5 Reasons Your Baby Might Need Antibiotics

When your baby is sick, it’s natural to want something that will make them feel better fast. Depending on your baby’s age and symptoms, antibiotics may be an effective—and in rare cases, lifesaving—treatment. But other times, antibiotics are not a safe or appropriate choice.

“Antibiotics are only effective against bacteria, which means they’re useless against viral ailments like the flu and colds,” explains Iona Munjal, MD, former director of the Pediatric Antimicrobial Stewardship Program at The Children’s Hospital at Montefiore Medical Center in New York. And sometimes, prescribing antibiotics can do more harm than good.

We talked to the experts to learn more about how and when antibiotics can help a baby, how fast they work, and safety tips so you can make the best possible decisions for your child.

When Do Infants Need Antibiotics?

In general, experts say that babies only need antibiotics when a bacterial infection is what’s making them sick. The following are the most common childhood ailments that doctors will sometimes treat with antibiotics.

Pneumonia

Pneumonia can be either viral or bacterial, but it’s often difficult to determine whether the cause of pneumonia is a virus (perhaps due to an upper respiratory infection) or bacteria. When bacterial pneumonia is suspected, pediatricians often prescribe antibiotics such as amoxicillin, ampicillin, and penicillin because infants have a higher rate of complications from this illness.

Symptoms of pneumonia in babies include:

• Cough
• Fast breathing
• Fever
• Grunting or wheezing sounds
• Poor feeding

Whooping cough (pertussis)

Pertussis (more commonly known as whooping cough) is caused by a highly contagious bacterium called Bordetella pertussis. Antibiotics are most effective at treating pertussis when they’re started within the first week or two of symptoms, before the signature whooping-like cough begins.

For babies younger than 1 month, azithromycin is the safest choice. Babies older than 1 month can take clarithromycin and erythromycin instead.

While antibiotics can treat whooping cough, the best way to prevent the illness is to ensure your baby is caught up on recommended vaccinations and encourage your baby’s caregivers to get vaccinated as well.

Ear infections

Many ear infections are viral (meaning an antibiotic won’t treat the infection), and about half of all ear infections resolve without antibiotics. While many health care providers will take a “wait and see” approach for ear infections in older kids, most will treat babies with antibiotics right away.

“A baby can’t tell you how much pain [they’re] in or if [they’re] feeling worse, which is why most pediatricians prescribe an antibiotic like amoxicillin,” says Allison Bartlett, MD, a pediatric infectious diseases specialist at the University of Chicago Medicine Comer Children’s Hospital.

Signs of ear infection in babies include:

• Ear tugging or pulling
• Excessive irritability or crying
• Fever
• Sleeping difficulties

Urinary tract infections (UTIs)

Urinary tract infections (UTIs) occur when bacteria enter the urethra, bladder, or kidneys. UTIs are treated with antibiotics. “A urine culture can confirm the diagnosis and identify which bacteria are causing the infection,” says Dr. Bartlett. “This helps the doctor choose the best antibiotic to target those specific bacteria.”

Fever is the most common sign of a UTI in an infant, but other symptoms can include irritability, vomiting, or blood in the urine.

Strep throat, sinusitis, and sepsis

Infants and young children rarely develop strep throat or bacterial sinusitis (sinus infection), but both are possible and may require antibiotics.

Also rare, and even more concerning, is sepsis. Sepsis is a blood infection caused by Escherichia coli (E. coli), Listeria, or Streptococcus bacteria. Newborns are at higher risk for sepsis if they are born pre-term, delivered more than 18 hours after water breaks, or need an extended hospital stay.

Is It Safe To Give Babies Antibiotics?

Antibiotics are generally very safe medications for babies, but like all medications, they can cause side effects or other problems in some children. Below are some possible complications to be aware of when treating infants or young children with antibiotics.

Allergic reactions

A small percentage of children have an allergy to antibiotics. About 10% of children in the US are allergic to penicillin, a common antibiotic.

A common sign of an allergic reaction to penicillin or other antibiotics is hives (swollen, itchy welts on the skin). Contact a health care provider immediately if your baby develops a rash while taking antibiotics. A mild reaction can quickly turn into a serious one.

Side effects

About 1 in 10 children experience side effects from taking antibiotics. Side effects aren’t always dangerous for babies, but they can be bothersome.

The most common antibiotic side effects include diarrhea, nausea, and stomach pain. “In addition to targeting bad bacteria, antibiotics kill off healthy bacteria in the gut. This can lead to stomach upset or diarrhea,” says Dr. Munjal.

Talk to your doctor about ways to help restore the bacteria in your child’s digestive tract, such as giving oral probiotics, which populate the gut with “good” bacteria to combat pathogens.

Antibiotic resistance

One of the biggest safety risks with antibiotic use is the development of antibiotic-resistant strains of bacteria. As more antibiotics are used globally, bacteria evolve to be more resistant to antibiotics, making these medications less effective.

This risk of antibiotic resistance is a key reason why doctors are very cautious about prescribing antibiotics only when necessary, and why you should always take antibiotics as prescribed.

Long-term health issues

Recent research suggests that the more a baby is exposed to antibiotics in infancy, the more likely they are to develop certain chronic health issues, including allergies, asthma, eczema, and excessive weight gain, later in life.

Researchers say it’s unclear whether antibiotic use in infancy causes these conditions. Children may be born with a predisposition for these health problems and have a higher risk for early symptoms that prompt antibiotic use.

Still, it’s a good idea to always talk thoughtfully with your child’s health care provider about the benefits and risks of giving your baby antibiotics and only using them when they’re necessary.

How Quickly Do Antibiotics Start To Work?

Most children start to feel better within 48 to 72 hours of starting antibiotic treatment, but it is important to continue to give the medicine for the prescribed length of time, even if your child seems better. Stopping medication early can cause the infection to return.

“A doctor may then need to prescribe a stronger antibiotic because the bacteria have built up resistance to the first medication, making the germs harder to kill,” says Dr. Bartlett.

As always, if you have questions about an illness, concerns about your child’s medication, or other lingering worries, don’t hesitate to reach out to a pediatric health care provider.