Ear Infections Countering Chronic Flare-Ups

Countering Chronic Flare-Ups

If your child gets through her toddler years without an ear infection, her guardian angel must be working overtime.

''A middle ear infection, also known as otitis media, is one of the most frequently diagnosed childhood illnesses,'' says Michael Macknin, M.D., head of the Section of General Pediatrics at the Cleveland Clinic Foundation in Ohio, clinical professor at Pennsylvania State University Medical School in Hershey and associate professor of pediatrics at Ohio State University Medical School in Columbus. The root of the problem lies in the eustachian tubes, narrow passageways that connect the back of the nose and throat to the middle ear. When a eustachian tube functions properly, it allows air into the middle ear while keeping out bacteria and debris from the nose and mouth. It also permits any fluid that may collect to drain out.

Babies and young children, however, have very tiny eustachian tubes that tend to get swollen and blocked each time a cold, sinus infection or allergy attack comes along. A swollen eustachian tube can't do its job, says Dr. Macknin, and that makes your child more susceptible to middle ear infection.

When your child comes down with a middle ear infection, you'll probably know it--at around 2:00 in the morning when she awakens, crying and feverish. Ear infections are usually, but not always, painful and may be accom-panied by irritability and some temporary hearing loss, notes Dr. Macknin. A full course of doctor-prescribed antibiotics should kill the bacteria, but fluid may remain in the middle ear, providing a warm, moist breeding ground for future infections.

If your child is taking antibiotics, follow your doctor's orders exactly. If you stop giving the medication prematurely because your child is feeling better, the bacteria might not be entirely wiped out. The survivors could multiply and bounce back, causing another infection, says Dr. Macknin.

Although your child should outgrow the tendency to get ear infections, lots of kids suffer with them throughout their preschool years. While you can't prevent ear infections completely, doctors say there are a number of ways you can reduce your child's chances of getting an infection. And even if your child gets one, you can make him more comfortable. Here are some suggestions.

Treatment

Use a painkiller for short-term relief. Prescription antibiotics should provide pain relief within 12 to 24 hours. But while you wait for that relief to kick in, your child can take acetaminophen (Children's Tylenol) if he needs it, says Charles D. Bluestone, M.D., professor of otolaryngology at the University of Pittsburgh School of Medicine and director of the Department of Pediatric Otolaryngology and the Otitis Media Research Center at the Children's Hospital of Pittsburgh. Check the package directions for the correct dosage for your child's age and weight. If your child is under age two, consult a physician.

Don't rely on over-the-counter ear drops that contain a local anesthetic to relieve the pain. ''None of them have been shown to be effective in controlled trials,'' Dr. Bluestone says.

Try some ''warm-up exercises.'' Children with ear pain may find warmth soothing. ''I sometimes recommend that parents put two or three drops of warm mineral oil into their child's ear,'' says Gerald Zahtz, M.D., assistant professor of otolaryngology at Albert Einstein College of Medicine in New York City and physician at the Long Island Jewish Medical Center in New Hyde Park, New York. ''But it's critical that the drops be the correct temperature. If they are too warm or too cold, you may induce dizziness. So aim for body temperature.''

Hold the mineral oil bottle in your hand for about 15 minutes before you put in the drops. Or fill a large bowl with hot water and keep the bottle in the water for about 5 minutes. Test the oil against your skin before putting it in the ear. Caution: Never use drops if the ear is draining, Dr. Zahtz advises.

Use a warm-water bottle. Dr. Zahtz recommends holding a hot-water bottle against the ear, but it should be filled with warm, not hot, water, he says. Also, wrap the bottle in a towel before placing it against the ear.

Preventive Care

Don't smoke around your child. Studies show that the children of smokers have more colds and ear infections than children of nonsmokers. ''If you smoke, the best thing you can do for your child is to quit. But if you don't quit, at least smoke outside. Don't smoke around your child,'' Dr. Macknin says.

Breastfeed your baby. Breastfeeding provides a protective benefit, because anitbodies passed along in the breast milk may decrease your baby's chance of getting an infection, notes Dr. Bluestone. There also seems to be something in mother's milk that helps prevent bacteria from sticking to the mucous membrane of the throat, making it less likely that germs will travel up the eustachian tube into the ear, he says. ''If you want to help prevent ear infections, you should breastfeed your baby for at least the first six months,'' Dr. Bluestone advises.

Feed baby in an upright position. When you bottlefeed or nurse your baby, keep his body in an upright position, especially if he tends to regurgitate a bit of his meal. ''If your baby is in a horizontal position while feeding, regurgitated milk can pass into the eustachian tube, and possibly cause an infection,'' says Dr. Zahtz. This is less likely to happen if you hold your baby at an angle of 45 degrees or more while feeding, he says.

Consider a babysitter instead of day care. Babies under one year old are especially vulnerable to the many viruses in a day-care environment, according to Dr. Bluestone. As a result, they end up with more ear infections than children who are cared for at home, he says. If possible, consider delaying day care until your child is past this critical age.

Ask the doctor about milk allergy. In rare cases, recurrent ear infections may be due to milk allergy, says Dr. Zahtz. ''If a child with chronic infections is less than a year old, I try taking him off all milk products for four weeks to see what develops.'' Don't make any diet changes without talking to your doctor first, though, advises Dr. Zahtz, or you could seriously compromise your child's health.

Watch for early signs of sinus infection. If your child has a cold, and the nasal mucus starts to thicken and become colored, consult a doctor. Thick yellow or green mucus may indicate a sinus infection that needs to be treated with antibiotics, says Dr. Zahtz. If the problem is treated early, there is a good chance that it won't lead to an ear infection, he says.