New Era of Minimal Treatment (Pedcast)

Topic Introduction

The other day I was thinking about how recommended therapies, also known as the “standard of care”, have changed during my pediatric career for routine illness. It struck me that we have entered an era of minimalism with regards to treatment. It seems to me that medicine has aged into middle age, no longer eager to “treat” every condition with a therapy, assuming that medical science was smarter than mother nature. I think that concept is passe. No, we have entered an era where interventionism is out and natural healing is in. Hence the rise of integrated medicine, homeopathic medicines, nutritional and aroma therapies.  Let me give you a few examples of how previously recommended treatments have changed during my pediatric career and I think you will see what I am talking about. Let’s start with a short list of health problems pediatricians are frequently consulted about and I think you will see what I am talking about.

Musical Introduction

Changing Approaches to Health Problems in Children

Infant Colic– this is a condition originally thought to be cause by an upset tummy in an infant (hence the name colic which refers to intermittent crampy pain in the stomach). When I started in pediatrics, the standard treatment for a colicy baby was some type of depressant medication, usually morphine drops called paregoric or some other brain depressant like barbiturates or alcohol. In fact I recall that when I arrived in Charlotte in 1982, one pediatric group sent every newborn home with a prescription for paregoric. Morphine for every child? Not in today’s world. In fact, none of these sedative-depressants are used anymore except in the most extreme cases of colic.

Colds and Cough– We certainly have backed away from the old days here. These medications are now not recommended for any child under 12 years of age. I’ll bet your childhood was full of cough and cold medications. Remember Robitussin, Dimetapp, Actifed, Cheratussin, Vicks, Hycodan, Tussianex, and Delsym, names from our childhood?  It turns out that not only were these medications of dubious value but unfortunately, hundreds of children overdosed on them each year, some even dying. Bye bye cough and cold medications. If you want to hear more about this subject, check out these archived episodes. I have talked about this topic extensively over the past few years.

Fever– In the era of meningitis and other serious blood stream infections in children, before the 1980’s, fever often meant serious, serious disease in a child. It still does at times, but rarely in today’s vaccine era. In the meningitis era, pediatricians believed that response or lack of response to anti fever medications could be helpful in sorting out which febrile child had a serious life threatening illness and which just had a self limiting viral illness. Response to fever treatment was an important tool pediatricians used to distinguish non serious, self limited viral illness from serious life threatening sickness. You can see why treating fever was such an obsession in those days. But not today. It turns out that lowering a child’s body temperature during a routine viral illness often prolongs the illness in terms of the illnesses total duration. In today’s world of minimalist treatments, fever reduction is often just a way to make a child more comfortable, not part of therapy or diagnosis of septic illness.  Ironically, in today’s world of pediatrics, you are more likely to read far more articles about the untoward side effects of acetaminophen or ibuprofen than their useful properties. Oh what a difference a few decades can make.

Diaper rash– Much has changed with regards to care of the diaper area in recent years as well. Powders have been out for quite some time because of their potential toxicity to a baby’s and mother’s lungs. If little Johnny or Janie gets a nasty rash in today’s world, no longer do we shotgun the treatment with potent steroids, antibiotics, and anti fungal combination creams.  No, now we target treatment with whatever seems to be most appropriate therapy given the child’s specific problem. The goal is to promote healing by restoring the child’s natural skin balance and protective defenses, whether that be by just air exposure, gentle cleansing with water, or probiotics– all really common sense, natural therapies.

Diarrhea– Did you know that Imodium, loperamide, was a baby anti diarrheal medical before the adult world discovered how effective it is and started using it. If you want a medication that can stop diarrhea, this is your baby (no pun intended). It is very effective but it turns out, that Imodium actually can prolong the duration of diarrhea and length of the illness.  Ironic, wouldn’t you say. A medicine designed to shorten diarrhea illness that actually prolongs the symptoms. There is a reason that a child’s body goes to all the effort to have diarrhea, to get rid of the offending germ–Da! Parents don’t like diarrhea but it has a use. And, it turns out that Imodium is a dangerous medication when given to children under age three years of age. (1) Its use is definitely off the recommended list for 21st century pediatrics in young children and maybe in all children.

Ear pain and Middle ear infection– When I was a young pediatrician, treatment of ear infections consumed a full 40% of a my office work time. Not so today. Not only do children not get nearly as many ear infections as they did 30 years ago largely due to vaccines, but pediatricians often recommend not treating them–heresy just a decade ago. Ear infections are uncomplicated and self-limiting infections in about 60% children who develop them– that natural healing thing again. Careful non-treatment is the modern approach.

Lacerations and abrasions- What could be more traditional than Mom or Dad getting out a bottle of peroxide to clean a scrape or cut that their child receives. Well, cleaning wounds with peroxide is no longer recommended. Soap and water-yes but not peroxide. It turns out that hydrogen peroxide does destroy bacteria in wounds but it also damages healthy tissues at the same time, ultimately slowing down the child’s healing. Mom, in the 21st century, put down the bottle of peroxide and back away!

So what is the theme here? It is the realization that stopping bodily reflexes like cough, fever, diarrhea, reflexes honed for thousands of years, is not wise and sometimes dangerous. Yes, it is unpleasant to see your child have cry with colic, have diarrhea, cough violently, or have a fever, but these biologic responses to illness are part of his or her natural healing and usually are just part of the process of them getting well. But not always and that’s where your child’s pediatrician can really help. If you have concerns about your child’s health or any aspect of their well being, make sure to get the advice from their pediatrician.  I think you will find them very useful.


I want to take a moment to thank all my followers. I hope that over the past five years of blogging, you have gotten as much out of the process as I have. Creation of this blog and the writing of my first book have been the experiences of a lifetime. I couldn’t have done it without your support.  I hope I can continue bringing you information that you can use to augment your parenting decisions. I am flattered and honored to be an influential part of your family so to speak. If you can, take a moment and send a comment to my blog at or a short review on iTunes. And remember, subscriptions are free and easy at my website. That way you can stay up to date with all my new pedcasts and articles. This is Doc Smo, recording in studio 1E, reminding you that the new treatment principle, is, keep it minimal. Until next time.

Smo Notes:

(1) Imodium effects on diarrheal illness