What do those antibiotics actually do? When do they work and when will they not? This is a parent’s guide to understanding how medicine works for your children.
Antibiotics have saved countless children’s lives. I prescribe them often and gratefully when they’re truly needed. But they’re not a magic cure-all. And as frustrating as that can feel when you’re dealing with a miserable, coughing child at bedtime, that reality is actually very good news for your child’s long-term health.
Not long ago, one of my own kids woke up coughing at 2 a.m. You know the kind—the barky, dramatic cough that sounds ten times worse in the dark. By morning, there was a runny nose, low-grade fever, and lots of whining. I did what every parent does: I ran through the mental checklist. Does this need antibiotics? Should I call? What if it turns into something worse?
And then I reminded myself of what I tell parents every single day.
Most childhood illnesses don’t need antibiotics, and giving them “just in case” doesn’t help kids get better faster.
What Antibiotics Actually Do (and Don’t Do)
Antibiotics are designed to kill bacteria. They do nothing against viruses.
That matters because most of what otherwise healthy kids get (think colds, coughs, sore throats, runny noses, flu, RSV, and many ear infections) are caused by viruses. In those cases, antibiotics won’t shorten the illness or make symptoms improve. What they can do is cause side effects like diarrhea, rashes, or yeast infections, which is the last thing a sick kid (or parent) needs. Frequent antibiotics also mess with our gut flora which has lots of negative health consequences.
So when your pediatrician says, “I don’t think an antibiotic will help right now,” what they’re really saying is:
- This looks viral.
- Your child’s immune system is doing exactly what it’s supposed to do.
- Adding medication would only add risk, not benefit.
The Problem With “Just in Case”
Every unnecessary antibiotic dose teaches bacteria how to get smarter and tougher. Over time, that leads to antibiotic resistance meaning that when a child truly does need antibiotics, the options may be fewer or less effective.
On a very practical level, overuse can also mean:
- More stomach upset and diarrhea
- Allergic reactions
- Medications that don’t work as well down the road
For things like mild ear infections, lingering coughs, or uncomplicated colds, watchful waiting is often the safest and healthiest option. Kids’ immune systems are remarkably capable, even when the symptoms look dramatic.
Modern pediatric guidelines actually encourage using antibiotics only when clearly indicated, and for the shortest effective course. The goal is to help kids recover while minimizing unnecessary risk.
If your child is sick, helpful questions to ask your pediatrician include:
- “Does this seem more viral or bacterial?”
- “What should I watch for that would change the plan?”
- “How can I help my child feel more comfortable at home?”
And then focus on the basics that truly help:
- Fluids and rest
- Saline and humidifiers
- Correct dosing of fever and pain medication
- Honey (for kids older than 1)
I know how hard it is to hear “no antibiotic” when your child feels awful and you just want a fix.
But often, that answer means your pediatrician is doing exactly what you want them to do: protecting your child today and preserving lifesaving medicines for the future.
It’s never wrong to have a sick child evaluated. Not everything is viral, and antibiotics absolutely have an important role when they’re needed. Your pediatrician is a trusted partner in helping sort out what’s going on, what your child needs right now, and what can safely be watched at home.
Sometimes the most valuable part of a visit isn’t a prescription, it’s clarity, reassurance, and a plan!
* The Health Log: A Parent’s Secret Weapon, What to Stock in Your Medicine Cabinet, and A school nurse takes you behind the scenes to learn how to read your child’s symptoms…especially on a school day. When Should You Keep Your Kids Home from School?
A great read! Is it recommended to give children probiotics? From what age? And what are the benefits?
Yes give ur kids fermented pickles from the company fer real foods it has enormous amount of probiotics
Great question! I love probiotics foods (yogurt, sourkrout etc) because I think there’s so much we still don’t understand about their benefit on our gut flora. That being said, probiotics are not routinely recommended for children, especially for acute infectious diarrhea, as studies have shown no meaningful benefit, even with commonly used strains. While some international studies suggest that specific probiotics may shorten diarrhea by a small amount (hours, not days), these results have not translated well to North American children,. Certain strains may offer modest, situation-specific benefits, such as slightly reducing antibiotic-associated diarrhea or marginally decreasing the frequency and duration of colds when taken for months, and one specific strain may help breastfed infants with colic. Probiotics have been studied from infancy and are generally safe in healthy children, but they should not be given to premature or immunocompromised children without medical guidance. Overall, probiotics should be used selectively and strain-specifically, not as a routine supplement, and a healthy diet and avoidance of unnecessary antibiotics remain far more important for gut health.
Thank you for addressing the issue of over-medicating!
I appreciated this well written and thought out article. I was just very surprised to see vitamins missing from the list of things you can do that does actually help your child. Giving your child immune boosters such as vitamin c, vitamin d, elderberry or echinacea, can go a long way in giving his body the boost it needs to get over the virus quicker.
I just read that newer studies have not shown elderberry or echinacea to actually help (potentially the original studies were funded by industries). Not sure if that is true, but I guess it’s possible!
Thank you! It’s a common and very reasonable question. When it comes to vitamins and “immune boosters,” the evidence is more limited than many people expect. For most healthy children who are not deficient, supplements like vitamin C, elderberry, or echinacea have not been shown to reliably shorten viral illnesses or prevent them. Vitamin D is important for overall health, and correcting a true deficiency matters, but giving extra vitamin D beyond that hasn’t consistently been shown to help kids recover faster from routine viral infections. That’s why I focused the article on interventions with the strongest evidence, like supportive care and avoiding unnecessary antibiotics. Supplements aren’t harmless, and more isn’t always better — so I try to be careful about recommending them routinely without clear benefit.
Can we get some info from the Dr of when a infant/child is contagious with only a ear infection, runny nose or cough. I unfortunately see people sending their kids out with heavy congested noses or coughs and I would like insight. Thank you
This is a great question, and it comes up a lot. Most ear infections themselves are not contagious — what is contagious is the viral illness that often comes with them, like a cold. A runny nose or cough usually means a child has a viral infection, and kids are typically most contagious in the first few days, especially before or right as symptoms start. That said, children can continue to have a lingering cough or congestion for 1–3 weeks after they’re no longer contagious, and I would never suggest keeping someone out of childcare for that long. In general, a child can usually be around others if they are fever-free for 24 hours, have enough energy to participate in normal activities, and aren’t having severe or worsening symptoms.
As a working parent I completely sympathize with the urgency to return kids back to childcare. As a pediatrician and someone who also wants to keep my own kids healthy, I recognize the frustration when you see other kids with runny noses back in school. So it can be a tough balance
“Every unnecessary antibiotic dose teaches bacteria how to get smarter and tougher.”
In reality, every antibiotic dose will teach bacteria how to get smarter and tougher.
Sometimes it’s worth it.
Sometimes it’s not.
Antibiotics do have a role to play- but even when they can be helpful, if there’s a way to help the body recover without them, it might be prudent to look into that other option.
Really well said!
Thank you!
Thank you for this much needed article. People are often misinformed that antibiotics will always help and beg their doctors for them but it can cause more harm than good. I always love reading your articles Jennie.
Thanks for this informative article.
Can you please elaborate on how to help a kid with an ear infection/cold by using saline and a humidifier. Do you suggest hot or cold humidifiers? Is there a specific one you’d recommend there’s tons on the market. Thanks!