Ear infections and children

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c:\documents and settings\nurse2\local settings\temporary internet files\content.ie5\0hqho5ir\mchm00264_0000[1].wmf EAR INFECTIONS AND CHILDREN

Next to common cold, an ear infection is the most common childhood illness. In fact, most children have had at least one ear infection by the time they are 3 years old. Most of the time ear infections clear up without causing any lasting problems. But, if they occur often or are not treated, they can lead to hearing loss or other damage. This handout is to inform parents about the symptoms, treatments, and possible complications of acute otitis media, a common infection of the middle ear.

How do ear infections develop?

The ear has three main parts: the outer ear, middle ear, and inner ear. A tiny tube, called the Eustachian tube, connects the middle ear to the back of the throat and nose. When a child has a cold, nose or throat infection, or allergy, the Eustachian tube can become blocked, causing a buildup of fluid in the middle ear. If this fluid becomes infected by bacteria or a virus, it can cause swelling of the eardrum and pain in the ear. This type of ear infection is called acute otitis media.

Often after the symptoms of acute otitis media clear up, fluid remains in the ear. Acute otitis media then develops into another kind of ear problem called otitis media with effusion. This condition is harder to detect than acute otitis media because, except for the fluid and some hearing loss that is usually mild, there are often no other noticeable symptoms. This fluid often lasts for up to 3 months and, in most cases, disappears on its own. The child’s hearing then returns to normal.
There are several risk factors for developing childhood ear infection, including:

Age: Infants and young children are more likely to get ear infections. The size and shape of their Eustachian tubes make it easier for fluid to build up. Ear infections occur most often in children between 3 months and 3 years of age. Also, the younger a child is at the time of the first ear infection, the greater chance he or she will have repeated infections.

Sex: Although researchers are not sure why, boys have more ear infections than girls.

Heredity: Ear infections can run in families. Children are more likely to have repeated middle-ear infections if a parent or sibling also had repeated ear infections.

Cold/Allergies: Colds often lead to ear infections. Children in group child care settings have a higher chance of passing their colds to each other because they are exposed to more germs and viruses from the other children. Allergies that cause stuffy noses can also lead to ear infections.

Tobacco Smoke: Children who breathe in someone else’s tobacco smoke have a higher risk of developing health problems, including ear infections.

Bottle-Feeding: Babies, who are bottle-fed, especially while they are lying down, get more ear infections than breastfed babies. If you bottle-feed your child, hold his or her head above the stomach level during feedings. This keeps the Eustachian tubes from getting blocked.
Parents can help reduce some of the risks of ear infections. For instance:

*Breastfeed instead of bottle-feed. Breastfeeding may decrease the risk of the frequent colds and ear infections. If you do bottle-feed, do not give your child a bottle while he or she is lying down in the crib or playpen.

*Keep your child away from tobacco smoke, especially in your home or car.

*Try to keep your child’s hands clean.

What are the symptoms of an ear infection?

Your child may have many symptoms during an ear infection. Talk with your pediatrician about the best way to treat your child's symptoms.

Pain: The most common symptom of an ear infection is pain. Older children can tell you that their ears hurt. Younger children may only seem irritable and cry. You may notice this more during feedings because sucking and swallowing may cause painful pressure changes in the middle ear.

Loss of appetite: Your child may have less of an appetite because of the ear pain.

Trouble sleeping: Your child may have trouble sleeping because of the ear pain.

Fever: Your child may have a temperature ranging from 100°F (normal) to 104°F.

Ear drainage: You might notice yellow or white fluid, possibly blood-tinged, draining from your child's ear. The fluid may have a foul odor and will look different from normal earwax (which is orange-yellow or reddish-brown). Pain and pressure often decrease after this drainage begins, but this doesn't always mean that the infection is going away. If this happens it's not an emergency, but your child will need to see your pediatrician.

Trouble hearing: During and after an ear infection, your child may have trouble hearing for several weeks. This occurs because the fluid behind the eardrum gets in the way of sound transmission. This is usually temporary and clears up after the fluid from the middle ear drains away.
Other causes of ear pain

There are other reasons besides an ear infection why your child's ears may hurt. The following can cause ear pain:

An infection of the skin of the ear canal, often called "swimmer's ear"

Blocked or plugged Eustachian tubes from colds or allergies

A sore throat

Teething or sore gums


Treating Middle Ear Fluid 

Treatment options for middle ear fluid include observation, tube surgery, or adenoid surgery. Because a treatment that works for one child may not work for another, your pediatrician can help you decide what treatment is best for your child. If one treatment doesn't work, another treatment can be tried. Ask your pediatrician about the costs, advantages, and disadvantages of each treatment.

Your pediatrician will decide if treatment is needed based on several factors including the following:

*How long your child has had middle ear fluid

*The amount of hearing loss or other problems, if any, caused by the fluid
Treatments not recommended

A number of treatments are not recommended for young children with middle ear fluid. These include decongestants and antihistamines; prolonged, frequent, or low-dose courses of antibiotics; and steroid nasal sprays.

Surgical treatments not recommended include myringotomy (draining of fluid without placing a tube) and tonsillectomy (removal of the tonsils). If your pediatrician suggests one of these surgeries, it may be for another medical reason. Ask your pediatrician why your child needs the surgery. If you are still unsure, you may want to talk to another doctor.
Other treatment options

No recommendation can be made regarding complementary and alternative medicine treatments, including herbal medicines, for middle ear fluid. There isn't enough evidence showing that these treatments work. Some of these treatments have major risks.

No recommendation can be made regarding allergy management treatments for middle ear fluid. There isn't enough evidence showing a cause-and-effect relationship between allergy and middle ear fluid. Also, the benefits of treatment are uncertain, there are major potentially harmful effects, and treatments can be expensive.


Complications from untreated ear infections

While your child is young and at higher risk for ear infections, it is important for you to know the symptoms and to get your child treatment if an infection develops. Although, it is very rare, complications from untreated ear infections can develop including:

*an infection of the inner ear that causes dizziness and imbalance (labyrinthitis)

*an infection of the skull behind the ear (mastoiditis)

*and infection of the membranes around the brain and spinal cord (meningitis)

*scarring or thickening of the eardrum

*facial paralysis

*permanent hearing loss
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Middle Ear Fluid and Your Child



Hassle-Free Meal Time1 star2 stars3 stars

Feeding my child is very difficult. How can I make mealtimes less of a hassle?

Here are 6 common unpleasant and unhealthy childhood eating situations and tips to handle them. Also, remember that food should be used as nourishment, not as a reward or punishment. In the long run, food rewards or bribes usually create more problems than they solve.

Feeding Kids – What’s Your Role?

While parents are the best judges of what children should eat and when, children are the best judges of how much they should eat.

Here are five important feeding jobs for parents and caregivers:

  1. Offer a variety of healthful and tasty foods. Be adventurous!

  2. Serve meals and snacks on a regular schedule.

  3. Make mealtime pleasant.

  4. Teach good manners at the table

  5. Set a good example.

Happy encounters with food a t any age help set the stage for sensible eating habits throughout life. Handling food and eating situations positively encourages healthful food choices.

Mealtime: Not a Battleground

Clean your plate.”

No dessert until you eat your vegetables.”

If you behave, you can have a piece of candy.”

To parents and caregivers, these phrases probably sound familiar. However, food should be used as nourishment, not as a reward or punishment. In the long run, food bribery usually creates more problems than it solves.

Feeding Challenges and Solutions

Food Jags: Eats one and only one food, meal after meal

Solution: Let the child eat what he or she wants if the jag food is healthy. Make sure the child is hungry at mealtime and offer other foods at each meal before the jag food. Don’t remove the jag food, but offer it as long as the child wants it. After a few days, the child likely will try other foods. Food jags rarely last long enough to cause any harm.

Food Strikes: Refuses to eat what's served, which can lead to "short-order cook syndrome"

Solution: Make sure the child is hungry when mealtime comes. Do not offer juices, sweetened drinks, or snacks too close to mealtime. Have whole-grain bread and rolls as well as fruit available at each meal, so there are usually

choices that the child likes. Be supportive, set limits, and don’t be afraid to let the child go hungry if he or she won’t eat what is served.

"The TV Habit": Wants to watch TV at mealtime

Solution: Turn off the TV. Watching TV during mealtimes is a distraction that prevents family interaction and interferes with a child’s eating. Value the time spent together while eating. Often it is the only time during the day that families can be together.

The Complainer: Whines or complains about the food served

Solution: First ask the child to eat other foods offered at the meal. If the child refuses, have the child go to his or her room or sit quietly away from the table until the meal is finished. Don’t let him or her take food along, return for dessert, or eat until the next planned meal or snack time.

"The Great American White Food Diet": Eats only white bread, potatoes, macaroni and milk

Solution: Avoid pressuring the child to eat other foods. Giving more attention to finicky eating habits only reinforces a child’s demands to limit foods. Continue to offer a variety of foods from all the food groups. Encourage a taste of whole grains as well as red, orange, and green foods. Eventually the child will move on to other foods.

Fear of New Foods: Refuses to try new foods

Solution: Continue to introduce and reinforce new foods over time. It may take many tries before a child is ready to taste a new food…and a lot of tastes before a child likes it. A good starting point is to encourage the child to simply allow a small portion of the new food to sit on his or her plate. Don’t force the child to try new foods. Also, remember that you are a role model—make sure your child sees you enjoying the food.

Note: Do not feed children younger than 4 round, firm food unless it is chopped completely. The following foods are choking hazards: nuts and seeds; chunks of meat or cheese; hot dogs; whole grapes; fruit chunks (such as apples); popcorn; raw vegetables; hard, gooey, or sticky candy; and chewing gum. Peanut butter can be a choking hazard for children younger than 2.

 Mealtime is More than Food

Youngsters are too smart to heed the old saying “Do as I say, not as I do.” Children learn by limitation what they see. Adults who eat poorly can’t expect their children to eat well. Set a good example by eating meals at regular times and by making healthful and tasty food choices.

Parents and caregivers are “gatekeepers,” who control what foods come into the house. Having lots of healthful foods around helps children understand that these food choices are a way of life.

Mealtime is family time. Children learn many things as you eat together. And pleasant social encounters with food help develop good food habits.

Three, Two, One… Let’s Eat!

Prepare children for meals. A five minute warning before mealtime lets them calm down, wash, their hands and get ready to eat. A child who is anxious, excited or tired may have trouble settling down to eat.

Consistent food messages encourage children to eat and help prevent arguments over food.

Try these simple steps:

  1. Be a smart gatekeeper. Buy a variety of foods you want the child to eat. Be adventurous with food!

  2. Be flexible. Don’t worry if the child skips a meal.

  3. Be sensible. Set an example by eating a variety of healthful foods yourself.

  4. Let children make their own food choices from the healthful choices you provide.

Occasional Meal Skipping and Finicky Food Habits are Okay

Well-meaning adults often view a child’s odd food and eating behaviors as a problem. However, childhood food jags, a fear of new foods and other feeding challenges are usually part of normal development.

There’s no need to worry if a child skips a meal or won’t eat the vegetables on his or her plate. Keep the big picture in mind. Offer a variety of healthful, tasty and nourishing foods. Over time, a child will get everything needed to grow and develop normally. Plenty of food variety and a relaxed, happy atmosphere at mealtime are the “ingredients” for a well-fed child.
Children often use the table as a stage for showing their independence. Sometimes, food is not the issue at all. The eating process is just one more way children learn about the world.
Work Up an Appetite!

Active play, along with eating right, promotes good health… and a healthy appetite! And it is the best exercise for toddlers and young children.

Making a snowman, playing tag, throwing balls, riding a bike and taking a nature walk are healthful and fun for the whole family. Don’t just watch. Join in and be active, too. When you’re physically active, you set a good example.
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Right from the start

How do I know if my child is eating enough?

*Children eat when they are hungry and usually stop when they are full. Some parents worry because young children appear to eat very small amounts of food, especially when compared with adult portions. A child who is growing well is getting enough to eat.

*To check your child’s eating pattern, pay attention to his or her food choices.

Make sure no one food group is completely left out. If this happens for a few days, don’t worry. But prolonged neglect of a food group could keep your child from getting enough nutrients.

*Encourage your child to be adventurous and eat a variety of foods within the food groups too. Even within a food group, different foods provide different nutrients. If the family is adventurous, then the child will likely join in.

Child-Size Servings: Be Realistic

*For children, adult-sized servings can be overwhelming. Offering child-sized servings encourages food acceptance.

*Here’s an easy guide to child-sized servings.

*Serve one-fourth to one-third of the adult portion size, or one measuring tablespoon of each food for each year of the child’s age.

*Give less than you think the child will eat. Let the child ask for more if he or she is still hungry.

Snacks Count Too

*Snacks make up an important part of childhood nutrition. Children must eat frequently. With their small stomachs, they cannot eat enough at meals alone for their high-energy needs. Three meals and 2 or 3 healthy snacks a day help children to meet their daily nutrition needs.

*To make the most of snacks, parents and caregivers should offer healthy snack choices and be consistent with the time snacks are served.

* Offer a variety of snacks. Choose mostly healthy snack foods that are a good source of nutrients (protein, vitamins, and minerals) as well as calories. Examples include raw vegetables, fresh or dried fruits, and low-fat dairy products. (See “Safety checks.”) One hundred percent fruit juices (unsweetened) are an alternative to soda and fruit drinks but should be limited to 4 to 6 ounces per day.

*Schedule snacks around normal daily events, and space them at least 2 hours before meals. Children should not feel full all the time. A feeling of hunger between meals and snacks encourages children to eat well when healthy foods are offered. If your schedule is hectic, pack a snack. This helps prevent a cranky, hungry child with no options besides fast food.

Foods to Choose

*Foods from all the groups work together to supply energy and nutrients necessary for health and growth. No one food group is more important than another. For good health, you and your child should choose foods from all 5 food groups.

*From the grain group: Whole-grain products such as breads, crackers, cereal, pasta, brown rice, bagels, tortillas, corn bread, pita bread, bran muffins, English muffins, matzo crackers, pancakes, breadsticks, and pretzels.

*From the vegetable group: Asparagus, beets, bok choy, broccoli, carrots, cauliflower, collard greens, corn, cucumbers, green and red peppers, jicama, kale, okra, peas, potatoes, pumpkin, snow peas, squash, spinach, string beans, sweet potatoes, tomatoes, vegetable juices, and zucchini. Some raw vegetables can be choking hazards for young children. (See “Safety checks.”)

*From the fruit group: Apples, applesauce, apricots, bananas, berries, cantaloupe, figs, 100% fruit juices (unsweetened), grapefruit, kiwi, mangoes, nectarines, oranges, papayas, peaches, pears, plums, pineapple, raisins, prunes, starfruit, strawberries, tangerines, and watermelon. Many of these can be offered as dried fruits as well. Some fresh and dried fruits can be choking hazards for young children. (See “Safety checks.”)

*From the meat, poultry, fish, dry beans, eggs, and nuts group: Lean cuts of beef, veal, pork, ham, and lamb; skinless chicken and turkey; fish; shellfish; cooked beans (kidney beans, black-eyed peas, pinto beans, lentils, black beans); refried beans (made without lard); peanut butter; eggs; reduced-fat deli meats; tofu; nuts; and peanuts. (See “Safety check.”)

*From the milk, yogurt, and cheese group: Low-fat milk, yogurt, cheese, string cheese, cottage cheese, pudding, custard, frozen yogurt, and ice milk.

Safety Check

*Choking hazards: Do not feed children younger than 4 round, firm food unless it is chopped completely. The following foods are choking hazards: nuts and seeds; chunks of meat or cheese; hot dogs; whole grapes; fruit chunks (such as apples); popcorn; raw vegetables; hard, gooey, or sticky candy; and chewing gum. Peanut butter can be a choking hazard for children younger than 2.

*Peanut allergies: Peanut and tree nut allergies are increasing. If your child has food allergies, or is diagnosed with peanut or tree nut allergies, avoid nuts and any food that contains or is made with nut products. If nuts are to be eaten away from home, check to make sure there are no children present with nut allergies.


Last Updated



Right From the Start: ABCs of Good Nutrition for Young Children


Did you know that hundreds of children younger than 1 year die every year in the United States because of injuries – most of which can be prevented?

Often, injuries happen because parents are not aware of what their children can do. Your child is a fast learner and will suddenly be able to roll over, crawl, sit, and stand. Your child may climb before walking, or walk with support months before you expect. Your child will grasp at almost anything and reach things they could not reach before.


Because of your child’s new abilities, he or she will fall often. Protect your child from injury. Use gates on stairways and doors. Install operable window guards all windows above the first floor. Remove sharp-edged or hard furniture from the room where your child plays.

Do not use a baby walker. Your child may tip it over, fall out of it, or fall down the stairs in it. Baby walkers allow children to get to places where they can pull hot foods or heavy objects down on themselves.

If your child has a serious fall or does not act normally after a fall, call your doctor.


At 6 to 12 months children grab at everything. NEVER leave cups of hot coffee on tables or counter edges. NEVER carry hot liquids or food near your child or while holding your child. He or she could get burned. Also, if your child is left to crawl or walk around stoves, wall or floor heaters, or other, hot appliances, he or she is likely to get burned. A safer place for your child while you are cooking, eating, or unable to provide your full attention is the playpen, crib, or stationary activity center, or buckled into a high chair.

If your child does get burned, put cold water on the burned area immediately. Keep the burned area in cold water for a few minutes to cool it off. Then cover the burn loosely with a dry bandage or clean cloth. Call your doctor for all burns. To protect your child from tap water scalds, the hottest temperature at the faucet should be no more than 120F. In many cases you can adjust your water heater.

Make sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year.


At this age your child loves to play in water. Empty all the water from a bathtub, pail, or any container of water immediately after use. Keep the door to the bathroom closed. NEVER leave your child alone in or near a bathtub, pail of water, wading or swimming pool, or any other water, even for a moment. Drowning can happen in less than 2 inches of water. Knowing how to swim does NOT make your child water safe at this age. Stay within an arm’s length of your child around water.

If you have a swimming pool, now is the time to install a fence that separates the house from the pool. The pool should be fenced in all 4 sides. Most children drown because they fall into a pool that is not fenced off from the house. Be prepared—install a fence around your pool now, before your child begins to walk!

Poisoning and Choking

Your child will explore the world by putting anything and everything into his or her mouth. NEVER leave small objects or balloons in your child’s reach, even for a moment. Don’t feed your child hard pieces of food such as hot dogs, raw carrots, grapes, peanuts, or popcorn. Cut all of his or her food into thin slices to prevent choking.

Be prepared if your child starts to choke. Learn how to save the life of a choking child. Ask your doctor to recommend the steps you need to take.

Children will put everything into their mouths, even if it doesn’t taste good. Many ordinary things in your house can be poisonous to your child. Be sure to keep household products such as cleaners, chemicals, and medicines up, up and away, completely out of sight and reach. Never store lye drain cleaners in your home. Use safety latches or locks on drawers and cupboards. Remember, your child doesn’t understand or remember “no” while exploring.

If your child does eat something that could be poisonous, call the Poison Help Line at 1800-222-1222 immediately. Do not make your child vomit.

Strangulation and Suffocation

Place your baby’s crib away from windows. Cords from window blinds and draperies can strangle your child. Tie cords high and out of reach do not know cords together.

Plastic wrappers and bags form a tight seal if placed over the mouth and nose and may suffocate your child. Keep them away from your child.

And Remember Car Safety

Car crashes are still a great danger to your child’s life and health. Most injuries and deaths caused by car crashes can be prevented by the use of care safety seats EVERY TIME your child is in the car. An infant must always ride in a rear-facing car safety seat in the back seat until he or she is a t least 1 year of age and at least 20 pounds. A rear-facing car safety seat should NEVER be placed in front of a passenger air bag. Your child, besides being much safer in a car safety seat, will behave better so you can pay attention to your driving. The safest place for all infants and children to ride is in the back seat.

Do not leave your child alone in a car. Keep vehicles and their trunks locked. Death from excess heat may occur in a closed car in warm weather in a short time.

Remember, the biggest threat to your child’s life and health is an injury.

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