Another Guide to toddlers and babies for Ear Infections and otitis media

otitis mediua or ear infections often accompanies a cold or other respiratory infection. It occurs when fluid collects in the middle ear and becomes infected, causing inflammation and painful pressure. Symptoms include irritability, poor appetite, fever, vomiting, runny nose, cough, and pulling at the ear. OME occurs when there is persistent (though not infected) middle ear fluid. It can occur on its own, but it often follows AOM; in general, the only symptom is hearing loss.

Why are ear infections so common in babies or kids?

Let's venture inside the middle ear to see how germs and tiny ears make such frequent contact. A canal called the eustachian tube connects the middle ear to the back of the throat and helps to equalize pressure. But the throat, along with the nose, serves as a moist breeding ground for bacteria. Because a baby's eustachian tube is short, wide and horizontal, throat and nose secretions -- and any germs they may be harboring -- travel more easily through it. Any fluid trapped in a cavity (such as the middle ear) acts as a medium for germs to grow, hence the frequent ear infections we see in many young children.

Why is it important to treat ear infections properly?

Your child's hearing depends on the proper vibrating of the eardrum and the structures of the middle. Repeated infections can damage the eardrum, while repeated fluid accumulation dampens the vibrations, both of which interfere with hearing. That's why it's imperative to take ear infections seriously, especially when your baby is learning to talk. Periodic hearing loss can lead to speech delays or even language problems that can affect her school performance later.

How can I spot an ear infection?

The following signs are babies' way of saying, "There's some painful stuff going on in my ear. Please take me to the doctor!" Early treatment makes for a better outcome, so if your baby has had several ear infections, learn to read his unique "sore-ear language." One sign you likely won't see is a fever. High temps don't often accompany an ear infection unless there's a more severe respiratory infection.

The nose knows In babies, middle-ear infections usually follow a cold, so what's coming out of the nose often reflects what's going on in the ear. A common scenario is that baby is mildly stuffy and has clear, watery nasal drainage, but isn't that sick -- until a few days later when crankiness kicks in and the discharge becomes more yellow or green and snotty.

It's been a hard day's night  If baby is waking more frequently at night and seems to be in pain, especially with a worsening cold, that's also a red flag. As the infected fluid places pressure on the eardrum, he may not want to lie flat when napping or sleeping. To alleviate the pressure, position him so that the sore ear faces up.

The eyes have it  The rule in our practice is that when a parent tells us their baby has a cold and eye drainage, we see them that day. In the early months, eye drainage may simply signal a clogged tear duct, but when accompanied by a cold, especially in an older infant, it usually means an underlying sinus and/or ear infection.

If I suspect an ear infection, should I always take my baby to the doctor?

Usually. Ear infections are hard to treat blind -- sort of like drawing a map when you're not sure where you're going. Your doctor needs to examine both the eardrum and the whole respiratory tract to make what is called the right "drug and bug" match.

Most mild to moderate ear infections will completely heal without the use of antibiotics, which is why the American Academy of Pediatrics recommends the "watch and wait" approach. "Watch" means to observe your child for signs that she is becoming sicker. "Wait" means the doctor may not immediately prescribe antibiotics for her, even if there is fluid behind the middle ear, unless she fails to improve on her own within two or three days.

He's tugging at his ears a lot, so why does the doctor say he's fine?

Ear-tugging doesn't necessarily signal an ear infection. It can be referred pain from teething or that baby is simply discovering his ears and likes pulling on them. However, if a baby has a cold, especially with nasal or eye drainage, and is pulling at his ears, the problem is likely not teething. Tugging, rubbing or banging on the ears can also be a sign that your child has some ear pain from persistent or chronic middle-ear fluid, a condition known as otitis media with effusion. In my practice I find that a mother's intuition is useful in alerting me that her baby is feeling worse. If you feel there's something more to your baby's symptoms, talk to your pediatrician.

How can I prevent ear infections altogether?

Now that you know how germs make their way into those little ears, here are some guidelines to keep that germy fluid from collecting behind your baby's eardrums:

Breastfeed  Mother's milk provides increased natural immunity.
Bottle-feed upright  Feed baby in an upright position (at least 30 degrees) and keep her upright at least 30 minutes afterward.
Keep allergens at bay  Irritants can cause fluid to build in the nasal passages and middle ear. Keep stuffed and real animals and other fuzzy things away while baby sleeps. And absolutely no smoking around baby!
Pass on pacifiers  Studies show a correlation between the frequency of pacifier use and ear infections. Limit pacifier use to when baby is falling asleep at night, especially once she is 6 months or older.
Boost immunity  Fruits, veggies and seafood have been shown to improve babies' developing immune systems.
She'll outgrow it  The good news is that as your child grows, the eustachian tube becomes longer and narrower, and slants more acutely, making it more difficult for germs and fluid to collect in the middle ear. At the same time, her immune system matures, minimizing those pesky ear infections.

Ear Infections: To Tube or Not?

It's bad enough having to watch your little guy suffer through one ear infection, let alone bout after painful bout.

Implanting ear tubes can significantly reduce and often eliminate infections for at least six months (they allow infections to drain and be easily treated with antibiotic drops). Still, it requires surgery. So how do you decide whether the procedure is right for your child? Grab a pen and take the mini-quiz below, designed with the help of Marcella Bothwell, M.D., a pediatric otolaryngologist at Rady Children's Hospital in San Diego:

1. How many times has your doctor prescribed antibiotics for ear infections?
A. Fewer than three times in six months, or fewer than four times in one year (Add 0 points)
B. Three or more times in six months, or four or more times in one year (Add 3 points)

2. How old is your child?
A. Over 2 (Add 1 point )
B. Under 2 (Add 2 points)

3. What kind of antibiotics has your child taken?
A. Only first-line antibiotics, such as amoxicillin or Zithromax (Add 1 point)
B. Broad-spectrum antibiotics, like Augmentin and Rocephin (Add 2 points)

4. Is your child in daycare?
A. No (Add 0 points)
B. Yes (Add 1 point)

Total score _______

To tube or not to tube?

Less than 3 points: It's very unlikely that ear tubes are appropriate for your child. He hasn't had multiple recurrent infections, which is the bare-minimum requirement for surgery. This is good news!

3 to 6 points: Your child may benefit from the procedure, especially if he's already been nabbed several times in the past year and has needed heavier-duty drugs to beat the bacteria. Both of those experiences suggest he is at higher risk for developing a resistant bug later. On the other hand, if your child has had only a couple of bouts that healed easily with mild antibiotics like penicillin, your doctor may suggest taking a watch-and-wait approach. The odds of picking up a hard-to-treat infection in the future are lower than for other children.

7 to 8 points: Tubes may give your honey welcome relief. He's likely already suffered significant pain and many sleepless nights; there's a good chance he has also already required stronger and stronger medicine to kick the infections. Kids in this category are generally under 2 and/or in daycare: They're exposed to more bacteria than other children, and their immature immune systems have a harder time fighting them. Share your findings with your doctor. Together you'll be able to come up with the best plan for your little one.

source : parenting.com