Title: The Unseen Challenges of Medicating Children: Insights from a Doctor in a Low-Income Country

By Damane Zehra, Radiation Oncology Resident, Pakistan

As a healthcare provider, I frequently contend with the expectation that I should be able—and obligated—to treat any patient, irrespective of their age. However, one particular challenge brings me considerable discomfort: the act of prescribing medication to children.

Although I have had some involvement with pediatric patients during my internship and residency, I still feel deeply unsettled when sought for guidance on how to care for sick children. The anxieties I face stem from emotional, clinical, and systemic issues, many of which are rooted in the healthcare dynamics of lower-middle-income nations such as mine.

Cultural Pressures and Erroneous Expectations

Raised in an environment where healthcare is costly and often out of reach, the local community instinctively turns to doctors in their vicinity—whether they be family, friends, or neighbors—for medical counsel. There exists a strong cultural assumption that if a family has a physician, health concerns should be handled without specialist input. For many, consulting a general practitioner for pediatric issues appears not only practical but also financially essential.

Nonetheless, the belief that a general physician can adequately address a complex pediatric case is as misguided as thinking a generalist could handle an advanced cancer diagnosis. Sure, information on treatment protocols is readily available—but only a pediatrician possesses the expertise to assess a child’s growth patterns, nutritional requirements, immune systems, and the long-term consequences of any given medication.

Pediatric Health: A Multifaceted Challenge

Children are not just small adults. Their treatment necessitates a grasp of an entirely different physiological framework. Important factors such as body mass index (BMI), developmental milestones, prenatal history, vaccination records, and even seemingly trivial allergies play a vital role in medication prescriptions.

Medications that are manageable or relatively safe for adults may produce severe, and sometimes devastating, effects in children. Resistance to drugs, hypersensitivity, and toxicities can be more pronounced and are significantly harder to manage in younger patients. And let’s not ignore the difficulty of prescribing the right dosage, which is dependent on weight, age, and metabolism—all of which can vary greatly in children.

The Antibiotic Quandary

A major source of pressure stems from the almost universal expectation among caregivers for antibiotics—regardless of whether the illness is due to a bacterial infection. In families where a child’s symptoms persist for an extended period, this demand becomes both emotional and urgent. “Do something—anything! Just make the child stop crying!”

Such urgency often results in the overprescription of antibiotics or steroids by general practitioners. This not only exacerbates the global issue of antibiotic resistance but also puts young patients at unnecessary and avoidable peril.

I have often found myself reluctant to prescribe antibiotics, opting instead for supportive care in cases of clear viral infections. But when recovery takes longer than expected or doesn’t occur at all, self-doubt creeps in: Should I have prescribed the antibiotic? Was my approach too cautious? These internal dilemmas are amplified by the critical voices of others: “You’re a doctor! Why is your sibling still unwell?”

Strained Family Members, Tough Decisions

My own younger siblings frequently fall ill, and I feel trapped by societal and familial pressures. “Tum doctor nahi ho kya?” (“Aren’t you a doctor?”) echoes in my ears repeatedly. Yet being a physician does not imply expertise across all age groups and specialties. Nevertheless, I continue to help them, often begrudgingly, fully aware that only a consultation with a qualified pediatrician can make a genuine difference.

A concerning instance I recently observed exemplifies how even healthcare professionals can succumb to this risky overconfidence. A toddler presented with a severe asthma attack because her physician-mother (a radiologist) had been administering antihistamines without seeking appropriate pediatric care. If this is how doctors manage their own children, what can be expected of the general public?

The Cost of Pediatric Expertise

Part of the hesitation to pursue specialist care is its financial burden. Pediatricians often have significantly higher fees, particularly in private hospitals. Though government hospitals often provide pediatric services, they tend to be overcrowded, underfunded, or logistically challenging to access.

This creates a self-perpetuating cycle: families default to general practitioners or self-treatment, resulting in misdiagnoses or protracted illnesses, which ultimately necessitate the very specialized care they aimed to avoid in the first place.

The Conclusion: Importance of Consulting a Pediatrician

One key message I wish every family to understand is this: when it comes to children’s health, particularly in acute situations, a pediatrician must be consulted. No matter how knowledgeable a family physician may be, or how many guidelines they can refer to, pediatric care is a specialized field for valid reasons.

In socio-economic contexts like ours, raising awareness and pursuing systemic reform are of paramount importance. There should be educational initiatives aimed at breaking down the misconception that all doctors possess equal qualifications for treating every ailment. Concurrently,