I absolutely hate prescribing medication to children.

I am quite worried when someone asks for my opinion on a sick child. I have some experience treating children during my internship and residency, yet I am pretty uncomfortable.

However, living in a lower middle-income country, where the average man already lives a difficult life due to high health care costs and limited income, health expenditure significantly impacts monthly finances. That is why people normally opt for a doctor’s free opinion who is accessible or friendly, regardless of his/her specialty. It’s only a doctor should be in their family, neighborhood, or social group.

Overdiagnosis and prescription of antibiotics or steroids due to limited knowledge or the inability of experienced pediatricians to be available at all times is a prevalent practice. Plus, pediatricians are expensive as hell. Still, I would prefer that my child be treated at a government hospital where a pediatrician can see him rather than a private hospital where a general physician sits.

Treating children necessitates considering various criteria, including BMI, birth history, vaccination status, allergies, nutritional status, eating habits, viral diseases, and expert diagnosing skills. Potential repercussions, such as drug resistance, hypersensitivity, drug interactions, and other factors, must also be considered when giving medications to children. Adult patients can still be managed if they develop complications from pharmacological side effects. However, managing kids is particularly challenging.

In my opinion, kids being treated by a doctor from your family is similar to a general practitioner treating cancer patients. Anyone can recommend treatment by seeing the NCCN guidelines, but only a qualified oncologist will examine future outcomes and factors, such as the patient’s overall survival, disease-free survival, and progression-free survival, while crafting a treatment plan for a cancer patient.

However, due to cost difficulties, illiteracy, poverty, and a variety of other causes, many general practitioners or doctors from other specialties have to treat pediatric patients, and many times, they try to treat their children themselves, too. I believe doctors are worse at self-medicating their children. Recently, I observed a toddler who appeared with an acute exacerbation of asthma and was in serious condition just because she had respiratory symptoms, and her mother continued to give her antihistamines on her own. It’s also worth noting that the mother was a doctor as well, albeit a radiologist.

The reluctance to prescribe antibiotics is likewise frowned upon in our culture. We believe that to treat children’s illnesses and keep them from becoming agitated or irritable for an extended period, we should simply ask the doctor to prescribe anything that can provide immediate relief.

I am very hesitant to give a child antibiotics, especially in viral illnesses, and do my best to use supportive measures, but many times, children do not improve, and I wonder if I was irresponsible and should have given them antibiotics sooner. But what can I do if I can’t convince those around me of the complexities of the matter and the fact that I’m not trained to treat children? Similarly, two of my siblings are quite young, and whenever they become sick, I am usually in a difficult situation because I have to treat them as everyone else says: “Tum doctor nahi ho kya?” (Are you a doctor? Aren’t you?)

“Kesi doctor ho? Ghar me bachay, har waqt beemar rehty hen.” (What kind of doctor are you? Your siblings are constantly sick.)

However, I have discovered an important fact over time: For children to recover from any sickness, they must eventually see a pediatrician. No matter how many family doctors you consult or how many remedies you try, it’s a fact that a pediatrician has a share of your income, and unless you pay for it out of your wallet, your children will only occasionally recover.

Damane Zehra is a radiation oncology resident in Pakistan.