Needless Child Doctoring

Most of the 3,000 U.S. physicians who gathered in Miami last week for the A.M.A.'s annual clinical meetings got their fill of advice on what to do for a variety of ailments. But the most refreshing bit of advice urged less instead of more doctoring. Many physicians, complained Dr. Robert Barrett Lawson, treat children, or even operate on them, when they really need no treatment at all.

Many current medical practices, suggested Dr. Lawson, head of the pediatrics department in the University of Miami's burgeoning, two-year-old School of Medicine, are as obsolete and uncalled-for as the "purging, puking and bleeding" which were once so highly recommended.

Teeth & Tongue. Needless doctoring can start right at birth, said Pediatrician Lawson, in cases where a baby happens to be born with teeth. These are often loose and appear to be of little use. But if left alone, they usually become firmly fixed in the jaw, whereas yanking them out may cause bleeding, ulcers or infection. Also, said Dr. Lawson, there is still too much routine clipping of tongues, although it is now known that a long membrane beneath the tongue does not affect speech or nursing to any extent.

As for the times when baby is "off his feed," Dr. Lawson saw nothing to worry about in most cases: "The prescription of tonics and elaborate vitamin mixtures serves only as a crutch and evades the real issue. Usually, these incidents reflect the mother's anxiety more than anything wrong with the child."

If, after a few months, the youngster still has a pronounced bulge around the navel, most parents get panicked about what the doctor calls umbilical hernia. It is customary then to strap the navel with adhesive, and in many cases surgery is advised. Needless, said Dr. Lawson. Even the bandages often cause skin irritation, and the vast majority of umbilical hernias disappear if left alone. Operations, he suggested, are unnecessary before the age of eight--and after that, they will be rare.

Tonsils & Colds. One of the most notorious areas for needless surgery lies in the tonsils. True, "a conscientious physician recognizes the need for an occasional tonsillectomy, but all too often it is done for no particular reason." The simple fact is, he said, that the size of the tonsils means next to nothing because they are normally enlarged in children between five and eight years of age.

The question of colds and other upper respiratory infections brought Dr. Lawson to his final blast against the overuse of antibiotics. More than 90% of children's fevers and respiratory and gastrointestinal infections are caused by viruses, he declared, and antibiotics are of no use against viruses. "Yet many physicians cannot refrain from scattering antibiotics far and wide because 1) the family expects it, 2) it won't do any harm. 3) it might do some good, or 4) you can't tell which infection is viral and which bacterial . . . The pressure to 'do something is always there, but it is often the truer test of the good physician to let nature take its course than to give treatment when treatment is not necessary."

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