DEAR DR.PAUL: My four year old son seems to be sick all the time. We are constantly at the doctor's office getting antibiotics for his infections. I am worried and wonder how can I tell if my son's proneness to upper respiratory infections is a symptom of an underlying problem?

DR.PAUL ANSWERS: Your question brings up two points. First, that many children, especially when first entering a day care or school setting, usually get sick frequently. The other point is the use, and sometimes overuse, of antibiotics in these children. We know that the average child who first enters daycare will get about 12-14 infections (either colds, or gastroenteritis) per year. This is because a child who attends daycare or school for the first time is exposed to many new germs in these settings.

As the years go by, the child develops immunity or protection against these infections and is sick less often. This means that a four-year-old child, for example, may be sick more frequently than every month and if each infection lasts about a week, a child can then seem to be sick all the time. This is a common situation.

The obvious concern is whether there is an underlying problem making a child prone to a large number of infections. One important clue lies in whether a child is growing well despite the repeated infections. Fortunately, in most cases, these children grow normally, according to the growth curves. This is a very important and reassuring find.

Another clue we look for is how severe the infections are: Do they require hospitalization such as for a severe pneumonia or infection of the blood? In most cases, the infections are not serious and usually subside on their own. This pattern or trend helps reassure us that the child has no underlying problem. If there is a suspicion of something more serious, then further tests are necessary. However, this is not the case in the majority of children with frequent infections.

The other point raised by this question is the need for antibiotics in a sick child. Clearly most infections we see in children, such as colds and gastroenteritis (diarrhea and vomiting), are usually caused by viruses. Viral infections do not require antibiotics and usually subside on their own. The need for antibiotics depends on the presence of an infection that we suspect is caused by a bacteria, such as an ear infection, "strep-throat" infection, or pneumonia confirmed by a chest x-ray. However, if there is no suspicion of a bacterial cause of an infection, I do not feel that antibiotics are necessary. Overuse or misuse of antibiotics, has resulted in certain bacteria becoming more resistant to commonly-used antibiotics.

I invite you to send me your child health and wellness related questions. One of the most satisfying aspects of being a pediatrician is answering parents questions and concerns..as I feel that the more you know about your child's health and wellness (in terms of illness, normal growth/development and importantly prevention), the more comfortable you can be with your kids! You can visit Dr. Paul's website by clicking the alphabet blocks.