With Medical Rx in Kids, “Less is Often More” (Pedcast)


Hello and welcome, I am your host, Dr. Paul Smolen, a board certified pediatrician with 37 years of practice. The other day, I was having a conversation with a mother about fever seizures. Her child had had one of these seizures and she found it extremely frightening. That’s understandable. Anyone who has seen a child have a generalized convulsion can understand this mom’s dread. During a seizure, it looks like the child is dying right in front of you.  I was explaining to this mom that fever seizures are almost always benign, are almost never harmful to the child, require no treatment, and are not even considered epilepsy. That led us into a discussion of a whole host of illnesses and symptoms that just 40 years ago were felt to “require” treatment but that was then and today is now! Today many symptoms and conditions don’t require treatment and are recognized as temporary states that will resolve with time.  In today’s pedcast, I thought it might be fun to go over some of the conditions and symptoms that pediatricians no longer recommend treatment for. Oh, what a difference a few decades can make. Stay tuned for about 10 minutes and I will show you just how much change there has been.

Musical Introduction

Less is More

“Less is more.” Have you ever heard people say that? Well, it is very true, especially, when it comes to treating the most common medical conditions children present to their parents. Take cough for instance. Yes, cough is a sign that something is wrong with the child and yes, it can be associated with very serious medical conditions but most of the time, it is simply the child’s way of keeping their lungs clean during a viral respiratory illness; a useful but annoying way to prevent the child from contracting pneumonia.  Stopping this reflex is exactly the opposite of what parents should want to do but… I can’t tell you how much cough syrup I prescribed at the onset of my career to stop this very useful reflex. After taking cough syrup, maybe the children who took it slept better when they were sick, but it certainly wasn’t curing anything. It may have actually been doing some harm. In today’s world of pediatrics, treating a cough is considered poor practice and even dangerous as we have talked about in many pedcasts in the past.

And how about fever, the great buggy man for parents. Again, fever almost always means something is wrong, usually an infection, and certainly should not be ignored but not panicked over either. It turns out that fever accelerates healing and reducing a child’s temperature can prolong the illness! I know this is a radical concept but fever actually helps a child get well! For most children, no fever medicine is needed at all unless the fever is extreme or the child is very uncomfortable. How refreshing is that!  In the era of almost no invasive bacterial illnesses thanks to vaccines, parents can simply “back away from the Tylenol bottle and take a more relaxed attitude about fever”.

And how about diarrhea, is that a useful thing for sick children as well? Of course it is! How else is your child’s body going to get rid of germs and toxins that they have inadvertently put in their mouth? Creating a tsunami of fluid hosing down the inside of their intestines is a very effective way of ridding them of germs that can cause disease. We don’t want to stop that and as you might expect, doing so with diarrhea medicine, prolongs the illness just like with fever meds. Again, mom, “back away from the diarrhea meds”.

This minimalist approach as I like to call it has now spread to the treatment of many of the classic pediatric disease: bronchiolitis previously treated with steroids and bronchodilators, bronchitis previously treated with antibiotics, fever seizures previously treated with strong anticonvulsants, gastro-esophageal reflux in babies previously treated with very potent antacids and anti-reflux medications, colic previously treated with narcotic drops, certain ear infections in older children previously treated with antibiotics, twisted legs in babies called tibial torsion previously treated with orthopedic leg twisting braces etc, etc.. All these treatments are now safely tucked away in the annals of pediatric medicine. Thank goodness.


So what are we to conclude from all of this? The amazing thing is that all this “therapy” was thought to be useful at the beginning of my pediatric career, just a few decades ago. Oh, we thought we had all the answers and that we knew best. Pediatricians have learned some painful lessons during my career and we have also gained much more respect for the natural healing powers that children’s bodies possess. What I have learned after 37 years of practicing pediatrics is… most of the time, pediatricians just need to get out of the way and let that natural healing happen. Remember this Doc Smo pearl, “Trust your child’s body; it has been practicing medicine longer than any doctor alive.”


Well, that’s it for this pedcast. If you enjoy exploring child health topics with pedcasts, leave your email address at my website by subscribing and i will drop you a note when I put out new content. Join the conversation why don’t you? This is Doc Smo, broadcasting from studio 1E in Charlotte NC, reminding you that less meds, might put your children in good stead. Until next time.

Many thanks to eight year old Slayden of Charlotte, N.C., for recording the introduction to this pedcast. He did a great job.