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How did my child get an ear infection – Part I ??

Ear infections come in two basic varieties; external, commonly occurring in the warm weather and referred to as “swimmer’s ear”, and internal or middle ear infections occurring mainly in the colder weather. The designation of external or middle is dependent on which side of the ear drum the infection is located. The outer ear canal, seen from the outside if you try to get a look in an ear, is a narrow bony channel covered with skin leading to the eardrum which is totally air tight and seals the chamber. On the other side of the ear drum lies the middle ear cavity containing specialized bones and small organs that allow sound frequencies entering the outer ear to be converted to impulses that eventually reach the brain and are interpreted as sound. This space would also be a closed space if it were not for the Eustachian tube which goes from the back of the nose to the middle ear cavity and keeps the pressure the same as the external canal.

The frequency of sounds represents a pulsed pattern and each frequency has its own pulse pattern. As the sound, usually consisting of different frequencies, reach the ear drum they set the eardrum vibrating at different rates; these vibrations are transferred from the outer ear to the middle ear by way of the eardrum, and then picked up on the other side by a connected series of small bones or ossicles that transmit the information to the auditory nerve and then on to the brain.

Now that we know how the ear works as relates to the anatomy we can discuss more fully what ear infections are all about:

External otitis is caused by a damp, warm environment in the outer ear canal which breaks down the skin and causes irritation leading to possible mild bacterial infection. There is swelling in the skin lining that narrow canal and very little space to allow for that swelling. As a result there is more irritation and resultant pain which can be quite severe at times. As this occurs there is a change in acid content of the external ear leading to more discomfort.

The first thing to do is to prevent any further fluid or moisture from entering that ear canal, no swimming or diving for several days. If there is mild pain a ½ to ½ mixture of vinegar and alcohol can be used in that ear for several days, along with mild pain killers such as Tylenol or Advil. If the pain is severe go to see your Doctor who may prescribe further treatments. In general this is not a dangerous problem even though it can be very painful.

A middle ear infection starts with a pressure change in the middle ear cavity from congestion and narrowing or complete blockage of the Eustachian tube. AT this point the child may say he/she cannot hear well or the ear “feels full”, or even hear the sloshing of fluid. After some period of time there is a collection of clear fluid with more pressure buildup and resultant pain. As the fluid builds up, bacteria can migrate into that space and begin growing leading to more pressure, pain, discomfort and sometimes fever. Your Doctor will suggest treatment methods that will greatly decrease pain and help heal the infection.

Some children tend to get repeated episodes of ear infections and I will deal with that problem in Part II of this post.

Kids and Rashes: Should You Worry??

little girl chicken pox and calamineOne of the most frequent reasons children are brought to their Pediatricians, the most frequent cause of parental concern, and sometimes the most difficult to diagnose, rashes can be caused by a laundry list of issues. For that reason rashes must be divided up by characteristics: is it raised or flat, can you feel it, is it itchy, is it small bumps, large welts, water blisters, or big flat areas, is it painful, are there accompanying symptoms, is it localized or generalized, what color is it, does it blanch to touch, and the list goes on.

Diagnosing the problem takes into consideration all of this plus an exam by your Doctor.

  • Some rashes are symptoms of a minor illness – most of the time viral, but a symptom nevertheless , just like runny nose and fever for a cold. The presence of a rash does not necessarily imply that it is contagious although it can give an indication of cause and an idea whether the underlying illness might be contagious. Certain rashes are terrible looking and the people who have them are very symptomatic; such as poison ivy with its open weeping sores – this rash contrary to popular opinion is not contagious and you cannot catch poison Ivy from person to person unless the first person has not yet washed off the resin from the poison ivy leaf on their skin that caused the problem. [In short: both rash and illness “may” be contagious, but like any viral cold, are not typically serious]*
  • Certain rashes are characteristic of some more significant illnesses, such as the rash of Chicken Pox along with typical symptoms and course of illness. In this case, although the vesicles in the rash of chicken pox holds the contaminated fluid- you still don’t catch the rash only. Again, it’s not the rash that is contagious, but contact with someone with chicken pox can produce the illness and subsequent rash. Small Pox, now nearly extinct has a typical course and rash. And that list can go on and on. [In short: the illness is contagious, the rash is only contagious in that it can cause spread of illness]*
  • The rashes we see in allergic responses are also not contagious. [In short: uncomfortable, but not contagious]*
  • On the other hand the rash of impetigo (a skin infection with staph or strep) can be very contagious. This eventually appears as weeping, scabbing lesions and is more common in the warm months. [In short: rash itself is highly contagious]*
  • Probably the most common type of rash seen in the Pediatrician’s office is the fine pink, pimple like rash associated with mild viral illness. Nothing can be done about these and they usually do not cause any symptom; they go away by themselves. [In short: typically minor symptoms, neither rash nor illness is contagious]*

The bottom line is if your child is acting sick and has a rash call your Pediatrician to weed through the various symptom and signs so as to get an idea as to causation. If your child is not sick this can wait until the next day or two.

Note – there are a myriad of topics that would include the presence of a rash and if anyone has a particular area of interest and can let me know, I will narrow the post down next time.

Photo credit: Auntie P; CC license

8 Steps to Boost Your Child’s Immune System

Editor’s Note: This is not an article about how to keep your kids safe from Coronavirus – our focus is to improve your child’s overall health and immune system. The healthier we can keep them, the more we improve their chances of fighting off each new bug that comes their way

The best offense is a good defense. It’s a saying that holds as true for football as it does for cold and flu season. But fending off colds doesn’t just mean reminding your kids to wash their hands. “How much you sleep, what you eat and how you spend your free time all play a role in having a strong immune system,” says Dr. Alan Greene, a clinical professor of pediatrics at Stanford University School of Medicine and an attending pediatrician at Packard Children’s Hospital in Palo Alto, Calif.

Follow this eight-step plan to keep your little ones — and you — healthy, happy and sniffle-free:

Scale back on sweets. According to the American Heart Association, the average American gets about 22 teaspoons of added sugar in one day — more than three times the amount the organization recommends. Not only can an excess of the sweet stuff pave the way for weight gain, but it can also wear down the immune system. “Refined sugar causes blood sugar spikes, which compromise white blood cells, the body’s first line of defense against colds,” says Greene. To scale back, swap out your kid’s soda for water and offer fruit instead of candy. The American Heart Association advises that children ages 4 to 8 who get about 1,600 calories a day should limit their sugar intake to 3 teaspoons — or 12 grams — a day.

Clear the air. Here’s another reason to protect your child from secondhand smoke and chemical-based household cleaners: “These pollutants damage cilia, the tiny hairs in your nose that help block viruses,” says Greene. Declare your home and car smoke-free zones, and use gentler cleaners — or save the serious scrubbing for the times your kid’s in day care or on a playdate.

Let ’em laugh. When life gets hectic, it’s sometimes simpler to rush through your day without cracking a smile. But taking time to have fun and giggle with your family is crucial for your well-being. In fact, research from Japan’s Osaka University Graduate School of Medicine found that watching funny movies boosts the production of the body’s natural cold- and flu-killing cells. Try having a tickle-fest, or pop in a chuckle-worthy DVD.

Serve some bacteria. The good kind, that is! “Probiotics strengthen the immune system,” says Greene. “The trick is giving your child enough of these friendly bacteria.” He recommends looking for a product with 5 to 10 billion units from more than one strain of probiotics, such as a combination of lactobacillus and bifidus regularis. Most yogurts contain only 1 billion units per serving, so consider stocking up on fortified juices too.

Score some D-fense. Not getting enough of this vitamin, which the body converts from sunlight, can increase your odds of catching a cold by up to 40 percent, reports a study from the University of Colorado School of Medicine. Because it’s very difficult to consume that much from foods (good sources include dairy and seafood), look to supplement your child’s diet with a vitamin that contains at least 600 IU of D, the amount recommended by the Institutes of Medicine. Pick a brand with D3, the form that’s more readily absorbed by the body.

Stress less. Too much tension can trigger the release of cortisol, a stress hormone that dampens your body’s defenses, says Greene. Of course, it’s impossible to rid your child’s life of all stresses, but teaching him coping techniques can help him better deal with them. The next time he seems anxious, have him lie down with one hand on his tummy. Ask him to take deep breath; his stomach should push against his hand when he inhales and move away when he exhales. Eventually, he’ll learn to take these “belly breaths” when he’s feeling frustrated.

Get moving. Freezing outside? Resist the temptation to camp out in front of the television. Staying active provides a number of healthy benefits, including a stronger immune system. According to a recent study published in the British Journal of Sports Medicine, people who worked out five days a week came down with 46-percent fewer colds than their couch-potato counterparts. So bundle up and go on a family walk or create an indoor obstacle course.

Have a set bedtime. Researchers at Carnegie Mellon University found that people who logged more quality shut-eye were five times less likely to get a cold than those who tended to toss and turn. Experts recommend that children younger than 12 should log 10 hours of sleep a night, one- to three-year-olds should get 12 to 14 hours, and those younger than 1 need 14 to 15 hours. To help put your little one — and colds — to bed, create an evening ritual that signals it’s time for sleep, like reading a favorite book or doing a few easy stretches.

Time for Colds and The Flu: What Can You & Your Family Do?

All the bugs and bacteria that plague human kind are essentially trapped indoors over the cold winter months: windows seldom get opened and cars are sealed shut with the heat on, schools harbor a variety of illnesses and are also sealed shut with temperatures way too high. It’s no wonder that this is a perfect season to share whatever cold or Flu with your closest neighbor. Young children, especially, are not the poster kids for hygiene, and touching and tasting the environment gives infants and toddlers a window on the world. Illnesses that get started in your child can spread rapidly to all members of the family.

Children Flu Sneeze Elbow SickViral infections and Flu are composed of minute particles that are just waiting for an opportunity to invade the next host. The easiest way to gain entry to the human body is through the mucous membranes that we all have – moist skin that you seldom think about; inside your nose, throat, lining your eyeballs, etc. Once they gain entry they invade normal cells and begin to replicate, reproducing themselves and in so doing, alter or kill the host cells. Whichever cells are involved and how your body reacts to the invasion will dictate the symptoms that you will experience. Most invasions are short lived and most for the purposes of this post are in the respiratory tract, upper (nose and throat) and lower (trachea and lungs).

How to cure a “cold” has been a mystery for scientists forever, but since they are short lived and generally do not produce major problems it has never been worth the resources to attempt multiple and complicated testing to nail down a cure. So viral colds live on and disrupt many lifestyles along the way. The favorite medicines in the world to attempt to cure just about anything are antibiotics, but to do so will not only have no effect on the cold but can cause problems of their own – resistances by bacteria to the antibiotic and reactions to that medicine. So we are left with “taking care” of the cold with various simple measures. Over the counter cold medicines have been shown to have very little effect on the symptoms or length of a cold and also have unwanted side effects.

How to prevent a cold or Flu, or viral illness from spreading is the main issue. Since these particles gain entry through mucus membranes, and are usually carried to that area by contact with your own colonized hands, it is very important to wash hands regularly and completely. Too often this is a cursory act of applying soap and washing it off, but scrubbing the hands for about 20 seconds (enough time to sing “Happy Birthday” twice) is usually necessary to do an adequate job. Avoid touching your face as most mucus membranes are in that area, especially your eyes. Of course the group that is most important (children) is not usually compliant with these issues, so you must teach this at home. Spread can also occur by droplets pushed into the air by coughing and sneezing and then transferred to others on your hands. Sneeze into the inside of your elbow and avoid spreading droplets into the air around you.

Unfortunately simple apparent cures, taking extra vitamins, etc. have been shown to have very little if any effect on a cold.

So, bear with it, it will be over soon, and do your best not to share it with anyone. And remember to get Flu immunization for your entire family (age six months and older) as soon as it comes out on the market, and since some Flu seasons can last into April get that Flu vaccine even in early March if you missed it at the end of last year.

Pneumonia, Bronchitis and Kids – More Common Than You Think

Pneumonia in kids is probably more common than we all realize. It represents an infection of the lung tissue which can be caused by viral illnesses, bacterial illnesses or a type of organism that is somewhere between a virus and bacteria called mycoplasma. The most common cause of pneumonia is usually viral, but viral illnesses can predispose lung tissue to become infected with bacteria. Other ways of acquiring pneumonia are by inhalation (this is unusual but certain illnesses such as tuberculosis and anthrax may be acquired in this manner).

The best way to diagnose kids with pneumonia is through a thorough history and physical exam that your doctor will perform on your child. Another way that can be used to diagnose pneumonia is through the use of a chest X-ray, but small areas of pneumonia or early pneumonia might not show up on X-ray. Your Doctor will be able to diagnose this early on by piecing together what you tell him and his observation and examination of your child.

One thinks of pneumonia as an illness with high fever and severe productive cough but this is not always the case and sometimes all that is seen are the symptoms created by the body to help compensate for the changes occurring in the lungs. If a large amount of lung tissue is involved and it becomes difficult for the gas exchange (oxygen in and carbon dioxide out) to take place then a signal is sent to the brain to increase the rate of breathing so that more air is forced in and more oxygen can be extracted. When it is even more difficult to breathe the child may use muscles not ordinarily used to help with breathing such as abdominal muscles and neck muscles and one can observe this. With further progression of the disease less oxygen will reach the body and mild blueness or cyanosis will be seen in the skin.

OK we’ve talked about the more severe problems with pneumonia but let’s get back to the beginning and restate that most pneumonia is mild and might very well be a natural progression of a cold. In a considerable amount of children with mild pneumonia the diagnosis might never be made because it is not severe. And because most of these are viral in nature, they will clear up as the cold clears without the use of an antibiotic, and the child never exhibits the signs and symptoms mentioned in the previous paragraph.

If your Doctor pieces together the parts of the history and physical exam and decides your child might have pneumonia, and if your child appears sick or ill, he might very well begin an antibiotic because the exact nature of the pneumonia might be difficult to determine. Most of the time pneumonia can be adequately treated at home without the need for hospitalization and he/she will recover fully without any subsequent problems.

Bronchitis is a wastebasket term describing what is thought to be inflammation and mucous collection in the tubes that lead from your nose and mouth down into your lungs due to many causes- again usually viral. Any cold with a significant loose cough probably represents some degree of bronchitis or tracheitis (higher up). Generally, it also does not necessarily need an antibiotic to “cure” it because bronchitis, like mild pneumonia, will also go away as the cold resolves. There are instances, again, when your child’s doctor might very well decide to use an antibiotic for your child and those would include when your child looks sick or ill (because significant bronchitis and pneumonia can look exactly the same) or if your child has any sort of chronic lung condition such as asthma or cystic fibrosis where the chance of bacterial infection is increased.

So, especially during the winter months, if your child is diagnosed with pneumonia or bronchitis, you needn’t panic or assume the worst. Just follow your child’s doctor’s advice and he/she will be just fine.

Your Kids, Strep and Strep Throat

strep throat examStrep infections are caused by a bacterium called Streptococcus Pyogenes and can range from mild to very severe and, at times, life threatening. The bacteria enter the human body by one of three ways: airborne, direct touch, or circulating through the blood stream and seeding into various organs. The most common illnesses we see in children are those that are airborne or acquired by direct touch and cause mild to moderate illnesses.

Some forms of impetigo, a superficial skin infection, can be caused by strep or staph and, while contagious to touch, can be easily treated and will not cause any subsequent problems

The more well known infection is that causing tonsillitis, an infection in the tissue of the tonsils, those lumps of pink tissue just behind and above the tongue when you open your mouth wide. This is also contagious and travels from untreated person to person through air droplets. Usually in the winter time, the person becomes ill rather rapidly, over 1-2 days with some combination of sore throat, fever, headache, generalized tiredness, muscle pains, trouble swallowing, and sometimes tender swollen glands in the front and side of your neck, up under the jaw. Often times the symptoms are mild but almost always eventually results in severe sore throat as the primary symptom. Children under the age of two years old seldom get significant illness.

When your Doctor examines your child he may find any combination of red swollen tonsils occasionally with white or grey pus on the surface, tender swollen glands in the neck, foul breath, fine red rash all over, and occasional red tongue with a rash on it.

The diagnosis can be made easily in the office by a rapid throat swab test which is positive in about 85% of people with significant strep throat. If your Doctor finds a negative rapid test and really feels that your child has strep throat he/she may elect to have a culture done on the same swab and even begin an antibiotic. The culture test can take 48 hours for the results.

There are many antibiotics that can successfully treat strep throat* and relief from symptoms is felt by your child within 24-48 hours. The reason that strep throat is treated at all is that in a very small percentage of patients with untreated strep throat there can arise certain serious illnesses that might lead to heart damage or kidney damage. If left untreated, this illness would go away on its own over a 3 – 5 day period, just like a cold. In general, ten days of medication is necessary but occasionally that time can be shortened depending on the antibiotic used: it is important for your child to complete the entire course of the antibiotic as prescribed by your Doctor. Usually within 24 – 48 hours of onset of treatment there are no more strep bacteria in the throat and your child may return to school.

Once the treatment has been completed, the illness is over.

This does not mean that your child cannot get strep throat again by contacting someone with active untreated strep infection, but the chances of acquiring those serious secondary problems has been reduced to nearly 0.

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* It is of interest to note that although strep throat is a very common illness and the strep bacteria has been exposed to more antibiotics than most other bacteria, strep alone has remained sensitive to just about all of the antibiotics used. Other bacteria develop rapid resistances to antibiotics they are repeatedly exposed to.

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