What if an Au Pair Doesn’t Want To Take Antibiotics– and we’re all sick!

by cv harquail on February 23, 2015

HostMomX raised this concern in the comments on the post about Dr. Host Dad and his Vitamin B injections:

au pair, au pair health concernsThis situation brings up a related issue that HD and I have wondered about. We have had several APs tell us that they are very anti antibiotic, and won’t take them.

I understand that attitude – I know a lot of people who feel that way, and for good reason. And I agree with those reasons – we are way too antibiotic dependent here, and the ill-effects of that have been well-documented.

Luckily these have been fairly hearty APs who have luckily not come down with any illnesses that would seem to have required antibiotics while they were with us – despite being slobbered on non-stop by our constantly-sick young children. So we never had to actually deal with the situation.

But we wondered – if the whole family comes down with some bacterial infection, say, strep throat, that knocks you out of commission with fever and related symptoms for quite some time if you don’t treat it with antibiotics, and we all get on antibiotics right away and get back in the saddle, but the AP refuses to take antibiotics and therefore can’t work for a week or more (and is also still contagious and could re-infect the family), what is the solution?

As illustrated by the horrendous-sounding situation with the Vitamin B shots (and our flu shot conversations ~ cv) , you can’t force someone to take medicine they don’t want to take.

And it doesn’t seem like a situation where you could (or would want to!) demand rematch – but it is horribly inconvenient and expensive in terms of scrambling for backup care.

It seems a lot different from the injury situations that have been discussed on here, where an AP breaks a bone and there is no way to heal that quickly; but with a bacterial infection, there is an option for avoiding a prolonged illness. With something like a bacterial illness, it would likely be over by the time rematch could “solve” it, and then irreparable damage would have been done by suggesting rematch.

Now – with the APs we’ve loved over the years who have had this attitude, I am sure we would have just dealt with it and tried our best not to feel resentful.

And of course we’ve dealt with many sick days needed by APs and nannies over the years – we all get sick, and others have to deal with it. I guess this situation feels different because there would be an easy medical solution that the AP is refusing to utilize, so I could see major resentment on my part if an AP needed two weeks off due to an illness she could easily have stopped in its tracks.

What do you all think?




Image: Blow! by Susan Sermoneta on Flickr


hOstCDmom February 25, 2015 at 10:37 am

I would add to HostMomX’s question the addition of: LICE and PINWORMS. Both highly contagious, very common among young children, and requiring treatment of all members in a household to avoid re-infection of the household. And both decidedly very ICKY!!

Should be working February 25, 2015 at 1:43 pm

My APs were very grateful that I asked our “lice lady” to check them carefully along with the rest of us and treat them when necessary. Which, given their long thick hair in each case, was an expensive proposition that we of course covered for her.

As I recall we had an even worse situation on here once, namely an AP whose boyfriend’s house had a bedbug infestation. “Treatment” at the boyfriend’s house was ambiguous in terms of its outcome and if the AP brought those things home it would mean ongoing, expensive, possibly ineradicable infestation. Antibiotics are to me more clearcut–if you need them, you take them or you can’t stay with us.

hOstCDmom February 25, 2015 at 10:41 am

I would require the AP to have testing to confirm the illness (strep test at my cost) and treatment with antibiotics, or, if she declined, which is of course her right, she would need to move out to the LCC’s or otherwise forthwith. I would consider her untreated, infectious state to be a health risk to my family. Strep, while often routine, can have serious health implications, especially for babies and children. I would not allow someone living in my home to present a known, active risk to my children in the face of a readily available, mainstream medical solution. I also would not accommodate to my professional detriment the AP having sick days for a treatable illness. AP is absolutely entitled to her position on antibiotics, and complete autonomy over her body and medical treatment, or lack thereof, but that doesn’t mean that her choices do not have consequences.

NoVA Twin Mom February 25, 2015 at 11:28 am

From a personal perspective, I (apparently) had untreated strep throat as a preschooler that turned into Scarlatina (better known as scarlet fever). The doctors were concerned about me, but MORE concerned about my infant sister, even putting her on preventive antibiotics. This would have been in the early 80s, so not that long ago. The upside is I haven’t had strep throat since, but I don’t recommend this as a method to avoid strep throat, as it may be purely coincidental that I had scarlet fever and haven’t had strep throat since.

So strep throat in particular needs to be tested for and treated. And I agree with hOstCDmom (and I believe TACL has made the comment in the past) – I would pay for the strep test to determine this and any necessary antibiotics – because if she wasn’t working for me she likely wouldn’t have caught this. (I’d want her insurance to be billed of course, but would fund the test up front if necessary and pay any out of pocket expense she encountered.)

I do see an argument for avoiding unnecessary antibiotics – but recognize that there are times when antibiotics are necessary!

Taking a Computer Lunch February 25, 2015 at 12:32 pm

The year child #2 was in kindergarten, our family experienced endemic strep throat. The Camel had it 11 times that year, and at one point the back of her neck opened up, exposing the hardware fusing her spine and risking her for a worse infection (fortunately my AP saw it and the Camel was in the hospital before the bacterial levels became life-threatening). That year we paid for the AP’s strep throat treatment a couple of times. What finally kicked it was throwing away all the tooth brushes, and wiping down all of the toys with a bleach solution. That, and insisting that child #2 wash his hands frequently (little germ ball).

Strep is a funny thing, last year when another AP’s boyfriend was visiting and felt miserable, both of them went to the CVS minute clinic – he tested negative and she positive – neither of my kids tested positive.

I’ve never had an AP reject antibiotics. I think they are more easy to obtain in Europe than in the U.S. If she did, I would make an appointment with my children’s pediatrician and have her explain the importance of taking them (preventing the strep from entering the heart and causing permanent damage is the one reason why DH and I don’t roll our eyes when the kids complain of a sore throat).

I do think that a good solution, should an AP refuse treatment for an infectious condition that might become endemic in our household, would be to ask the LCC to relocate her until her infection had cleared. Whenever the AP becomes sick from the kids, I reimburse her for the difference in insurance coverage (which is pathetic for most APs), but if she were to refuse the treatment, then the cost of returning to the physician to prove that she was infection-free would be on her.

Like I said, it has never happened in my house – usually everyone is anxious to feel better! (And yes, the Camel has been hospitalized from infections brought in to my house – although not from APs – just visiting relatives.)

hOstCDmom February 25, 2015 at 12:46 pm

To be clear, when I said I would ask the AP to move out forthwith, she would not be welcome to move back in (other than to pack her things). If no treatment were her stance, our relationship would be over – I would not be willing to cover her sickness+ refusal of treatment with back up care, nor would I be willing to risk having the same situation occur again. While some might see this as unfair, her unwillingness to have treatment would be a permanent relationship ender. As I said, choices have consequences.

Emerald City HM February 25, 2015 at 1:10 pm

I’m with you on this one.

NNTexasHM February 25, 2015 at 11:51 pm


When I interview I have lean red to ask explicitly “would you be wiling to get a flu vaccine, take antibiotics if you got sick, and / or other measures to take care of yourself but more importantly, my child.”

If the answer is no, it may work for other families but not for us.

WarmStateMomma February 27, 2015 at 10:49 am


Multitasking Host Mom February 25, 2015 at 12:57 pm

I am in the health care field and I agree that antibiotics can be over used, but obviously there are many cases where they are needed and even life saving. I do not think an AP who would refuse to take antibiotics for strep throat (something that if untreated could turn into a serious illness) would be a good fit for our family. I am not saying I would rematch over it specifically, but it would show such a difference in philosophy that I don’t know if we could continue.
We had an AP a few years ago that was from Europe and wanted to go to college to be to be a nurse when she returned. Yet she didn’t want to take any medication. I would feel so bad as I saw her sick with a cold constantly blowing her nose and coughing, but she refused to take anything for it even when I offered to buy her something. Lucky she was a hard worker and she never asked for a sick day. But honestly I would have felt frustrated if she had because she could have easily felt better if she had just taken some over the counter medication.
We recently moved and have a new LCC. Part of her talk when she came to the house soon after our latest AP arrived was discussing not asking for sick days for minor issues. I appreciated that she set that expectation.

UKAu Pair February 25, 2015 at 1:21 pm

I’m European and I very rarely take medicine for anything (I can’t imagine taking it for a cold, apart from paracetemol if I was feeling really grotty).

Regarding antibiotics, if I were to become ill and the doctor was able to demonstrate to me that it was a bacterial infection, of course I’d take antibiotics. If my host family tried to give me antibiotics purely because I was ill then I would refuse- I know how antibacterial resistant illnesses develop and I’m not going to contribute to them because I can’t be bothered to find out whether what I have is viral or bacterial.

However, I also don’t take sick days (unless I’ve thrown up), I drink lots of water and I wash my hands regularly (hooray, first aid training). I can completely see where host families are coming from and I support their right to ask an AP to leave if they feel that she is endangering their children’s safety, but I hope that they would respect the wishes of an AP who wanted proof that an illness was bacterial before proceeding with antibiotics.

hOstCDmom February 25, 2015 at 1:31 pm

I agree with you UKAP – I too am wary of contributing to antibiotic resistant infections, and I would want proof that an illness was bacterial before I would take antibiotics or give them to my kids!, or at least a doctor’s reasoned conclusion in a case that didn’t have some type of definitive test (such as a cat bite — 80% of cat bites become infected, but it is hard to test for them until the infection has advanced significantly, but a doctor making the case to me that I needed antibiotics based on his/her professional experience/research and the facts at hand would suffice). I am not an MD, and even if I were I wouldn’t prescribe for my own AP – as discussed in other threads, I would want a neutral, professional third party physician who could develop the appropriate doctor-patient relationship with my AP. But if a medical professional stated that an infection needed antibiotics and the AP refused, I would not be able to continue my relationship with that AP. The risk to my family, and the burden on me to cover her sick time. would outweigh the other positives there might be. I would rematch forthwith, and have the AP move out that day. I would be fair in a rematch situation with the agency and any potential HF that contacted me – I would just state the facts of why I rematched and let the potential HF weigh if/how that matters to them (there might be other HF for whom this would be a non-issue)

AuPair Paris February 25, 2015 at 3:30 pm

Yeah, this is my stance too. I have a sensitivity to most antibiotics (not an allergy), so I’ll only take them when *absolutely* necessary. Most infections I’ve had, I explain this to the doctor, and they tell me the likely duration of the infection, if it’s left untreated – usually it’s about a week. But these are things like wisdom teeth/localised infections which aren’t really infectious. If it were contagious or dangerous to the kids I was watching, I’d take the anti-bs!

I would probably spend the entire week much, much iller though. Feverish and throwing up non-stop, and just really hideously ill – that’s what always happens when I take them. :( So it wouldn’t really solve the childcare problem…

Seattle Mom February 25, 2015 at 5:50 pm

I agree, for the most part. I also don’t take drugs much.

But I recently learned through personal experience that when you have confirmed pneumonia the doctors put you on strong antibiotics immediately without knowing if it is bacterial or viral. The reason is that bacterial pneumonia is very dangerous and can kill you if left untreated, so they don’t want to wait and see if it goes away. Viral pneumonia takes longer to get better but is less dangerous. This is one case of “better safe than sorry.”

I’m grateful that I am the only one in my family who got pneumonia this year, including my au pair.

Old China Hand February 25, 2015 at 1:44 pm

Our APs are from China, where any sickness (cold, whatever) is immediately treated with 2xday IV drip penicillin for 3 days. It is considered to be more effective and thus need shorter treatment time if given by drip. A family friend MD confirmed to me that this isn’t true. You can buy amoxicillin over the counter and now neither penicillin and amoxicillin are particularly effective against most diseases there. Our AP didn’t blink when I told her I was taking her to get a flu shot and I would pay for it. Everyone in the family has a cold right now except AP and she was shocked that I am not taking the kids to the doc to get them their meds for the cold. Of course I tried to explain why this wasn’t what we do here. Her poor English and my non-medical Chinese made it a little difficult, but I am guessing that she wouldn’t hesitate to take sudafed if she got sick or to go to the CVS clinic if we suspected an infection. Anyway, just a different perspective.

An AP who refused to take meds would be a poor match for my family. I am too big a fan of vaccines and appropriate medicines to keep problems from getting worse (antibiotics for infections) and to enable you to feel better (allergy and cold medicines, nausea meds when I was pregnant).

Taking a Computer Lunch February 25, 2015 at 2:26 pm

Don’t get me started on people who refuse to be vaccinated!

Old China Hand February 25, 2015 at 2:29 pm

I was disappointed to discover that as a parent I have to worry about pseudo-science surrounding vaccines in addition to the pseudo-science I deal with as a geologist (climate change and evolution).

ChiHostMom February 26, 2015 at 7:18 pm

Just tossing in a ditto here. And wondering if I know Old China Hand in person as a biologist…

Old China Hand February 26, 2015 at 10:14 pm

possibly, if you also work in China or was part of a graduate program where lots of people did. I didn’t think I knew anyone else who hosts aps, but it would be kind of cool if I do. cv can give you my email, as I don’t mind emailing in real life. Warmstatemomma and I commiserate about weird Chinese ap things regularly. :)

SwissAuPair February 26, 2015 at 8:20 am

Vaccines are cultural. For me it is normal to only get the “tetanus” (not sure if this is the right english word) vaccine. When I was younger I got a lot more, but as a grown up, only this one is recommended in Switzerland. I would get the flu shot if I would work with older or medically fragile people, but never “just because”. In all my life I was sick for one week, because of the flu .
I had some bacterial infections last year, after I was not sick at all for over 3 years, like two times a bladder infection and one time a tonsillitis. I had to take antibiotics every time and they made me feel sick (gastrointestinal). The symptoms of the origin sickness were gone within 24 hours, but since I had to take antibiotics for a few more days, I had to stay at home until I finished the package. I simply can’t run to a toilet every 15 minutes when I’m at work.

old au pair mom February 26, 2015 at 12:03 am

Interesting. My Asian APs had never had Tylenol. When I suggested one take it for period cramps she was skeptical, but willing. After, she called it a wonder drug. I always point out the shared medicine cabinet, let’s face it , those OTC drugs are pricey, and over time, all our APs took what was needed. After I knew them better, I would whip up a hot toddy if they had a cold and sing the virtues of Vicks formula 44 or at least a scotch before bed. Our Northern European APs were right there with us.
One very dear AP had stitches in her calf from a camping accident and my DH, who does not get involved other than a sincere thank you, put his foot down and her leg was elevated, with ice, while she commanded the troops from the couch. She was reluctant to rest but DH was more reluctant to have her jeopardize her recovery. My boys loved her and her soft spoken ways. As we say in our home, there are many ways to skin a cat (I know, it is a horrible saying! Where did it even come from? We are not a family of taxidermists!) Helping your AP is helping yourself. Over time, they become beloved and you want for them to feel better. That being said, I could not tolerate a sickly AP and I always work to avoid them. I accomplish what I have to, even when I am not feeling well, it is just American way.

WarmStateMomma February 27, 2015 at 10:55 am

My Chinese APs have been amazed at the wonder drug, Tylenol. It’s effectiveness at reducing fevers in infants has astounded them and both have a sister who is a nurse. They aren’t familiar with the commonly-accepted health practices here and their idea of “Western medicine” is a far cry from what we expect in the US, but they also seem unlikely to question a doctor’s advice.

old au pair mom February 27, 2015 at 2:38 pm

Warm state and Old China, Not related to illness, but do you have a Chinese AP because you have adopted children or for the ability to teach Mandarin? I have a little one, adopted from China: she is just a wonder. We are in our 15th year of hosting APs because we added her to our family.

Old China Hand February 27, 2015 at 4:11 pm

Neither of us has adopted kids from China and we are both from white American families (I once referred to us as “foreign” using a Chinese frame of reference). I was raised in Hong Kong, do my research in China, and speak Mandarin. I want my kids bilingual and it seemed like a good choice since I already speak the language. I’d be happy to talk with you more off line if you want. CV can give you my email (and I’ll check that account to see if you write).

DrMom February 25, 2015 at 1:49 pm

Most bacterial infections are not contagious.
The medical community is starting to change it’s mind about even treating strept throats with antibiotic (ATB) altogether – apparently, the risks of ATB may be greater than the risk of complication from a strept throat… Guidelines are likely to change to plain advil for strept throat in the next few years… You have to be careful: 80% of otitis are viral, urinary infections are often viral, pneumonias are a lot less frequent than viral reps track infections… You may want to be careful, even within the physician’s community, it’s not black and white: we are cutting back on ATB prescriptions in general.
I practice medicine in Canada and the mentality is different – I think american doctors have more pressure to give antibiotics because of the permanent legal threaths than anywhere else (that’s probably true of a lot of interventions). I think that resonates in the whole culture of medicine in the US, you have to know that too and you seem to get that, from your post. AP may have heard bad things about the US Health Care System and not trust american providers.

If my AP was very sick I would ask her to go to the clinic. If she lets you, go along and ask the doctors what the consequences of not taking antibiotics are for your family – US doctors may be quick on the prescribing switch, but are honest when you ask for an opinion about the absolute necessity (I’ve received super good care in the US – I’ve been offered to much tests and treatments, but advice were always honest about genuine need for treatment versus legal recommandations, when I asked for it in a way that did not compromise their legal responsibility). If she is contagious, I would isolate her from the rest of the family.
I would be very upset to be forced to take ATB: not very different than the vitamin B12 story… When ATB are absolutely needed, the doctor will make that clear, it’s his job to convince her. If your kids have special needs or immunity problems it’s a case for rematch. Hope this is of some use!

Dorsi February 25, 2015 at 3:08 pm

FYI on strep throat — the rapid test you get at a clinic (or even an ER) is not all that accurate. There are many false negatives. A significant portion of people are chronically colonized — they always have strep at the back of their throats. There is a trend toward not necessarily treating strep with antibiotics — it seems that they don’t really decrease duration of illness, nor do they do a lot to decrease post-strep complications. It is certainly not standard of care to avoid antibiotics for strep, but some physicians and pharmacists choose not to treat themselves/family members. (Of course, this wouldn’t apply in the case of a medically fragile child).

However, that is somewhat unrelated to central question here: is the Au Pair making choices that prevent her from fulfilling her duties, or putting other family members at risk? If the answer is yes, she doesn’t have the judgment required to be in my home. I had an AP who got terrible headaches and asked frequently for time off, but didn’t want to take any over-the-counter medication. She is free to avoid standard medications for headaches, as long as she fulfills her duties otherwise. (Ah….the happy memories of the “should have rematched” AP!)

Mimi February 25, 2015 at 4:37 pm

I have a infant and am high risk for illness as I have an autoimmune disorder and take immunosuppressant meds. I would also go the route of having a physician explain to her the repercussions of not treating her illness, but I’m anti antibiotic unless it’s warranted. I have quarantined a sick AP and provided limited care to her only when HD was traveling for work and I was the only one around to take care of everyone. Otherwise, I’ve risked my health to care for an AP with the flu who had refused to get a flu shot that we offered to pay for. (She did take the meds prescribed her.)

A mediocre AP making poor health choices (probably chronically) wouldn’t last in my home and I’m with Old China Hand in that a chronically/seriously ill AP who refused to take meds would be a rematch for my family.

Did we ever get a definitive answer to the question raised awhile back about government requirements regarding paying for/giving sick days?

HRHM February 25, 2015 at 10:44 pm

The state department website is CRYSTAL clear on this. You must pay the Au Pair for 51 weeks of childcare. 2 of those weeks must be paid vacation. Any other weeks, weather she works or not, must be paid at the full stipend level. To do otherwise is a violation of the state dept rules and your agency contract. You cannot dock pay for sick days and you cannot make up those hours unless you can do it within the same work week (ie you give her off Monday for sick but then ask her to work Saturday instead is ok; You give her off three days for sick and then ask her to work the next three saturdays after her full work week is not) You can ask her to use her vacation time for sick time but you risk serious bad blood doing this. I would say if she was out of commision for 3 weeks, asking her to use a vacation week to cover one isn’t out of line, especially if you had to pay for pinch hitter coverage. Not all agree with me on that one…

Dorsi February 26, 2015 at 5:50 pm

To be clear (which likely applies much more to those of us with an irregular schedule) – you can absolutely require the AP to make up the time, as long as you do not violate any work hour rules. So – my AP is sick on a Wednesday and she was supposed to work 12p-7p. When I made the schedule, she was supposed to work Thursday 11a-5p and Friday 7a-3p. I can change her to Thurs 11a-7p and Fri 7a-5p, Sat 9a-12. Same number of hours (which would be under 45 for the week, as my initial schedule would be under 45 for the week). No more than 10 hours per day.

I wouldn’t usually do this, but it would be fully allowed under the SD rules. And, as HRHM noted, there is no legitimate reason to ever dock the APs pay.

Taking a Computer Lunch February 25, 2015 at 11:25 pm

I’ve been a HM for nearl 15 years. I know that some HF have experienced accidental injuries that knocked an AP out of commission. I have been fortunate. While nearly every AP has required at least one sick day during her year with us, most have not required many more. I think this happens, in part, because they see us, the HP, haul our butts out of bed and do our best to function. (I once changed a tire on the AP car when I was home sick with pneumonia. She was very put out when instead of offering to switch cars, I told her to drive it over the tire place because the tire was under warranty.)

Only once did I have an AP “take a mental health day” – which happened to be the same day my kids had no school, which forced DH and I eat to work a half day. When I found out she wasn’t really sick, I put her on warning – “Do it again, and you’ll find yourself with a curfew 8 hours before your next shift.” Since my APs start working at 6 am, you better believe she never did it again.

Being sick happens. The trick is to assess, “Will requiring the AP to work anyway put my kids’ health at risk?” If the answer is yes, then suck it up and send her back to bed.

ChiHostMom February 26, 2015 at 7:22 pm

One other comment on strep and scarlet fever. Scarlet fever left a few people I know deaf in at least one year. So if an au pair in my house refused an anti-biotic for a highly contagious easily treatable bacterial infection that would be grounds for re-match. I’d like to hope that I screen for “reasonable enough” that I’ll never be in that situation.

AuPair Paris February 27, 2015 at 5:24 am

I’m not an idiot, I swear… I think it might be a cultural difference in the way we talk about sickness… But I don’t know what strep throat is! This thread is quite scary with its talk of scarlet fever and strep throat, but I’ve only ever heard of the latter on American TV, or in American books. What is it? I mean, how do you know to get tested for it? What’s the difference between strep throat and just a nasty sore throat from a cold? Or should I be getting tested/thinking of antibiotics whenever I get a sore throat?

Have just thought – we do talk about throat infections here, and get antibiotics for that – we tend to go to the doctor after about a week of a really agonising sore throat, in case it’s that… Is that the same thing?

UKAu Pair February 27, 2015 at 5:46 am

I’ve been confused too. :P It must be either something that doesn’t exist here or something with a different name (like ‘glandular fever’ is ‘mono’ in America).

Scarlet Fever exists here (I had it twice when I was a baby) but it’s incredibly uncommon.

German exAuPair February 27, 2015 at 7:26 am

I think strep throat in Europe goes under the umbrella term pharyngitis (and/or tonsillitis? and/or angina [not pectoris])? Strep(tococcus pyogenes) is the bacterium that causes it. At least in Germany it’s called after the main symptom not the bacterium. It’s fever, sore throat, pus on tonsils etc. One of my US stereotypes is taking antibiotics because a sore throat could be strep ;)

I don’t think there is one antibiotic that you can get over the counter in Germany, you always need a prescription. I think that’s why we tend to just cure a simple sore throat with tea, cough drops, lots of fluid and rest. Taking antibiotics ‘just’ for a sore throat (unless you / someone in your family / someone you work with is immunocompromised) is very uncommon and even with a mild fever many people wait 3 to 5 days to see their doctor (that comes with being allowed to stay home sick for up to 3 days without a doctor’s note in most companies). Only if the symptoms last you will usually go to an ENT and get checked. They often simply prescribe a broad-spectrum antibiotic and will only check for kind of infection it really is if the antibiotic doesn’t help. Thus you might have had strep without knowing (I think it tends to be common in children).

[Not a MD… a philologist with approximately 70 throat infections in her life]

Taking a Computer Lunch February 27, 2015 at 8:20 am

Strep throat and scarlet fever are caused by the same bacteria – streptococcus – which can cause a host of diseases, not just a bacterial throat infection. A sore throat without cold or flu symptoms may indicate strep throat; a stomach ache without vomiting, diarrhea, or overeating; a severe headache, a rash on the chest.

It is not particularly common in adults, but here in the United States it is common in young children in preschool and elementary school, because they’re not great about washing their hands and they touch everything.

It became endemic in my house when child #2 entered kindergarten – the whole class just passed it around and around (that’s how I learned about the stomach ache being a symptom – and the #1 reason why I decided I didn’t need to clean my kids’ plates by eating what they left behind!). In most people, the infection will go away without treatment, but in a small percentage of those the infection enters the heart and causes permanent damage, which in my opinion makes taking antibiotics worth it. In medically fragile people, the risk of not treating the infection – or exposing them to an untreated infection – is potentially life threatening.

My children’s pediatrician will not prescribe antibiotics for a sore threat – there has to be a medically confirmed strep test (she does both a rapid test and a 24-hour culture). I’m allergic to antibiotics, so I do what I can to keep myself healthy – which includes frequently hand-washing.

old au pair mom February 27, 2015 at 2:32 pm

Often, the school nurse will send an email alerting families if a student in your child’s grade has strep or mono. A parent and an AP can use that info to help make a more informed decision.

German Au-Pair February 27, 2015 at 8:34 am

Swiss AP, it seems to be a bakterielle Mandelentzündung bzw Streptokokkeninfektion. Which I’ve had about a hundred times by the way. I do get antibiotics every time though so I don’t know about the consequences if you don’t take any. But the fear that seems to exist in the US doesn’t seem to be common here. My ENT has never warned me about that being incredibly dangerous and I used to get it every single time I had a cold through childhood.
It seems there are diseases in some countries that don’t exist in others. In Germany having a Hörsturz (conductive hearing loss) is so common that everyone knows someone who’s had one. There ae American websites who make fun of the fact that this seems to be something that ONLY occurs in Germany.

NoVA Twin Mom February 27, 2015 at 9:23 am

I’ll answer the question about how to get tested – you go to a doctor and they take what is basically a really long Q-tip (cotton swab) and brush the back of your throat. It’s painless but often causes people to gag. Then they test the swab to see if you have strep.

WebMD is a fairly reputable site (as much as any are) – here’s what they have to say about symptoms: http://www.webmd.com/oral-health/tc/strep-throat-topic-overview

UKAu Pair February 27, 2015 at 11:06 am

Thanks TACL and others- that’s really interesting.

German AP I agree that there seem to be illnesses in some countries that don’t really exist in others (or there isn’t the same fear). Like you, I’ve never heard of the fear of strep throat that seems to be more common in America, but we will go to the doctor if we have a really awful sore throat for a long time (usually turns out to be tonsillitis though).

I love the cultural differences that come up through the AP initiative! :)

AuPair Paris February 28, 2015 at 5:39 am

Definitely! The culture of health in France is so different from the UK too. When I was still all culture-shocked at the beginning I thought it was ridiculous – going to the doctor and demanding antibiotics for a cold – on the first day of symptoms! But as I stayed a little while longer, I’ve noticed the corollary. Health and safety is not such a big thing here. My youngest falls over on the playground a lot. I ask what’s happened and the teachers just say “she fell”. She once hit her head while I was looking after her, and I sat her down, and did all the tests for a concussion, which came up clear, then rang my host parents to ask if I should take her to the doctor anyway. They were completely bemused! They just said “she sounds fine…”

Consequently, when accidents happen, the kids are much calmer. My eldest fell off her scooter and needed stitches the other day (I was there, but not as adult in charge). She didn’t cry – she looked at her injury and called me and her Mum over, and her Mum took her off to the hospital. No drama at all, from Mum or child.

God forbid someone sneezes, of an evening though!

(Sorry, this is all totally off topic but I just find it so interesting!)

SFhostmom February 27, 2015 at 1:42 am

Wow, I guess I am in the minority because my ap recently had confirmed strep and didn’t want antibiotics, and I was fine with that. I’d also read that the data shows antibiotic treatment reduces the duration of strep throat by 16 hours, on average, which seemed like a very small benefit. I did recently read “missing microbes” however, which does a nice job making the case that antibiotics carry risks that are almost never discussed, due to changes to the microbiome. So perhaps I was influenced by that too.

DrMom February 27, 2015 at 10:57 am


In England, everyone is not suggested to run for a rapid strept.

American HF need to see their own CULTURAL biais. Antibiotics are not necessarily required for a strept throat, and the medical community, in the US, is revisiting the best practice for strept throats, as it seems that the risk of having complications from a strept throat may be less important that the risk of having complications due to antibiotherapy…

French AP: Amygdalite bactérienne; on traite avec de la pénicilline.

AnotherSeattleHostMom February 28, 2015 at 1:06 pm

“The good thing about science is that it’s true whether or not you believe in it.” ? Neil deGrasse Tyson

Cultural bias or not, if a reputable physician (we see physicians at the University of Washington’s clinics) has told our Au Pair that she needs to take antibiotics to: protect our family from infection, cure her infection, or even reduce her symptoms that she has due to a bacterial infection, I expect her to take the antibiotics. End of. The exception to this is if the au pair herself is a medical doctor who has done an infectious disease fellowship :)

Seriously though, I am a registered nurse and have taken antibiotics once in my adult life (last year for an ear infection that hurt worse than childbirth) and the antibiotics made me feel better overnight. I have been to the doctor for various ailments over the last 20 years at least 20 times (including possible “sinus infections” and other potentially bacterial diseases) and the ear infection is the only time the doctor has EVER recommended antibiotics. So the idea that doctors in America want to hand antibiotics like candy is misguided I think, at least in my experience.

I wouldn’t continue to host an au pair who refused medical advice to her own detriment or the detriment of our family. If she has different beliefs about how to handle general ailments like cramps and colds that sometimes just need time and rest to resolve, I fully support that as long as it doesn’t impact our family negatively.

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