The link between antibiotics, sweet cravings and restlessness in children, explained by Dr. Olimpia Pașca, MedLife. “Not every sore throat is treated with an antibiotic”

Only one child out of 10 treated with antibiotics actually needed such treatment, estimates Dr. Easter Olympiapediatrician within Hyperclinics MedLife Oradeareferring to the cases he sees in the cabinet. For many children, however, after repeated administrations, manifestations may appear that parents do not immediately associate with the treatment, but with digestive problems or fads: increased appetite for sweets and carbohydrates in general, restlessness, irritability, more restless sleep, stomach pains. The cause may be an unbalanced microbiome, says the doctor. “Not every sore throat is treated with antibiotics,” she warns, explaining the effects antibiotics can have on the gut flora and what parents can do to support it after treatment.

In the pediatrician Olimpia Pașca's office, children frequently arrive who, after several episodes of colds with fever and red throat, treated with antibiotics, remain with manifestations that do not seem to be related to the original problem: abdominal pain, constipation, reflux, skin with lesions of atopic dermatitis, food intolerances, restless sleep or an uncontrollable appetite for sweets and carbohydrates. They can all be related, says Dr. Pașca: the unbalanced gut microbiome.

“The antibiotic disrupts the intestinal flora. And the intestinal flora has a very important role in health: it supports immunity, protects us from allergies and also influences the gut-brain axis”, explains the pediatrician.

The role of the microbiome in immunity

In the first years of life, the microbiome builds rapidly and is sensitive to change. When the balance is out of balance, the consequences begin to appear: some children have repeated seemingly inexplicable digestive symptoms, others experience dermatitis, others catch colds often, are always bloated and may even have behavioral problems.

The link between the microbiome and immunity is well supported in the medical literature, and differences in the microbiome can appear from birth (eg, depending on the type of birth and nutrition in the early months), with breastfeeding and natural childbirth playing an important role in modulating these differences.

Antibiotic for red throat or fever: when it is useful

The most common situations encountered by Dr. Pașca are small patients treated with antibiotics for high fever, which often scares the parents, and for red throat. The problem is that in many cases a viral infection may be to blame, and taking antibiotics is unnecessary and may even be harmful. “Not every fever needs to be treated with an antibiotic. Many times, it's a viral infection. Also, not every sore throat needs an antibiotic,” says Dr. Pașca. In her clinical experience, very few of the cases she sees end up actually needing antibiotics – “I'd say around 10%”.

Moreover, the specialized literature emphasizes the importance of the judicious use of antibiotics, given that most seasonal respiratory infections in children are viral and are not treated with antibiotics, and unnecessary administration brings adverse effects and contributes to antimicrobial resistance.

The doctor's message is not, however, to completely avoid antibiotics, because there are situations in which the administration of such drugs is essential – such as bacterial infections confirmed by analysis or highly probable, after the use of clinical tools and rapid tests.

Fever is not a disease. When it is necessary to intervene with antithermics and when not

Fear of fever is a common problem among parents and often leads to the overuse of treatments – be it antipyretics or even antibiotics. In addition, some parents use anti-inflammatories such as ibuprofen for other symptoms that upset the child, not only for fever: stuffy nose, sore throat – or even from the desire to return him to the community faster. A lesser-known but research-supported consequence of overuse of anti-inflammatories is that they lower immunity.

“Fever is a sign that the body is fighting and we have to let it fight a little”, says the doctor, emphasizing that the treatment must be adapted to the child (age, history, risk of febrile convulsions, etc.) and that the decision is made together with the doctor who evaluates him.

Used inappropriately, antithermics can prolong the evolution of the virus or increase the risk of superinfection, precisely because fever is part of the defense mechanism.

What happens in the gut after the antibiotic: diarrhea is only part of the problem

When we talk about the effects of antibiotics, parents often think of diarrhea or constipation. But the pediatrician describes a bigger picture: recurrent abdominal pain, bloating, reflux, loaded tongue, morning breath, more cravings than ever for sweets and an almost exclusive preference for carbohydrates, to which can be added restlessness, restless sleep and irritability.

“When there is a disturbance of the intestinal flora, children prefer to eat more sweets, carbohydrates – bread, pasta, bananas, potatoes”, says Dr. Pașca. In addition, she adds, some families notice irritability, restlessness or fragmented sleep – the explanation being the two-way connection between the gut and the brain (the gut-brain axis), which has been intensively studied in recent years.

Probiotics are not taken randomly. The solutions recommended by the doctor

The term “probiotic” administered during antibiotic treatment is very generic. In fact, rebalancing the gut flora both during and after the antibiotic course should be established and customized with the pediatrician. “The antibiotic must be given with a probiotic – some can be administered at the same time, others at a distance from the antibiotic. And I insist on continuing the treatment with the probiotic for at least a week or two after completing the course of antibiotics”, emphasizes Dr. Pașca, adding that sometimes he chooses different probiotics, including changing them every 1-3 months, depending on the symptoms.

Here an important nuance is worth it: in clinical trials, the benefits are dependent on the strain and dose (not all probiotics are equivalent), and the recommendation is personalized – especially in children with chronic diseases or compromised immunity.

In parallel, the doctor emphasizes foods that feed the “good” bacteria: prebiotics, such as fibers from vegetables, fruits, legumes, whole grains – adapted to age and habits that support a diverse microbiome, including outdoor physical activity.

What other treatments can affect the intestinal flora

The doctor says that not only antibiotics can disrupt the balance of the microbiome, but also the prolonged use of anti-allergic drugs or dietary supplements, such as synthetic vitamin C. It is best for parents to discuss all supplements and long-term treatments given to children with their pediatrician, because at young ages the risk-benefit balance can change quickly and adjustments and customizations of dosages and treatments may be needed.

When microbiome testing is needed

Dr. Olimpia Pașca says that when symptoms persist (increased cravings for sweets and carbohydrates, bloating, gas, abdominal pain, reflux, loaded tongue, bad breath in the morning, irritability or restless sleep), certain microbiome tests may be helpful. In her practice, she uses two types of assessments, depending on the child's age: the analysis called “Microbiome”, generally recommended for children over 3 years old, and an analysis for the youngest, which she calls “Dysbiosis”. Both are stool investigations that can suggest whether the gut flora is out of balance and which direction of rebalancing makes sense in the context of symptoms.

The doctor also explains that, in addition to these microbiome-oriented tests, there are other stool analyzes that can help to understand the problem from several angles: if there are signs of intestinal inflammation, if the intestine is “irritated” after repeated problems (including after antibiotics) or if there are signs that can accompany allergic-type manifestations.

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