with ear buds at the highest volume to do damage to your hearing,” Geier said. “By the time your ears start ringing, the damage has already been done.”

If you suspect your child has suffered hearing damage, tell your pediatrician.  Apple, the manufacturer of the iPod, offers tips on its Web site (www.apple.com/itunes) for locking your child’s iPod at a safe volume. Your son may not want to hear it, but you as a parent should insist that he lock down the volume or hand over the iPod.

If he protests too much, you might point out to him that 60% of the artists in the Rock and Roll Hall of Fame suffer hearing loss, from their exposure to amplified music and use of headphones.  Among the hard-of-hearing luminaries are U2’s Bono, Pete Townsend, Eric Clapton, Phil Collins and Mick Fleetwood.  All reportedly regret not taking better care of their hearing.

 

Dear Dr. Bob:

My little girl is about to reach her first birthday and our pediatrician has suggested she should start seeing a dentist.  Is this normal, or do you think her doctor suspects a problem?

 

            The American Academy of Pediatric Dentistry recommends at least two check-ups a year for all children, once they are 1 year old.

            Unfortunately, many children visit the dentist much less regularly.  A study conducted by the U.S. Agency for Healthcare Research and Quality reports that fewer than half of all American adolescents (45%) visit the dentist each year.

            Dental visits for minority children are even less frequent.  The report states that only 34% of African-American children and 33% of Hispanics visit the dentist even once a year.  Children from low-income families fare even worse, with only 31% receiving annual dental check-ups.

            Your child’s dental health is vitally important.  Once a child reaches his or her first birthday, put those twice-annual dentist visits on your calendar in ink.

 

Dr. Bob Wilmott is Chief of Pediatrics at SSM Cardinal Glennon Children’s Medical Center and is a Professor of Pediatric Medicine at Saint Louis University School of Medicine. If you have a child health question for Dr. Wilmott, go to the “Ask Dr. Bob” section of the Cardinal Glennon Web site at www.cardinalglennon.com.

 

 

1/28/2008