The Times They Are A-Changin'

What pediatricians once told parents is not the same as what they tell them today. Nancy Barnett, M.D., a pediatrician with the Santa Clara Center of the Palo Alto Medical Foundation, provides information about tonsillectomies, milk and antibiotics.

We now know more about what tonsils, the oval-shaped, pink masses of tissue on both sides in the back of the throat, do for the body. Far from being useless parts that are best cut out by a surgeon, the tonsils are actually part of your immune system.

The tonsils typically become inflamed because of an infection. They will look red and swollen, and may be covered with a white or yellow coating. A child whose tonsils are inflamed may complain of a sore throat and pain when swallowing. He or she may also have "throaty" voice, swollen glands in the neck and a fever. These symptoms can be caused by a virus or a bacteria.

Needless to say, this is rather uncomfortable for the child. However, once the body fights off the infection, the tonsils will return to normal size.

Sometimes tonsils may also become enlarged without any obvious signs of infection. However, even in these cases the tonsils often shrink without any treatment.

Today, the American Academy of Pediatrics only recommends surgery to remove the tonsils if the tonsils become so swollen the child has trouble breathing and swallowing normally, has an excessive number of severe infections each year caused by streptoccus bacteria (strep throat) or has swollen neck glands for six months or longer despite taking antibiotics.

My daycare asks the parents to take turns providing a daily snack for the children. I always bring whole milk, but some parents now will only bring 2% milk. What do doctors recommend for toddlers?

This is another area where recommendations are changing. Doctors used to think that toddlers' small stomachs and picky eating habits meant that foods with highly concentrated energy, like full-fat milk, were best. However, with the rise in childhood obesity, doctors have become more cautious about recommending some high-fat foods. After age 1, it is usually safe to switch healthy toddlers with normal weight gain to whatever milk the rest of the family drinks. Skim, 1% or 2% milk are all acceptable with the goal of having your toddler drink 16 to 24 ounces of milk per day.

It seems like it is getting harder and harder to get a prescription for antibiotics for my kids. Why is that?

Antibiotics used to be prescribed more often than they are today, but doctors now recognize that there are some very good reasons not to use them for every runny nose or fever. First of all, antibiotics only work on illnesses caused by bacteria. They do not help treat diseases like the common cold and the flu that are caused by viruses.

Second, while antibiotics are safe and helpful when used correctly, they are not completely harmless. According to the American Academy of Pediatrics, about 15 percent of children who take the most common antibiotics develop side effects like vomiting and diarrhea and five percent have allergic reactions.

Finally, the most important reason to skip antibiotics when they are not needed is that if you give bacteria enough experience with a particular antibiotic, the bacteria can become immune to that antibiotic. This is what creates the "super bugs" like the hard-to-treat Methicillin-Resistant Staphylococcus Aureus (MRSA), a staph infection that is increasingly affecting school-age children.
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