OTITIS MEDIA WITH EFFUSION (OME) : THE PERLMUTTER RECOMMENDATION

If your 2- or 3-year-old gets an ear infection (diagnosed by your physician), I recommend not pursuing antibiotic therapy for at least the first forty-eigth to seventy-two hours, as the cause may be a virus: in addition, antibiotics typically will not eliminate middle ear fluid. You should ask your physician for an anesthetic eardrop to decrease the pain. In addition, diphenhydramine (Benadryl) often works wonders in terms of “taking the age off” and allowing you and your child to get some much needed rest. The specific products I recommend are Children’s Benadryl Dye-Free Allergy Liquid of Benadryl Dye-Free Allergy Gels. Make sure to read the package so you use the appropriate dosage for your child.

Another excellent choice to alleviate the pain of an ear infection for your child is children’s strengh ibuprofen, as it will both alleviate pain and reduce inflammation and fever. Again, pay attention to the directions an the package to ensure you give your child the right dosage for his or her weigth and age.

Keep your infant well hydrated by increasing the frequency of breast freeding; for the older child, offer plenty of spring water and diluted fruit juices and avoid dairy products, as they tend to increase the mucous secretions.

I have found Recharge Sports Drink particularly helpful when kids have ear infection, colds, or diarrhea. Recharge is an all-natural product that contains important electrolytes, which , in my opinion, clearly help children feel better sooner. Other helpful ideas include propping tour child’s head up with a pillow or two to improve drainage of fluid through the eustachian tube. In addition, a warm, moist compress will also often help alleviate pain.

Fluid behind the eardrum (OME) can significantly harm a child’s hearing. If the problem persist, children may, in fact require the insertion of ear tubes. This allows drainage of the fluid and ventilation of the region behind the eardrum, allowing hearing to be restored.

Finally, it’s also important to remember that ear infections, on rare occasion, can be a sign of other, more serious problems. Call your doctor if your child experiences a severe headache, stiffness of the neck, fever, chills, sudden hearing loss, dizziness, or sudden and severe ear pain with drainage, even if the pain is alleviated upon drainage.

On very useful device is the EarCheck monitor, which uses sound waves to eveluate the eardrum. The EarCheck monitor can signify the degree if infection and help you determine whether or not you need to visit your child’s pediatrician. 

HOW TO PREVENT HEARING LOSS FROM TAKING A TOLL ON YOUR CHILD’S DEVELOPMENT

With all this evidence that hearing impairment affects a child’s development and performance, I believe strongly in screening children for hearing as early as possible.

In fact, I am very much in favor of screening newborns for hearing problems, which is not a universal practice. A growing number  of proffesionals, including neonatologist, believe it imperative to screen infants as early as possible, ideally at birth and certainly by the age of 1 to 2 months at the latest. Each day, some thirty-three infants in the United States are born with total hearing loss, the most common congenital disorder in newborns, and twenty times more prevalent than phenylketonuria, a condition for which all newborn are currently screened. An estimated sixty additional infants per day are born with moderate hearing loss that could be exposed with universal newborn screening and intervention programs. Furthermore, statistics show that 90 percent of hearing-impaired infants have known risk factors. That infants at highest risk for hearing loss, not surprisingly, are those in the neonatal intensive care unit where the risk of moderate-to-severe permanent hearing loss in both ears is ten to twenty times higher than in the general population.

As advocates of early hearing detection and intervention programs (EHDI) can tell you, universal newborn hearing screening can identify those infants who have even moderate hearing loss, enabling them to receive speech and language therapy, amplification, and family support immediately, before their development falls far behind that the other children of their age. This kind of universal screening even has the potential to reduce the disparity in language skills between deaf and hearing children.

THE IMPACT OF EAR INFECTIONS ON CHILDRENS LANGUAGE SKILLS

Most of the research both on otitis media and OME over the past ten years has focused on the effects of temporary hearing loss on the development of language skills in children younger than 3 years old. One study examined a group of 3 to 8-years-olds who had histories of chronic ear infections and OME, all of whom got ear infections before 18 monts of age. The study found that although these children did misarticulate more consonants than children without histories of ear infections, both groups made errors on the same sounds.


Several studies suggest a direct relationship between educational achievement and occurance of otitis media and OME. Interestingly, a few of these studies also suggest that children with intermittent hearing loss may have more difficulties with speech and language that children with steady mild-to-moderate hearing impairment.


But one study of 698 children of diverse backgrounds showed that prolonged or chronic otitis media or OME, especially in children between 6 to 12 months, may put children at risk for cognitive delays at around 3 years of age. Conceivably, if these children were identified and given help their cognitive deficits were first uncovered, they would be able to get back up to speed, and thus, even by the age of 5, be at reduced risk for negative development effects. These finding provide an even stronger argument for early testing of hearing impairment, especially in at risk children.


Most importantly, remember that the window during which screening and subsequent therapy will held a child overcome any developmental deficits brought on by hearing loss is brief, and considered by most experts to end at age 3. This even more reason to have early and frequent testing and pursue corrective therapy if needed.

EAR INFECTION

More than 10 million children are treated each year for ear infections, and chances are, your child is one of them. If an ear infection clears up quickly, it's no more of problem than the common cold. In many cases, however, ear infections become chronic, which can cause permanent hearing loss in small children.


The first two years of life are critical for the development of language skills and obviously hearing function plays the pivotal role in this achievement. Hearing impairment is thus a fundamentally important issue, as it is related to significant delays in speech and language development, both of which affect academic performance as well as social and emotional growth. It's also important to note that children with hearing impairment often demonstrate emotional and behavioral problems that, in and of themselves, can result in poor academic performance.


Despite the fact that ear infection are so common and that they often lead to hearing problems, hearing impairment is generally not recognized until a child is between 2 and 2.5 years old. But is imperative to identify hearing loss much earlier. As many as 80 percent of children get middle ear infections , technically known as otitis media, by the age of three. These middle ear infection can affect a child's hearing when they become chronic, or when fluid builds up behind the eardrum. A middle ear infection that includes fluid buildup behind the eardrum is called otitis media with effusion (OME). These middle ear infections, especially OME, are the most common causes of inadequate hearing in children.


Smarter Child Tip A recent study showed that infants who used pacifiers had a 40 percent increase in the risk of ear infections; interestingly, when parents were counseled to reduce use of the pacifiers, the study demonstrated a 29 percent decrease in the rate of ear infections. They added that since ear infections are so common in childhood, even a slight change in habits that reduces their frequency would be extremely beneficial in preventing infections. But don't throw out the pacifier yet. A recent study sugested that babies who sucked on pacifiers while falling asleep were at a dramatically reduced risk of sudden infant death syndrome (SIDS). So the sensible solution seems to be reserving the use of pacifiers to calm your baby at bedtime.


It is also important to recognize that most middle ear infections (about two-thirds of uncomplicated infections) will clear up on their own within twenty-four hours, and in more than 80 percent of uncomplicated infections, symptoms will diminish or disappear within one to seven days. Since many middle ear infections are caused by viruses, antibiotics, which fight bacterial infections, do not help to clear up the primary infection, nor they eliminate middle ear fluid. Antibiotics, which are widely overused in treating ear infections, are thus frequently unnecessary, and can even be harmful in some cases, as overusing antibiotics can breed antibiotics-resistant strains of bacteria. Perhaps even more important is the fact that frequent use of antibiotics in children has been linked to a higher incidence of attention deficit hyperactivity disorder (ADHD). Of course, it's up to your doctor whether or not  to prescribe an antibiotic, but all too often, doctors succumb to the pleading of anxious parents who feel that an antibiotic will solve the problem quickly. The reality is, it makes better sense to monitor the problem for a week or so to see if it resolves on its own. As noted earlier, in most cases, it will. Save the antibiotic for the rare ear infection so severe that it doesn't clear up on its own.


As for removing the adenoids of children suffering from recurrent ear infections, recent has shown the benefit of this procedure with respect to reducing frequency of ear infections to be so small that many doctors now do not recommend this approach as a primary treatment in children up to 2 years of age.

A SAFER DRUG

In my opinion, a much safer medication choice than steroids for treating asthma is montlukast (Singulair). This new medication is safe for 2-to 5-year-olds, and the dosage is one milligram chewable tablet each evening. While I am not a big proponent of medication, especially in children, Singulair is highly effective and well tolerated, especially in exercise-induced asthma.


The best approach is for parents to help their child manage his or her asthma so that it doesn't become a major problem. Try to keep your child away from the environmental triggers that cause the attacks whenever possible. Reduce your child's exposure to stress. Key factors that increase stress in young children include inappropriate television prgograms, interaction with violent children and exposure to family conflict.

CORTICOSTEROIDS ARE NOT GOOD FOR THE BRAIN

The most common treatment for childhood asthma is the use of corticosteroid drugs,synthetic version of the hormone cortisol,which is normally produced by the adrenal glands.Corticostreroids can be inhaled or taken in pill form and are powerfull drugs with potentially devastating side effects. In particular, I am concerned about the effect of inhaled corticosteroids on BDNF, the growth hormone in the brain that is critical for brain development. German researchers recently found that asthmatic patient who used inhaled corticosteroids had significantly lower levels of BDNF than asthmatic patients not treated with these drugs. The long-term use of inhaled corticosteroids can cause other worrisome nasty side effects, specifially including damage to the hippocampus, the memory center of the brain, not to mention a slew of other physical problems including blood sugar abnormalities and thining of bones.

The best way to offset the reduction of BDNF caused by the use of steroid medication is to make sure your child takes a DHA supplement each day. Due to the antiinflammatory effect of DHA, I think it's wise for all children with asthma to take extra DHA whether or not they are taking steroids.

- Children between the ages of 6 months to 2 years should take 200 milligrams of DHA daily.

- Children between the ages of 2 months to 5 should take 400 milligrams of DHA daily.

THE HYGIENE HYPOTHESIS

Although it seems counterintuitive, children who are exposed early in life to animal  and natural allergens (such as plants) do not have a higher incidence of asthma-in fact,their risk is reduced.Some scientist believe that the exponential increase in allergy and asthma is due to our modern intolerance of dirt.We’re simply too clean! No kidding.They point out that prior to the twentieth century,most people lived on farms, where kids had close contact with farm animals and dirt, the kind you grow things in.Back then,the  system of a child was taught early on how to tell a true enemy from a foe.Through experience,the immune system of a nineteenth-century child knew that pollen from a flower was nothing to fear,or the dander of a cat was harmless.It didn’t go into overdrive every time it was exposed to something new,triggering an allergic reaction.Deprived of these early   lessons,the immune systems of children today are more prone to allergy,which can lead to asthma.Moreover, we load our children up with antibiotics,which over time may hamper normal immune function.

Smarter Child Tip Breast-feeding,which is beneficial to your child in so many other ways,also appears to offer strong protection against asthma.According to study publised by the National Institutes of Health evaluating children ages 3 to 5,a history of being breast-fed was associated with a 59 percent reduction in the risk of developing asthma.Interestingly,children who were breast-fed showed on a reduction in risk for asthma even if they were exposed to environmental tobacco smoke.(This doesn’t mean that it’s okay to smoke around your children.We know that there is a greater risk of asthma and other health problems in kids who have been exposed to seconhhand smoke,but the risk is somewhat diminished if youe child is breast-fed).