As a nurse, I think about things like “febrile seizures,” or brain damage from fevers, and rush for Acetaminophen or Ibuprofen (popularly consumed as Tylenol® or Motrin®).

But is rushing for one of these items the smartest thing to do? Is it crucial to maintain a normal temperature? And how do you monitor and treat a fever for your child in the best possible way?
 

Signs of Fever

Signs of a high fever include:

• hot dry skin
• temperature above 41 Celsius
  (105.8 Fahrenheit)

Click here for more information about how to spot a fever in children.
 

Fever Research Update

In a Clinical Report put out by the American Academy of Pediatrics in 2011, some important guidelines were outlined based on research studies of general healthy children. The findings of this study included the following:

• Fever is common in children
• Fever is the body’s way of fighting infection
• Some fevers can actually help a child recover faster from viruses
• Fever cannot make an illness worse
• Fever cannot cause long-term neurological problems
• It is rare for high fevers to cause convulsions or comas

Click here for the official research study overview.
 

Treating a Child’s Fever

Taking your child’s temperature
Get a good thermometer and learn how to take your child’s temperature. 

• Tips for Taking a Baby’s Temperature

Maintaining Body Temperature

• Keep the room temperature between 70-74 degrees Fahrenheit
• Dress your child in light cotton pajamas
• If your child has chills, cover with an extra blanket and remove when the chills stop 

Watch Your Child
Observe your child for signs of serious illness. Call your pediatrician with any of the symptoms below and report the temperature as well.

Rest and Hydrate
Make sure your child gets plenty of rest and give your child plenty of fluids to prevent dehydration and help the body cool itself. Good choices for hydration during a fever are: water, clear soups, popsicles and jello.
 

Acetaminophen or Ibuprofen

Look for next week’s post, where I’ll treat you to the latest updates about moms alternating acetaminophen and ibuprofen as fever treatment. The answer may surprise you. In the meantime, thanks for reading.

I have a little monkey of a toddler.

He is 18 months old and climbs EVERYTHING. In particular, he loves to climb up on our couch and watch the world go by outside. He leans on the window and giggles at the squirrels and birds in our yard.

The problem is, toddlers don’t have much in the way of safety awareness!  And my little one is no exception.

Since he’s become so mobile, I’ve had to start keeping the window behind the couch closed when he’s awake, so that he doesn’t push the screen out and accidentally fall out of the window.

Our house is a one-story ranch, so it wouldn’t be far for him to fall if he did accidentally do so, but being the safety-conscious, somewhat paranoid, pediatric rehab nurse mama that I am, I don’t want to take that chance! You see, I had no idea how frequently kids fall out of windows and experience life-threatening trauma as a result until I started working in the Division of Rehabilitative Medicine at Children’s Hospital Los Angeles.

Most children suffer a traumatic brain injury after a fall from a window. Some tragically die. The highest cause of traumatic brain injury in children ages 0-4 years old is falls.
More information on falls – injury statistics and incidence rates

Even infants will climb sofas as they explore their environment.

Kids Fall Headfirst

Kids are top-heavy by nature because of how they are built. So they usually fall headfirst. The ground below an open window might be grass, it might be bushes, or it might be cement (not exactly a soft landing when falling headfirst).

Parents’ Remorse

Now that I work in “rehab,” the Rehabilitative Medicine Division at Children’s Hospital Los Angeles, I have seen and heard grief-stricken parents sharing their remorse over what could have been prevented so easily. Some of the more heartbroken parents are the ones who saw the fall take place and didn’t get there in time. It is heartbreaking to hear them say things like, “I saw it happen, but I couldn’t get to Johnny in time,” or “I grabbed the edge of Susie’s dress, but it wasn’t enough and she slipped out of my grasp and fell.” Parents or other caregivers feel incredibly sad and guilty that they were not able to protect their child.

I see a photo like this and just cringe.

A Reason to Rearrange Your Furniture

I have become aware of how furniture is arranged in our house and the safety levels of each placement as a result of working in our hospital’s rehab department. I’m excited to share that there are some pretty simple ways to try to prevent a fall from a window. Most simply involve rearranging the furniture.

Watch for “Climbable Furniture”

Don’t place “climbable” furniture under a second (or third, or fourth) story window. This includes couches, chairs, and ESPECIALLY a child’s bed. Don’t forget other rooms like dens, offices and sitting areas in bedrooms. Older children will even climb dressers as well.

Close and Lock Windows

If you are forced to place furniture under a window, keep that window closed AND locked when small children are present. If you have a low-to-the-ground window, keep it closed and locked at all times when children are present.

Bars on Windows

Some parents choose to install bars on windows to overcome this safety issue. Barred windows can prevent kids from falling through an open window. However they do not represent a foolproof safety solution because they need to be able to be opened in case of a fire.

Rooms with Accessible Windows

There may be some instances where you simply may not be able to find a simple solution for the accessible windows in your home. In these cases, it will be crucial to provide close supervision when small children are in a room with accessible windows. And be sure to cover this topic with relatives and babysitters who watch your child.

Avoiding Accidents

I hope I’ve helped provide you with a few helpful tips that will help you know what to look for to avoid needless falls from windows. In the meantime, please let me know if you found any problem areas in your home and how you plan to rearrange the furniture to prevent head injuries for your child.

Unintentional injury remains one of the top five leading causes of death in children.

The Emergency Department at Children’s Hospital Los Angeles sees far too many accidents taking place in the home, ranging from falls, near drowning, poisonings and even burns.

While constant supervision is the best way to prevent injuries, using layers of protection can help reduce the risk of home-related injuries to children. Even the most watchful parents cannot keep kids completely out of harm’s way every second, and utilizing tools can aid even the busiest parent. 

As a nurse on the Rehabilitation Unit here at Children’s Hospital Los Angeles, I have taken care of children who have nearly drowned, fallen out of a two-story window, and those who have unintentionally overdosed on a family member’s medication, just to name a few. I have witnessed the devastation, stress and guilt these situations can cause a family.

That’s why I know it is so important for parents to look for potential hazards in their home and take steps to remove them before it’s too late.

I will address the two general safety area concerns within the home:

1. Drowning and water safety
2. Fall prevention

Drowning and Water Safety

The home environment has potential for many hidden drowning hazards for children. Drowning injuries and deaths can occur not only in oceans, pools and spas, but also in bathtubs, toilets and buckets.

• Never leave your child unattended in the bathtub or any body of water, even if they know how to swim. A child can drown in just 2 inches of water.
• Keep toilet lids closed and use toilet seat locks. Toddlers can fall headfirst into the toilet and drown. It is best to restrict access to danger zones in the home such as bathrooms and kitchens. This can be done with door handle locks or gates.
• Empty all buckets, containers and wading pools immediately after use and store upside down and out of reach of small children.

Please read Hot Days, Cool Water: Summer Safety Tips by my colleague, nurse Gloria Verret, to learn more about pool safety at home and how drowning can affect your child. 

Falls

As your child develops he or she will first roll over, then sit and crawl, and before you know it,  walk everywhere.

Your toddler will move faster than your eye can see, so consider some of these safety tips to prevent them from tumbling unsafely in your home:

• Use window guards to prevent your child from falling through screens or open windows. Open windows from the top down whenever possible.  
• Never leave a child unattended around stairs, even if they are in a gated area.
• Install hardware-mounted (they are sturdier than pressure-mounted) safety gates at the top and bottom of stairways.
• Keep hallways and stairways well-lit and free of clutter (especially toys … they attract children).
• Tack down rugs and runners to prevent tripping.
• Child safety seats (car seats) or bouncer seats should NEVER be placed on top of counters or furniture.
• Do not place an infant in the middle of an adult bed unattended.
• Move furniture away from windows. This reduces a child’s ability to climb up to a window.
• Secure shelves, TVs, dressers and other furniture that may tip over. Children often climb on furniture and injuries from tip-overs can be quite severe.

These are just a few of the things you can do to child-proof your home.  A few layers of protection can go a long way to keeping your children safe. Stay tuned … in my follow-up post, I’ll provide you with child-proofing tips for fire and poison safety!

In my last post, Hot Days, Cool Water: Summer Safety Tips, I shared important water safety tips for parents and really focused on what parents should remember when their children are playing in the pool.

But it’s too easy to forget that the pool isn’t the only place where kids are at risk for drowning.

This post discusses the importance of being vigilant while your children are playing in hot tubs, containers of water and in the ocean.

I’ll also discuss what dry drowning is and how to keep an open eye for its symptoms. 

Hot Tubs and Containers of Water

Many families allow children to play in or with containers of water such a “kiddie pools” or buckets of water. Some also allow their children to play in hot tubs (or Jacuzzis).

The same supervision is required during play time and it’s important to properly cover a hot tub when it’s not in use.

Ocean Safety Tips for Kids and Adults

For those of us lucky enough to live close to a coast, playing in the ocean is a great and inexpensive way for a family to cool off during the summer months.

However, it’s even more important for parents to keep a watchful eye on their children and follow these tips on an outing to the beach.

• Always swim with a buddy
• Stay near the lifeguard station
• Don’t wear heavy clothes, always wear a real swimsuit
• Listen to and obey the lifeguards and any warnings posted
• Don’t use alcohol when swimming

Dry Drowning

I recall a sad news story in which a child who seemed to recover easily from an episode of almost drowning only to die in the night from the injury to his lungs.

This phenomenon is called dry drowning and takes place when a person aspirates water into the lungs, which disrupts the supply of oxygen. This is a situation requiring medical treatment and a delay can lead to death.

Signs and Symptoms of Dry Drowning:

• Difficulty breathing, shallow breathing, fast breathing
• Pain in the chest when breathing
• Sudden change in mood
• Confusion
• Decreased energy, increased agitation
• Pale or blue skin
• Inability to speak clearly
• Sweaty skin
• Cough

If you have reason to believe your child could be suffering from dry drowning, take him or her to the emergency room for monitoring and treatment.

Smooth Swimming

In my first post on water safety, I shared my personal experience with my daughter which alerted me to how quickly and silently a child can slip beneath the water.  Any parent who’s had a near-drowning scare with their child knows just how quickly a little one can slip underneath the surface.

While I worried that this early experience would make her fearful of water, it turned out quite the opposite.  I placed her in swimming lessons where she learned to be a strong and confident swimmer. Ever since, she has been my swimming buddy, fearlessly diving into oceans and pools. She’s even a member of a champion collegiate water sports team, the University of California Berkeley Rowing Team!

For me, summer conjures up days of fun in oceans, lakes and pools because I love the water. It also reminds me of some close calls of my own, especially one episode involving my daughter.  In fact, I have told the story repeatedly—I will never forget that day.

On a hot summer day in Atlanta, Georgia, I took my then 2-year-old daughter to the neighborhood public pool. I walked behind her in the shallow end, with the water level just above her stomach. With a little trip, she went under.

The seconds felt like an eternity. While she floated, motionless, I pulled her out of the water. She was perfectly fine, but I realized then just how easily and silently children can drown.

As a nurse on the Rehabilitation Unit here at Children’s Hospital Los Angeles, I have taken care of children who have nearly drowned. I have witnessed the neurological devastation it can cause, including severe brain damage and comatose children. That’s why I know why it’s so important for parents to take care when their children are playing in any kind of water.

What is drowning?

Drowning describes death from asphyxia due to suffocation. This happens when liquid enters the lungs and prevents the absorption of oxygen, starves the victim’s brain of oxygen and causes myocardial infarction, or a heart attack.

Drowning is quick and silent. Victims cannot call for help as they do not have enough air. It is rare for a drowning victim to thrash. A child can drown in any amount of water in the time it takes to answer a phone.

For this reason, it is so important not to leave children unattended in or near water. Children can drown in just two inches of water, which can take place in bathtubs, toilets, buckets, anywhere free standing water is found.

According to the World Health Organization, drowning is the third leading cause of adult unintentional death. In the U.S., it is the second leading cause of death in children under the age of 12. The peak age is younger than 4, and between 5 and 25. In children less than 1 year old, deaths are usually in bathtubs. Pools are the cause of drowning death in children less than 5 and in young adults it is usually lakes and rivers, often involving diving or alcohol use.

How to Protect Your Children

If you have a private pool make sure you …

• have a secure locked fence or barrier around the pool
• install alarms to notify you someone has gotten into the pool area
• consider an underwater wave alarm
• make sure your pool has no drains or suctions that are unsecured, as children can become trapped in them
• keep the water clean and clear so that you can see the bottom and everyone in it
• Always have a parent in the pool with younger children so they understand that a parent should always be with them

If you are having a pool day …

• assign an adult to watch the pool undistracted from socializing and make sure the adult knows he/she is assigned to this duty
• make sure your children know how to swim
• make sure you know CPR and have a cell phone nearby to call for help if needed
• always have a parent in the pool with younger children so they understand a parent should always be with them

Always Follow the ABC’s of Drowning Prevention

            A for Adult Supervision
            B for Barriers
            C for CPR and classes

Always use a life jacket for children who cannot swim. Floaties do not provide any protection and should not be considered a water safety device.

Don’t Forget to Have Fun!

By taking the proper water safety precautions, you and your family can cool off this summer safely. Keep an eye out for my next post. I’ll continue this discussion of water safety with tips on how to keep your children safe in hot tubs, buckets of water and will explain what dry drowning is.

If you are a smoker, you should know there is no risk-free level of exposure to tobacco smoke. In adults, secondhand smoke can cause serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer.

In pregnant women, secondhand smoke has been shown to cause low birth weight as well as a host of other issues for the child. Basically, when you smoke around your children, they are smoking too and face the same (if not worse) health risks you do.

What is secondhand smoke and how is it harmful?

Second hand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by a smoker. Also known as environmental tobacco smoke (ETS), it is especially harmful to young children and can cause disease and premature death in adults and children who do not smoke.

California has some of the strictest laws against smoking in the nation … and for good reason. There are more than 4000 chemicals in tobacco smoke of which at least 250 are known to be harmful and more than 50 are known to cause cancer. [Source: LungsUSA.org]

A person’s risk of developing cancer from secondhand smoke is about 100 times greater than from outdoor cancer-causing pollutants with more than 3,000 non-smokers to dying of lung cancer each year. [Source: LungsUSA.org]

Who is at risk?

Although inhaling secondhand smoke is dangerous to everyone, fetuses, infants, and children are at most risk because it can damage their developing organs, such as the lungs and brain.

Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year. 430 sudden infant death syndrome (SIDS) deaths in the U.S. annually result from secondhand smoke.

In infants, ETS often attributed as a cause for sudden death and is listed as a cause for more than 600,000 premature deaths a year. 31 percent of the deaths attributable to secondhand smoke occur in children. [Source: LungsUSA.org]

Let’s take a closer look at the specific risks children face when exposed to secondhand smoke in …

Fetal and Newborn Development

Maternal, fetal, and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest smoking during pregnancy can contribute to the occurrence of birth defects such as cleft lip or palate. Smoking mothers produce less milk and their babies tend to have a lower birth weight. Maternal smoking also is associated with neonatal death from SIDS, the major cause of death in infants between the ages of one month and a year.

Lungs and Respiratory Tract

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis and chronic respiratory problems such as cough and postnasal drip. It also increases the number of childhood colds and sore throats.

In children under two, ETS exposure increases the likelihood of bronchitis and pneumonia.

Ears

Exposure to ETS increases both the number of ear infections a child will experience, and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This irritation can cause swelling in the middle ear and create an obstruction which interferes with pressure equalization, leading to possible pain, fluid and infection.

Ear infections and middle ear fluid are the most common cause of hearing loss in children. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

Brain

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement has also been demonstrated.

Legacy of Addiction

About 40% of all children are regularly exposed to secondhand smoke at home. Youth exposed to secondhand smoke at home are 1 ½ – 2 times more likely to start smoking than those not exposed to this behavior. While these facts are alarming, you can decrease your child’s risk of becoming a smoker by taking action as an adult.

What can parents do?

You can take the following measures to ensure that your children are living in a smoke-free environment.

• If you smoke, stop now. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
• If you have household members who smoke, do what you can to help them stop. If it is not possible for them to quit, do not allow them to smoke in your home or near your children.
• Also, do not smoke or allow smoking in your car. Make sure that your children’s schools and day-care facilities are smoke-free.

Resources to Support Quitting Smoking

• Tips from the American Lung Association
• The No Butts Helpline
• The American Lung Association Smokefree Air Challenge Petition

Because I’m a nurse working in at Children’s Hospital Los Angeles in California, I’d also like to address state law and where these two overlap.

California Law

California requires individuals riding in motorized vehicles to wear proper restraints.  For adults and kids over the age of 6, a correctly-worn seat belt qualifies as a proper safety restraint. 

Kids under the age of 6 have a different set of guidelines.

They may not ride in the front seat of a car with active passenger airbags if:

• They are younger than 1 year old.
• They weigh less than 20 pounds.
• They are riding in a rear-facing car seat.

They must ride in the rear seat of a car in a safety seat that meets federal motor vehicle safety standards until age 6 or when they weigh 60 pounds. 
A child under the age of 6 may ride in the front seat ONLY if:

• There is no rear seat; the rear seats are side-facing or rear-facing.
• The child passenger restraint system can’t be properly installed in the rear seat.
• All rear seats are already occupied by kids under the age of 12 years.
• There is a medical reason that the child can’t ride in the back seat.  Be sure to carry a doctor’s note in this case. 

What if the AAP recommends something different than the state does?

We have to abide by state law, however, if the AAP recommends stricter guidelines than the state does, it’s a better rule of thumb to go with the stricter guidelines, as long as all requirements of the seat belt law are met. 

When can my child ride in the front seat?

California state law is fairly liberal regarding this issue. However, the AAP recommends that parents not allow their child to ride in the front seat of a car with airbags until they are 13 years old. When an airbag deploys in a crash it is very forceful, and if the child isn’t big enough, the airbag could cause damage to their chest and/or head, possibly even resulting in death. 

Does that mean airbags are bad?  No! They are just meant to be used for older teens and adults.

What if my child is a passenger in another adult’s car?

If this adult will be using the child’s own seat, make sure the caregiver knows how to properly install and use it. Give the seat to the caregiver before they need to drive the child somewhere. If the seat doesn’t fit, the child shouldn’t ride in it.  If the child will ride in a borrowed seat, make sure they fit in the seat and check the height and weight limits. If all of that checks out, they’re good to go!

Who can help me make sure my car seat is properly fitted in my car?

There are many places that employ CPS technicians – the people who make sure car seats fit right. Start by calling your local California Highway Patrol (CHP) office or fire station.  They can point you in the right direction. 

Anything else I should know?

Yes. Safety is important. Car accidents are the number one cause of death in kids up to the age of 21. Nobody anticipates being in a car accident. Safety is not something that parents should ever negotiate about with their kids. If wearing seatbelts or sitting in a car seat is an expectation every time a child gets in a car, they will accept it.  By simply wearing a seatbelt or sitting in a properly-fitted car seat, your child will be safer.

In this post, I’ll discuss the most recently-released policy statement from the American Academy of Pediatrics (AAP) regarding rear-facing car seats.

The AAP now recommends that kids remain in rear-facing car seats at least until they are 2 years old.  This recommendation has created a lot of buzz about car safety for kids in general, so I’m going to explain in detail the ins and outs of car seats, booster seats and seat belts.

Also, as a nurse working at Children’s Hospital Los Angeles, I’ll specifically address California’s laws governing car safety in a follow-up post. 

I’ll start by taking a look at what the AAP recommends for child safety in motorized vehicles and why.

AAP Recommendations

Infants and Toddlers

The AAP makes two recommendations for infants and toddlers. 

• All infants and toddlers should ride in rear-facing car seats until they are 2 years old
• Rear-facing seats should be used until children have outgrown the height and weight limits for the seat. 

That may mean the child is in a rear-facing seat when they are older than 2 years old because they aren’t yet big enough for a forward-facing seat. 

This recommendation was made in part as a result of a study regarding injury prevention, which revealed that a rear-facing car seat is 75 percent more effective at preventing death or significant injury in a car accident, especially in side crashes. That’s a big number! 

But parents might now be asking themselves, “Are there rear-facing car seats that can handle the bigger weight limit?”  Fortunately, the answer is yes! 

In fact, three kinds of seats can be used as rear-facing seats:

• Infant seats
• Convertible seats
• 3-in-1 seats 

For more details and photos of the different types of seats available, as well as details about car-seat installation, read this RN Remedies post by my fellow nurse blogger, Jennifer Buchanan.

Before purchasing a specific seat, be sure it fits in the car in which it will be used.  And ensure that weight and height limits are appropriate for the child for which the seat is intended.  The child’s feet may touch the back seat.  The child should be able to bend their knees and still be comfortable.

How to Install a Rear-Facing Child Safety Seat

Now, I’ll discuss when it’s appropriate switch your child to a forward-facing seat.

Toddlers and Preschoolers

The following guidelines recommended by the AAP are for:

• Toddlers and preschoolers 2 years and older
• Kids who have outgrown their rear-facing seat before the age of 2 (and are older than 1)

These children should use a forward-facing car seat with a five-point harness for as long as possible, which should be at least until the age of 4. In fact, the AAP feels so strongly about the harness that they recommend purchasing another seat with a harness that has a bigger weight limit rather than switching to a booster seat before the child reaches 4.

There are five kinds of seats that work for kids this age:

• Convertible seats
• Forward-facing seats
• Combination seats
• Built-in seats
• Travel vests 

Be sure to check the manufacturer’s instructions for weight and height limits for each.

School-Aged Children

When a child outgrows their forward-facing car seat, they are ready for a belt-positioning booster seat. They should use the booster seat until the seat belt fits properly without the booster seat. This is usually when the child is about 4 foot 9 inches tall or is between 8 and 12 years old.

How does a parent know when their child has outgrown the booster seat?
This takes place when the child’s shoulders are above the tallest harness slots, their ears are at the top of the seat or they have outgrown the weight and height limits for the seat. 

Older Children

Seat belts were designed with adults in mind, so it makes sense to wait until a child is adult-sized to use them!  The safest kind of seat belt is the lap and shoulder seat belt combination. It fits properly when the following criteria are met:

• The shoulder belt sits between the neck and shoulder and across the chest, NOT on the neck or throat. 
• The lap belt fits snugly across the thighs, NOT the belly. 
• The child can sit with their knees comfortably bent and their back against the seat.

Some Safety Tips about Seat Belts 

Never tuck the strap behind the back or under the arm. That makes the chest strap useless in a crash. Also, seat belts aren’t meant to be shared. Every person in the car should have their own seat belt.If there aren’t enough seat belts to go around, another car should be used.

Resources at Our Hospital

Our hospital offers a host of free classes for parents through the Kohl’s Safety & Injury Prevention Program at our hospital.  You are always invited to attend.

Just check our schedule and let us know that you’re coming.  We’ll look forward to meeting you and teaching you how to keep your child healthy and safe.

Stay Tuned

Keep an eye out for my next post, where I will discuss how this new policy update specifically affects parents in California!

One weekend, I was at work on my unit at Children’s Hospital Los Angeles when I started to feel as if the sounds of the entire hospital were thrumming and throbbing in my head.  High-pitched voices sounded sharp.  Middle sounds were muffled.

I shared how I was feeling with my nurse practitioner colleague and she responded with two words:  “Ear Infection.”

And with that, she pulled out an otoscope to peer into my ear. While she examined me, everyone on the unit began to swap stories about our children and their experiences getting ear infections.  With three out of four kids getting an ear infection between the ages of two and four, these types of stories are all too common. The reason children get ear infections more often than adults is because their inner ear anatomy is different than that of adults, but I’ll explain more about that later in the post.

All the attention and discussion my ear infection caused on our unit made me think it would be a good idea to write a post for parents which covers:

• Causes of Ear Infections
• Signs and Symptoms

In a follow-up post, I discuss treatment options, which can sometimes include surgery. But first, here’s some basic information about the anatomy of the human ear.

How the Ear Works

The ear is responsible for hearing and balance. Check out this video for a detailed explanation of exactly how our ears help us to hear.

Causes of Ear Infections

Role of the Eustachian Tubes

The internal workings of your ears use fluid to maintain same pressure as the outside world and this task falls to the Eustachian Tubes.

Eustachian Tubes connect your ear to the back of your throat, letting air in to equalize pressure in your ears, and allowing mucous to drain into the back of the throat.

You probably recognize this sensation because it’s the “popping” feeling you often get while yawning, swallowing or riding on an airplane.

Kids and the Eustachian Tubes

In children, the Eustachian Tubes are shorter, narrower and more horizontal than in adults. Because of this, children more frequently experience clogging by congestion and fluid build-up in this tube, which can be caused by upper respiratory infections or colds. Germs can breed in the fluid, which is a prime cause of ear infection in kids.

Other Causes of Ear Infections

In addition to clogging of the Eustachian Tubes, there are several other possible causes of ear infections in children, including:

• Exposure to cigarette smoke
• Bottle feeding
• Cold weather
• Upper respiratory infections

Signs and Symptoms of Ear Infections

Your child may be suffering from an ear infection if he or she exhibits the following symptoms:  

• Diarrhea
• Eating less
• Fever
• Irritability
• Nausea
• Pain, tugging on ear, complaints of pain
• Vomiting

Special Note for Infants
Some infants will not tug or pull at their ears, but may exhibit fevers or other symptoms.

Special Note for School-Age Children
In older children, behavior in school may change and be attributed to inattention, but may in fact be caused by their inability to hear.

Going to the Doctor

If you suspect your child has an ear infection, make an appointment with your pediatrician.  Like my nurse practitioner friend, your child’s doctor may use an otoscope to examine your child’s ear for signs of infection such as redness, swelling, fluid build-up or pus. The doctor may also conduct further studies if the infection seems persistent or more serious.

This can include some or all of the following:

• Lab tests
  The doctor will send a culture from the fluid in your child’s ear to see what types of bacteria are there to determine the cause and the best treatment for the infection.
• Scans
  A skull X-ray may be ordered to see if the bones are infected.  A CT-scan may also be ordered.
• Hearing tests

How I Recovered

My nurse practitioner colleague flushed my ears with water and ended up removing what she said looked like sand from my ear,  which was probably just wax compounded by the infection. All day long, the joke was that seashells and fish from my swims in the ocean were hanging out in my ears!

I also made an appointment with my doctor, who prescribed ear drops to help my ears heal from the infection. Fortunately for me, the treatment for my ear infection was relatively simple and non-invasive.

However, there are many children who suffer from chronic ear infections and they require more complex treatments. We see many of them at our hospital in the Division of Otolaryngology – Head & Neck Surgery.

In my next post, I’ll discuss those treatment options, which can include antibiotics and even surgery.

Education on causes, prevention and what to do if your child is choking can impact your child’s chance of survival.  This is precisely what I hope to illustrate in this blog post, including helpful information about:

• Prevention
• Troublesome Foods
• Dangerous Household Items
• Signs of Choking
• What to do When a Child is Choking

What Choking Is

Choking occurs when something is blocking the airway, rendering a child unable to breathe.

Airway Sizes

Children have airways that are 1/3 the size of an adult.  Their windpipes or breathing tubes are approximately the size of a drinking straw.  As they grow, the size of their pinky finger is a good gauge for the size of their airway.

Partial Blockage

If a child can speak or cough the airway is only partially blocked.  If partial blockage occurs, you need to call 911. DO NOT attempt to open airway, but DO encourage the child to cough.

Prevention – Lower Risks in Your Child’s Environment

It’s impossible to eliminate every single thing from your environment that might cause your child to choke. But there are many things parents can remove from the environment to lower a child’s risk for choking. Some common choking hazards include toys, household items and food.  Of these, food is the most common cause of choking.

Safe Eating Practices for Kids

Accompanying your child while they eat not only provides an opportunity for bonding, but also ensures you’ll see if they’re chewing their food properly.  Sitting while eating and not doing anything else—like riding in a car or playing—is the safest way for children to enjoy their meal. An unhurried meal and snack time gives a child ample time to chew their food.  This is also a good time to lead by example with good posture, which is key to helping them chew and swallow solid foods.

Preparing Foods to Avoid Choking Hazards

Food is safest for children when it has been a) cut into small pieces and b) seeds and pits have been removed.  Here are some examples of ways to prepare common foods to make them safer for children:

• Cut hot dogs into bite-size pieces (cutting both length and width-wise)
• Soften vegetables by cooking or steaming them (this makes them easier to chew)
• Sticky foods should be consumed in small amounts (for example, peanut butter or cream cheese consumed in large “globs” can stick to the roof of a child’s mouth)
• Drink liquids between mouthfuls, rather than together with food

Foods Which Can Cause Choking

Foods that are the most commonly associated with children choking include:

• Candy (specifically, hard candy)
• Caramels
• Cheese (specifically, cubed cheese)
• Chips
• Fruits (specifically, fruit with skins)
• Grapes (specifically, whole grapes)
• Gum
• Ice cubes
• Lollipops
• Marshmallows
• Nuts
• Peanut butter
• Popcorn
• Pretzels
• Raisins
• Vegetables (specifically, raw vegetables)

Cutting up foods into small pieces and using methods of food preparation that make it easier to chew can lessen the risk of a child choking while eating these foods.

Dangerous Household Items

Toys are a big source of choking hazards.  Deflated or broken latex balloons are especially dangerous since the balloons can stick to the breathing tube and be difficult to remove. Make sure smaller children can’t get hold of toys with small parts intended for older kids. Follow the age recommendations on toy packages.

Here’s a list of more items that can pose a choking hazard to children and should be placed out of reach of little ones. These items should be placed out of the reach of older siblings, who might accidentally give them to younger siblings.

• Balloons
• Batteries
• Bolts
• Bottle caps (including syrup and soda caps)
• Coins
• Crayons (specifically, broken crayons)
• Doll accessories
• Erasers
• Jewelry (rings, earrings, pins, etc.)
• Nails, bolts, and screws,
• Paper clips
• Safety pins
• Screws
• Small balls
• Small office supplies (brads, pushpins, etc.)
• Tacks
• Toys with small parts

Use a Choke Tube Guide

Parents can use a choke tube guide (also known as a small parts tester), a plastic device available in most baby stores, to see if a toy is a choking risk. However, a toilet paper roll works just as well.

The following websites also have great tips regarding choking prevention for parents.

• American Academy of Pediatrics
• American Red Cross
• Consumer product safety
• Child proof your home

Recognize Choking Signs and React

Signs of Choking

• Child begins to cough, gag or has high-pitched, noisy breathing
• An older child (over 1 year of age) may hold neck with both hands
• The child’s lips and/or skin may turn blue

What to do When a Child is Choking

• If the child is unable to speak or cough, give the Heimlich Maneuver.
  • If the child is no longer breathing you need to shout for help, place the child on the ground and follow the next steps.
  • If you are alone, start CPR. (Sign up for CPR classes.)
  • Continue CPR until child moves or help arrives.  If you are alone, after 5 cycles or 2 minutes of CPR, leave the child and call 911.
  • Continue to push on the stomach until the object is out and the child can talk and breathe or until the child is no longer breathing.

Saving Lives

Educating yourself with these few, simple steps to ensure a safe environment for your child, could help save their lives. Sharing this information with other parents is a great way to empower others to do the same.