The faces across the table are worried, Being parents of a sick child is never easy and even more so when their paediatrician, sitting comfortably in his cushy, swiveling chair, is telling them coolly not to use any medicine. How could it be possible to get rid of an illness without any medicine? Just two days ago the previous doctor had written for them a hefty prescription and in spite of those medicines the child was not improving. They just keep looking at the doctor wondering about his credentials and cursing themselves for finding a doctor who won't write out a prescription!
Scenes like these are too familiar for paediatricians an over the world. Parents and patients in general, seem to have a belief imprinted on their minds that medicines cure illnesses. I am not disputing the role of medicines and advanced technology in the process of cure but just want to point out a disturbing tendency of over-reliance and , over-dependence on these means of treatment. The thing that disturbs me is the way we are neglecting the most important part of treatment and that is the human body and its own defense- system. The role of medicines is to aid the body's defence- mechanisms to counter illnesses. It is unfortunate that the general public awareness about this fact is practically non-existent and the medical faculty also hasn't been too forthcoming in explaining that. In many instances, medicines are unnecessary and could even worsen the situation. This often results in patients/parents demanding medicines like antibiotics, stool-binders, anti-vomiting agents and appetite stimulants -and more often than not, they find a person donning a white coat and having an impressive medical degree to boot who hands over such prescriptions nonchalantly. Let's examine some common problems where rushing for medicines is mostly counter-productive. 1. FEVER
The most commonly encountered fevers are caused by viral infections and last for three-four days.The treatment required is just to provide adequate doses of Paracetamol (Acetaminophen) -an over-the-counter non-prescription medicine, plenty of warm fluids and rest. Antibiotics are unnecessary in most cases unless there is a definite evidence of bacterial infection. Most common cause of fever not coming down after Paracetamol is inadequate dosage and infrequent administration. The best policy is to give this medicine every four-five hours in a dose advised by doctor for the first two days of fever irrespective of the temperature. One word of caution is not to rely on the doses advised on the label of the bottle. Though these instructions serve as guidelines, many a time they are misleading as no consideration is given to the actual weight of the child, which is the prime determinant of drug-dosage in childhood. 2. COLD AND COUGH
Again, almost the same explanation. Most of the upper respiratory tract infections are caused by viruses which are unaffected by any antibiotic and are self-limiting, lasting for 7-10 days. Apart from the tried and trusted triad of rest, warm fluids and paracetamol, other simple but effective measures are steam inhalation and warm salt-water gargles. Cough/cold medicines available in the market are more or less similar. Most of them are mixtures with something to lessen the nasal congestion, something to thin the secretions and something to help those secretions come out. So changing from one to another usually doesn't make much sense. Dry cough requires medicines different from wet one, in fact herbal and honey preparations which act as soothers are much safer and effective in any type of cough. Rapid breathing, difficulty in breathing, wheezing and persistent cough/cold beyond one week- are the danger signals and warrant immediate medical attention, 3. DIARRHEA
Common causes for diarrhea in childhood are gastrointestinal infections (as usual mostly viral in origin), food poisoning and antibiotic induced diarrhea. Most of the time, replenishing the fluid losses and adjusting diet are the only measures needed. Antimicrobial and antiparasitic medicines' routinely given could in fact prolong the course of illness. Stool binders like kaolin-pectin combination could prove dangerous in cases of infective diarrhea. High grade fever, sick look, severe associated symptoms indicating involvement of other systems or presence of blood in stools are the situations where appropriate medicines are needed after consultation with the doctor, 4. VOMITING AND ABDOMINAL PAIN
The cause of vomiting could be as simple as an upper respiratory tract infection or a mild bout of gastroenteritis or as serious as appendicitis or meningitis. So knowing and treating the cause takes precedence over just treating this symptom with some medicines which suppress vomiting. Almost the same logic applies to abdominal pain where just offering painkillers is dangerous as it just masks the cause, 5. APPETITEI have yet to come across parents who are totally satisfied with their kid's appetite. 'Doesn't eat anything' -is the commonest complaint especially in toddlers and pre-school children. Actually even physiologically this phase of development is associated with slower growth rates, reduced appetites and negative behavioural patterns so in most cases there is practically nothing wrong with the child. Routinely prescribing specific appetite stimulants is a practice strongly discouraged by all the standard textbooks. Giving a daily multi-vitamin and mineral supplement is a safe way of avoiding nutritional deficiencies in such fussy children, These are some of the most common situations for which medicines are routinely 'expected' and usually those expectations are fulfilled with a prescription full of useless medicines, The need of the hour is to keep this 'medicine mentality' in check and to understand that best treatment is the one which relies on least medicines! |
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