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sushilbrito
27-02-2007, 02:46 PM
Causes of ear infections and how to help when your baby has sore ears.

Remember the last time you flew? The moment during descent when it felt as if your eardrums would burst?

Most babies and toddlers — about 80 percent — feel a similar sensation at least once before turning two, though the pressure and pain linger longer than a moment. The cause is acute otitis media (AOM), a buildup of infected fluid behind the eardrum.

While AOM can occur before six months and after age three, ear infection rates peak around 15 months, says M. Clifford Fabian, a Toronto otolaryngologist specializing in paediatric ear, nose and throat problems. “It usually happens anywhere between just under one year to three years of age.”

Causes

Why do so many toddlers get sore ears? One reason is the size and slope of their Eustachian tubes, the tiny tunnels connecting the back of the nose and throat to the middle ear space. Babies and toddlers have shorter, straighter, less slanted Eustachian tubes than older children, which means bacteria and viruses don’t have to travel far to reach the middle ear. The walls of these channels (which stiffen with age) are flexible early in life, which means they easily collapse, preventing normal drainage of fluid produced by cells inside the ear.

Secondly, little people spend lots of time lying down, promoting pooling of fluid in the middle ear. (Bottle-feeding in a prone position increases the likelihood of liquid trickling into the ear.)

Finally, kids in this age group haven’t built up resistance to common germs like cold and flu viruses. These respiratory infections — which they pick up at daycare, playschool and anywhere else they’re in contact with other kids — can cause the Eustachian tubes to swell and become blocked, allowing the microscopic culprits to multiply in the accumulated moisture.

“It’s like putting a bit of water in a cup — if it’s left there and doesn’t drain, it becomes contaminated,” explains Ottawa paediatrician William James.

Unlike a cup, however, your baby’s ear doesn’t have a wide opening you can easily peer into. So how can you tell what’s going on in there? Fabian advises parents to keep their appointments for routine well baby visits, so the doctor can check the ears for fluid. Some kids develop “silent” infections that aren’t accompanied by obvious symptoms.

Otherwise, until a toddler is old enough to say her ears are sore, parents have to stay alert to subtle signs. Tugging on the ear is one possible clue Teething pain sometimes travels down a nerve near the eardrum, which may lead to ear pulling. More suspicious is a constellation of symptoms: sniffles or runny nose (many ear infections follow a cold or tummy bug), irritability and fever, and fussing during feeding, naptime or bedtime.

“Crying when lying down at night or waking up crying is often a telltale sign,” says Kim Blake, a paediatrician at the IWK Health Centre and associate professor at Dalhousie University in Halifax.

Should you take your child to the doctor immediately if you suspect an ear infection? That depends on how sick he seems. If he’s running a slight temperature and seems mildly ill, you can probably hold off for a day or two, treating the pain with children’s acetaminophen or ibuprofen.

If your toddler is sobbing inconsolably, you’ll want her seen sooner — though it’s normally not necessary to rush to the emergency room at midnight. A dose of acetaminophen every four hours will probably be enough to ease the pain until your doctor’s office opens in the morning.

Over-the-counter analgesic or herbal eardrops or garlic oil (warm to body temperature by holding the bottle in your hand before dripping a little in each ear) can also feel comforting. (Caution: Don’t use drops if discharge or fluid is leaking from the ear.)

When you do go to the doctor, a look through the otoscope can provide a few more clues. A ruddy eardrum that remains rigid when air is puffed against it with this instrument is one clue the middle ear may be infected (though crying can cause redness), but even then, it’s difficult for doctors to discern whether a virus or bacteria is to blame.


“If they’ve had a bit of a fever and a runny nose, then get better, but the fever goes up again within the next ten days, that triggers concern it may have turned into a bacterial infection,” she adds. This pattern suggests that while the body has successfully vanquished the original viral infection, residual swelling of the Eustachian tubes has trapped fluid in which bacteria have begun to breed.

If your baby’s eardrum is bright red and bulging, there’s pus present, or your toddler seems otherwise ill, your doctor will usually suspect a bacterial infection.

“If a child comes in with a high fever, is extremely irritable and just looks sick, I’ll usually say, ‘OK, we’ll start antibiotics,’ If your baby is younger than two, your doctor may also opt to start medications early.

If your baby doesn’t show obvious signs of an infection (such as an oozing eardrum and soaring temperature), many doctors have begun to suggest holding off on antibiotics for 48 to 72 hours, since studies suggest more than 80 percent of AOM episodes clear up spontaneously within that window. As well, most ear infections are caused by viruses, which aren’t affected by antibiotics, and overuse of these drugs help create drug-resistant strains of bacteria, which means the medications may not work when we really need them. And of course, like any other medication, antibiotics can have side effects, like stomach upset and diarrhea.

If your doctor advises watchful waiting, treat discomfort and fever with your usual kids’ pain reliever and offer lots of liquids. Prop up the head of your toddler’s bed or crib, and sit her upright in a backpack or sling as much as possible to promote fluid drainage. For a stuffy nose, your doctor may recommend nasal saline drops.

If the symptoms worsen, or don’t abate in a day or two, your doctor will probably give the go-ahead for antibiotics. Many physicians use amoxicillin first; others favour different drugs, since some savvier bacteria have learned to defend themselves against the penicillin family. What you use is less important than how: Finish the medication — stopping too soon kills only weak bacteria, allowing stronger strains to thrive.

In most cases, symptoms begin to improve soon after starting the prescription. However, if your baby doesn’t seem better within a day or so, check back with the doctor — she may need to switch to another drug.

Once you’ve gotten to the bottom of the bottle, your doctor will usually recommend a follow-up visit to keep an eye on your child’s ears. Even after the ear is free of infection, fluid may linger for as long as three months. (About half of the time, this condition — known as otitis media with effusion or OME — clears up within four weeks; in 60 to 90 percent of cases it’s gone by the three-month mark.)

If the fluid doesn’t drain away, your doctor will likely refer you to an otolaryngologist and an audiologist who can test hearing.
“If you don’t get rid of that fluid, it can sometimes cause hearing issues,” explains James. “The concern is that at this age, children might not pick up speech quite as rapidly as they should.”

Even newborns can have their hearing tested — a painless process that involves measuring brain activity in response to sounds or conditioning a baby to look up when a sound is played by pairing noises with the appearance of an exciting toy. By bouncing sound waves off the eardrum, audiologists can also test eardrum function and tell whether or not there is leftover fluid lingering behind it.
Some risk factors for AOM are out of a parent’s hands. For instance, kids with allergies and those with Down’s syndrome are more prone to ear infections. However, the following steps can reduce a child’s risk:

• Breastfeed

• Don’t lie your child flat to bottle-feed

• Provide a smoke-free environment

• Place your baby to sleep on her back

• Wash hands and toys frequently, at home and daycare

• Avoid sharing utensils and cups

• Treat contributing medical conditions such as allergies (dust and milk are common culprits) and gastro-esophageal reflux (stomach contents “backing up” into the throat)

• Immunize (Hib vaccine, annual flu shots and the new pneumococcal vaccine all cut down on AOM. These vaccines are not all covered by provincial health care plans. Discuss with your doctor whether you should consider them for your child.)

• Consider a daycare placement with no more than five children.

makeupgirl
29-03-2007, 08:49 PM
Is there any way to stop baby from crying (due to air pressure in the ear) when the airplane is taking off?

candle
22-04-2007, 11:03 PM
Hello all. I'd like to know the answer to the above question too. My friend's little one, is not a baby but she's 10. She follows me for holidays quite often, and is now afraid to take her next flight due to ear pains.

I was advised to give her something to chew, like chewing gum or a sweet to suck, but it has not worked. Obviously her ear drums do not pop automatically as the pressure changes on take off and on board because I face the same problem, but I could bear it. But I know it has been bad for her. It would be a pity if she could not bear to take another flight ever again.

Thanks a lot in advance.

LMei
23-04-2007, 10:48 AM
my bro-in-law who is a steward told me that the babies should be sucking especially during take-off and landing. Either that or if they are sleeping, they should be fine. Once in the air, their ears won't pop.

LMei
23-04-2007, 10:53 AM
Hello all. I'd like to know the answer to the above question too. My friend's little one, is not a baby but she's 10. She follows me for holidays quite often, and is now afraid to take her next flight due to ear pains.

I was advised to give her something to chew, like chewing gum or a sweet to suck, but it has not worked. Obviously her ear drums do not pop automatically as the pressure changes on take off and on board because I face the same problem, but I could bear it. But I know it has been bad for her. It would be a pity if she could not bear to take another flight ever again.

Thanks a lot in advance.
When I was young, and my ears do not pop on flight, my mum will tell me to squeeze my nostrils close and blow (like blowing your nose when you are having flu except your nose is closed). it always helps to pop the ears. though i have to do it a few times. But it does help.

candle
25-04-2007, 11:30 PM
When I was young, and my ears do not pop on flight, my mum will tell me to squeeze my nostrils close and blow (like blowing your nose when you are having flu except your nose is closed). it always helps to pop the ears. though i have to do it a few times. But it does help.
This we have tried and it did not work for her either. Her mum has decided to stop her from accompanying me on my holiday trips. She has developed a fear of flying.

But thank you for the suggestion.

LMei
26-04-2007, 11:37 AM
Oh the poor girl. Was she having flu/running nose during those flights. It does affect the ears terribly if you are ill.