Your child has a fever, cough and runny nose. You take him to the pediatrician. Don’t expect your child’s doctor to always prescribe antibiotics.

Here’s why not: Guidelines from the American Academy of Pediatrics and the Centers for Disease Control and Prevention say that “most of the time children don’t need antibiotics to treat a respiratory illness,” says Dr. Ingrid Sterling of St. Luke’s Zahra Pediatrics in East Stroudsburg. In fact, she says, antibiotics may do more harm than good for your child who has a cold or flu.

Some parents may believe that antibiotics will help their child get better faster, or prevent other infections from developing, Sterling says. However, Sterling tells parents she doesn’t prescribe antibiotics freely for common cold symptoms for several important reasons.

One reason is that antibiotics work on bacterial infections and, most upper respiratory illnesses, including the common cold and flu, are caused by viruses. Antibiotics won’t help illnesses caused by viruses, Sterling says.

Overuse makes infections harder to treat

Another reason is that overuse or misuse of antibiotics encourages bacteria to mutate, Sterling says. If the bacteria changes, medicines won’t work as well to get rid of them. This is called “antibiotic resistance.” “When bacteria become resistant to the medications, it becomes more difficult to treat infections,” Sterling says.

While on antibiotics, some children develop rashes. “It can be hard to say whether it’s a true allergy to the medication or a viral reaction,” Sterling says. The rash can confuse the issue and make it difficult for their doctor to treat your children if they do need an antibiotic at another time, she says.

Children with a runny nose, some ear infections and some sore throats don’t always need antibiotics either, Sterling says,

“Just because your child’s mucus is colored – green or yellow — it doesn’t necessarily mean your child has a bacterial infection.” Treat a runny nose with humidity, a saline rinse and time, and it is very likely to clear on its own, Sterling says.

The same is true with ear infections, Sterling says. Following guidelines set by the AAP, for some children who have signs of an ear infection, including fluid in the middle ear and a fever, it still may be best to watch and wait to see if it will clear on its own, Sterling says.

When antibiotics may be necessary

Still, there may be times when an antibiotic is necessary, Sterling says.

Most sore throats are caused by viruses, but strep throat is bacterial. If your child tests positive for strep, antibiotics will be necessary, Sterling says.

Sterling says she also considers prescribing an antibiotic if:

• Your child’s cough or other symptoms do not get better or get worse over the next 10 to 14 days.

• Your child’s symptoms get better in 10 days or so, but get worse again shortly after.