But because of “medical scepticism, the parents encouraged poor adherence to the antibiotic regime”.
Antibiotics were prescribed but not used in the case involving a 9-year-old girl whose minor eyelid infection worsened to a life-threatening degree, the authors of a New Zealand Medical Journal report say.
Instead, diluted silver nitrate was topically applied to the infected area twice a day.
Four days later the girl was taken back to hospital with worsening swelling and tenderness, and an MRI confirmed all her sinuses were infected, as well as around her eye, and she had Pott’s puffy tumour – a fluid-filled lump that can be life-threatening.
She also had a superior sagittal sinus thrombosis, where one of the sinuses that drain blood from her brain had clotted, Arnold said.
“It can be very serious, very quickly and not uncommonly lead to death if untreated. She had to have urgent surgery where otherwise we probably could’ve avoided things with just medical treatment.”
The girl’s eyelid (left) when first seen by doctors, but the swelling had increased (right) when she went back to hospital four days later. Photo / New Zealand Medical Journal
The girl “absolutely” could have died, he said.
“The infection itself was advanced and needed IV [intravenous] antibiotics and the site of infection needed surgical drainage … and then she was also given an extended course of treatment and monitoring for that dural venous sinus thrombosis [a stroke caused by a blood clot in the brain’s venous drainage channels], which is the complications of the infection.
“So she could’ve died from the infection, and could’ve died from complications from the infection.”
The girl was on intravenous antibiotics for six weeks, the first two in hospital after her discharge was delayed by her parents’ reluctance to provide a home address for continuing outpatient treatment.
She has since fully recovered.
The girl’s parents hadn’t indicated they were against the prescribed medicine when she was initially seen for her then-minor infection, Arnold said.
When her condition worsened, her parents contacted a surgeon their friend knew – another example of mistrusting the system, he said.
The girl’s parents “didn’t trust doctors, they didn’t trust politicians, they didn’t trust any institutions”, ophthalmology registrar Dr Morgan Arnold says.
Once back in hospital, it still took “a lot to convince them we needed to treat [her]” even though they’d been told their daughter’s condition was life-threatening.
It was “very hard” to get an explanation for their reluctance, Arnold said.
“A whole bunch of mistrust of medicine and institutions and modern science as a whole without being able to drill into any reasoning for it.
“They very much didn’t trust doctors, they didn’t trust politicians, they didn’t trust any institutions.”
‘Massive’ increase in misinformation since pandemic
In New Zealand and globally, medical care was increasingly complicated by rising health misinformation, which had “massively increased” after the Covid-19 pandemic and in connection with increased social media use, Arnold and Elder wrote in their report.
In 2022, a baby boy needing life-saving heart surgery was placed under the temporary guardianship of the High Court after his parents opposed him receiving transfused blood from vaccinated donors.
Critically ill Baby W was subsequently taken from his parents by police before the ultimately successful surgery, sparking protests outside the court and Starship children’s hospital by supporters of the parents.
Baby W and his mother outside the High Court at Auckland in December 2022 with lawyer Sue Gray (left) and anti-vaccine protester Liz Gunn (right). Photo / Alex Burton
Because they relied on parental adherence to evidence-based medicine, children were particularly vulnerable, Arnold and Elder’s report says.
“Ideally, clinicians should employ proactive advocacy strategies to ensure parental co-operation with medical treatment without relying on evidence of disease progression to sway parental opinion.”
Early discussions around the treatment provided and any barriers the patient foresaw could identify where further information was needed, with clinicians needing to be skilled and confident in getting the evidence base of their recommendation across.
“Clinicians should approach these conversations with empathy and care to facilitate an open and honest dialogue.”
A “high index of suspicion” and proactive management of health literacy in patients and their families, particularly in unwell children, was needed to avoid complications, they wrote.
‘We don’t judge you’
Arnold’s message to parents was to be upfront, too.
“We lucked out with [this girl] not having any long-term complications … but the next kid might not [be as fortunate].”
If a parent wanted to try an alternative treatment, they should tell their doctor, he said.
“We don’t judge you … if it’s not harmful, we won’t discourage it. We’ll just explain why the [conventional treatment] evidence base is there and why we believe [it] is needed.”