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Another Ear Infection…What Can I Do – Part II??

Since we now understand how ear infections occur (see Ear Infections – Part I), it’s time to deal with the child who seems to get repeated ear infections. Ear infections, particularly the middle ear type, are responsible for providers ordering more prescription antibiotics than any other childhood disease.

There are a certain number of children who just seem to get an outer ear infection (otitis externa) every time they get their ears under water, usually during the warmer months of the year. There are even some who get this when they do not get their ears under water, but usually these episodes are also in the warmer months. I spoke about the treatment of the sudden or acute ear infection, but what to do about the repeated episodes. The best answer to this is using either a prescription medication or better yet, one not costing you anything at all. Mix ½ to ½ mixture of white vinegar and rubbing alcohol and place a couple drops of this into your child’s ear as soon as they get out of the pool or lake or ocean and try to limit the time those ears remain submerged. This has a way of drying out the external ear canal and helping to change the acid content of the eardrum. Ear plugs may be effective under certain circumstances but in general if you force a plug into the ear it may just irritate the skin which is exactly what we wish to avoid.

Middle ear infections (otitis media) are a different matter entirely. Remember that these are primarily due to a blockage in the normal valve system of your middle ear, with resultant pressure, fluid and infectious results. (Please refer back to part I if this is confusing). These changes happen in a progression that can occur suddenly or can develop over time.

While the obvious answer would be to use a “cold medicine” early on in the process this does not seem to influence the course of events as outlined, when looked at in controlled studies. The other end of the spectrum for treating the occurrence of multiple recurrent middle ear infections is to alter the normal anatomy in such a way as to prevent buildup of pressure in that small space which can then lead to fluid accumulation and bacterial secondary infection. This is accomplished through the use of very small tubes that can be surgically inserted through the eardrum and will serve to equalize the pressure on both sides of the eardrum. The system will calm down and the incidence of new infections will drop tremendously.

But that is a surgical procedure under some type of anesthesia, and even with tubes in the proper place, there can still be fluid production which then drains out of the ear chronically. Also, the mere act of making a hole in the eardrum through which a tube can be put in place, can slightly damage and scar that eardrum. Depending on the type of tube implanted in the eardrum, it usually comes out by itself after six to twelve months and the eardrum heals. Occasionally, the ear drum fails to heal completely and there is a perforation that might need to be surgically repaired in the future.

We treat middle ear infections for one of several reasons: to control the pain, to prevent any further extension of the infection into sensitive areas, and to preserve speech and hearing in your child.

Fortunately there are other approaches to the treatment of recurrent middle ear infections. Each significant ear infection should recognized and treated appropriately and the fluid buildup behind the eardrum monitored for resolution.

  • Fluid constantly in touch with the ear drum will dampen the usual vibrations and dull the hearing while it is there. Hearing testing can be run routinely to follow any changes in hearing.
  • All types of medications have been tried at one time or another: preventative doses of antibiotics have and still are being used for several weeks to months in an effort to prevent the bacterial infections, but the increasing number of bacteria becoming resistant to common antibiotics have caused physicians to re –think the use of long term medication.
  • Cortisone preparations by mouth have been tried to help with the middle ear inflammation, with varying results.
  • Occasionally, when all forms of treatment fail it is up to the ENT surgeon to place those tubes and let the middle ear system calm down.

So, there are many things to consider in finding a course of action for your child with recurrent ear infections and your Doctor will be familiar with each of the methods and can discuss them with you.

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.

Who is The REAL Lifeguard at Your Kid’s Pool This Summer??

Who is the real lifeguardI was doing the usual mom chit-chat at Scouts while my son worked towards his water safety badge and fielded the inevitable question from the Scout leader, ‘what do you do?’. My answer, “I’m a global activist working to end child drowning. One child drowns every minute.” And then came the typical response, “Wow, I didn’t know it was such an issue, but it is certainly needed, the lifeguards need to do a much better job.” She then related a story about how she and her husband were at a pool with their baby and 3-year old son. She was sitting at the side holding the baby, her husband was in another area, and the 3-year old suddenly went past his depth and was bobbing up and down under the water, drowning. She screamed for the lifeguard, her husband screamed for the lifeguard but also managed to get to their son before any serious injury occurred. She related the story in harrowing detail and emphasized several times how the lifeguard had clearly not been doing his job well since her son had almost drowned in a crowded pool, so she understood why drowning is such a problem.

What is your initial reaction? Quite possibly the same as hers, the fault was with the lifeguard, if he had been paying attention her son never would have almost drowned. It’s an incredibly common belief, but the reality is quite different. These are excellent, diligent and concerned parents, and they believe, just as most people believe, that if you go to a pool or beach with a lifeguard on duty, you and your children will be safe. Yes, that’s true, if you swim in an area with a lifeguard, your chance of drowning is reduced to 1 in 18 million. That’s very good odds, even better when you consider that 75% of open water drownings occur when a lifeguard is not present. There is no two ways about it, if you swim in an area with a lifeguard, you are much safer, but it’s not just the lifeguard’s job to keep you safe. I do place the blame for that misconception squarely on the shoulders of those of us in the drowning prevention field, we haven’t explained what the true role of a lifeguard is, so let me start now to change how we view lifeguards.

When it comes to water and children, especially young children or non-swimmers, you, the parent, are the first lifeguard on duty. You need to be touch distance from your young or non-swimmer, meaning you can reach out and grab them at any time. Why?

  • First, a child can drown in 2 minutes in 2 inches of water. Even the best lifeguard, diligently scanning a crowded pool can miss seeing a small child under water, especially if the sun is glinting off the water or there are many people in the pool obscuring visibility under the surface. Plus, most people don’t even recognize someone is drowning since it’s not like in the movies, there is no flailing of arms or screaming. Click here to see what it really looks like – and don’t worry, the boy is rescued.
  • Second, you don’t want your child to be in a situation where they need to be rescued. You know how hard it can be to spot a small child in a crowded place. Even the fastest lifeguard will take precious seconds to spot the danger and make their way to the victim, and that can be a really frightening few seconds for a child.

Lifeguards are like police and firemen, their job is to prevent accidents by watching for dangerous behavior and educating the public, and to perform rescues when things do go wrong, but it’s not their job to babysit or watch just one child, much less the 100 children in the water on a busy summer afternoon. Think about it, you don’t let your 3-year old walk 3 blocks to preschool just because your town has police whose job is to keep people safe, do you? The good news is that having a lifeguard on duty is like having a firefighter stand in your front yard just in case a fire breaks out. 95% of a lifeguard’s job is preventing an accident in the first place and only 5% is actually rescuing someone in distress. With you on guard, hopefully it won’t ever be your child in distress.

Now that you’re thinking, ‘great, so much for relaxing at the pool this summer’, I have some very good news. Taking a baby or young child to the pool is better than having a personal trainer and Weight Watchers combined if you take advantage of the time in the pool with them. Trust me, I worked off two pregnancies swirling my children around in the water. Next month I hope you’ll check back for my tried-and-true ‘fun for kids, great easy workout for mom’ plan!

Personal WaterCraft & Kids: How to Make Them Fun AND Safe!

Watercraft familySummer is fast approaching and that means that thousands of children will be hitting the water looking to go fast! Summer is the time to think about the beach and being outside and speeding around oceans, lakes or canals in PWC or personal watercrafts. PWC have steadily risen in ownership in the U.S to well over a million and with that increase in ownership come’s an increase in operators and injuries to the tune of over 12,000 documented injuries annually. Most injuries seem to occur when PWC collide—either with other vessels including other PWC or with fixed objects such as docks or tree stumps. Behavioral factors cited in 3 studies include operator inexperience (most operators had <20 hours of experience in boat operation), operator inattention, and excess speed or reckless operation. Some PWC can seat as many as 3 people and hit speeds of 60 mph. PWC are the only recreational boats for which the leading cause of death is not drowning; most fatalities result from blunt trauma.

The answer to the question of how to keep our children safe on the water seems to be the same as it has been for quite some time. Education and hands on practice. We need to educate our children and ourselves on water safety, both in and out of the water and both for operating and riding on a PWC. The Personal Watercraft Industry Association has the following recommendations:

RECOMMENDATIONS

  1. No one younger than 16 years should operate PWC.
  2. The operator and every passenger must wear a US Coast Guard-approved personal flotation device.
  3. Alcohol or other drug use should be avoided before and while operating PWC.
  4. Participation in a safe boater course with specific information about PWC should be required before operating PWC.
  5. Safe operating practices, such as no operation between sunset and sunrise, no wake jumping, and observing posted speed limits or no-wake zones, should be followed. (No-wake zone means the craft speed is slow enough that no wake is formed behind the craft as it crosses a specific area.)
  6. PWC should not be operated where swimmers are in the water.
  7. If a PWC is being used to tow another person on skis, knee boards, tubes, or other devices, a second person must face the rear to monitor the person being towed.
  8. All persons who rent PWC should be required to comply with these recommendations.
  9. Protective equipment such as wet suits, gloves, boots, eyewear, and helmets may be appropriate to wear.

When it comes to PWC, owning and operating a PWC is the same as owning and operating a car and should be treated with the same amount of respect. Would you hand over your car keys to your child who has little to no driver training? Of course not and the same should hold true when it comes to any PWC. The numbers don’t lie. Everyone needs PWC drivers Ed. Putting in the time before hand will save a lot of pain and suffering during what should be the most fun time of the year for kids.

Thank you and be safe

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Editor’s Note:  This post first appeared on Pediatric Safety in April 2013. We thought now might be a good time to revisit it. 

Summer’s On the Way: How to Keep Your Kids Safe Near Water

girl swims with coachNow that the holidays have passed and the school year is back in full swing, the kids can see spring break and summer on the horizon. Spring break will be here in a few months and before you know it summer will be in full swing as well.  I realize that I am writing this from warm and sunny Miami and you may be reading this with 4 feet of snow outside but it does not change the fact that now is the time to start preparing for the summer activities and mainly the water activities.

Fire departments around the country prepare for summer with drowning and water rescue scenarios, so if your children do not yet know how to swim on their own then now is the time to start teaching them, or get them into classes that will prepare them for being in or around the water.   I think it goes without saying that water is deadly for anyone but mostly for children and not every child picks it up at the same pace.  Some kids pick it up right away and swim like little fish and some take longer so I am hoping that you can locate swimming classes in your area, but if you cannot please check websites like the Red Cross: Swim Class and Water Safety Training or your local Boys and Girls Clubs for classes in your area or at least for ones not too far away.

Giving your children a foundation in water safety and the ability to swim will serve them whether they are around a pool or out on a boat and will give you a little piece of mind that your child is prepared and will know what to do should an accident happen.

Summer Safety Checklist for Parents…From Our Top Paramedic

Attractive young beautiful girl drinking water from plastic bottlesSchool will soon be out, summer will officially be upon us, and the kids will be looking for things to do. All of these things are going to happen soon so it is time to break out the summer safety tip checklist to ensure that we not only have a fun summer but that we also have a safe summer. The two most common emergencies we encounter in summer time are heat related illnesses and water emergencies. Heat related illnesses can range from cramps and dizziness, to fainting and passing out.  The key to heat illnesses is to stay vigilant with your kids and hydrate them.  If you know they will be outside during the day, then they need to hydrate before, during, and after outside time.  Stay aware of the signs of heat problems.  Cramps, dizziness, dry red skin, and nausea are just some of the warning signs.  If you encounter any of these heat problems with your children, please move them to a cool place with shade or air conditioning, and slowly cool them down with cool towels and water, and if the heat problems are causing your child severe problems, with breathing or blacking out, then call 911 immediately.

Water emergencies can range from falling off a boat to drownings in pools.  The key to water safety and children is 100% focus with no distractions.  Kids can drown in a very small amount of water and it can happen in what seems like a blink of an eye, so the best strategy is to never let them out of your sight when near or in the water.  If your child does not know how to swim then swimming lessons can be a fun summer activity that lasts a lifetime.  If you and your children will be on a watercraft of any kind, please remember to wear life-jackets at all times and obey the rules of the water.   If your child is going to a summer camp with a pool or traveling to a pool then purchase them their own flotation jacket or shirt to take with them.

If your child is going to camp this summer, please take a little time and do your homework on the camp and its counselors.  Finding out things like how many kids will be in the camp, what is the counselor to kid ratio, are all camp staff members certified in CPR, how is the camp set up? Is it near water? Etc.  Asking questions like these will let you know how committed the camp is to your child’s safety. If your child is staying home during the summer, the questions are almost the same.  Who is watching the child, do they know CPR, can they swim, will they have 100% focus at all times with your child,  can they handle an emergency with your child like a fall or something more severe?  Having an older sibling stay home and watch a younger one during the summer can both a blessing and gamble, so make sure everyone is clear about what is expected and what to do in an emergency.

The two things we always tell people are

– Nobody is drowning proof, and

– Hydrate hydrate hydrate.

Thank you and have a safe summer.

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