What to Expect the Toddler Years (216 page)

Method of transmission.
Direct contact with an infected person; breathing in large (and, sometimes, small) contaminated droplets in the air from coughs or sneezes, which can spray the virus as far as 25 feet; or touching an article recently contaminated by the nose or throat secretions of an infected person. Those with flu are most communicable from the day before symptoms occur until symptoms begin to subside, though children may continue shedding the virus in nasal secretions for a week or longer. The incubation period is most often 1 to 3 days.

Duration.
Generally 5 to 7 days in healthy individuals.

Treatment.
General treatment includes fluids, rest, and a nutritious diet. To relieve symptoms: humidified air (see page 838), acetaminophen only as needed for pain or high fever (do
not
give aspirin or any medication containing aspirin or salicylates); cough suppressants, if recommended by the doctor, to aid sleep or improve comfort (although a recent study cast doubt on their effectiveness in children); and, if necessary, decongestants, again, of questionable effectiveness and
only if prescribed. An antiviral drug may be prescribed for those children with severe symptoms or at high risk of complications.

Prevention.
Avoid contact with infected individuals; flu shots (see page 563).

Complications.
Occasionally, pneumonia; sinusitis; otitis media; Reye syndrome (linked to the use of aspirin in children infected with a flu virus).

Symptoms.
Usually, ear pain, in one or both ears. Pain often worsens at night, because lying down changes pressure in the ear (the child may complain, or tug, rub, or clutch at an affected ear), fever (low-grade to high), fatigue, and irritability. Sometimes, nausea and/or vomiting, loss of appetite, loose stools, muffled hearing due to inability of eardrum to vibrate normally. Occasionally, no symptoms are apparent at all. On examination, the eardrum appears pink early in the illness, then red and bulging (though an eardrum may also appear red if a child’s been crying, or because of the type of light being used).

If the eardrum perforates (develops a small hole), pus, often blood-tinged, may spill into the ear canal, relieving the pressure and thus the pain. The eardrum usually heals in about a week, but treatment of the infection helps to prevent further damage, so tell your doctor if you suspect a rupture (crust in and around the ear is a telltale sign).

Sometimes, even after treatment, fluid remains in the middle ear, a condition called otitis media with effusion (see page 610).

Season.
Any time, but most often winter and early spring.

Cause.
Usually bacteria, but sometimes viruses, which move up into the tiny middle-ear cavity (it’s about the size of a seed from a string bean) from the nose or throat through a eustachian tube that isn’t draining properly, usually due to inflammation from a cold, sinusitis, sore throat, or allergies. Behind the inflamed eardrum, the build-up of pus and mucus produced by the body in an attempt to respond to the infection causes the pain of earache. Otitis media is more common in babies and children under six than in adults because their eustachian tubes are shorter (making it easier for them to become blocked and allowing germs to travel up them more quickly) and horizontal rather than slanted (making drainage poor), and because they get more colds and other respiratory illnesses.

Method of transmission.
Not direct—otitis media isn’t passed from person to person. It often follows a cold or flu. There may be a family predisposition to middle-ear infection.

Duration.
Although pain usually diminishes or disappears shortly after treatment is begun, it can take 10 days to 8 weeks of antibiotic medication to resolve an acute ear infection; fluid may remain in the middle ear for much longer (see otitis media with effusion, page 610).

Treatment.
Acetaminophen, as needed, for fever and pain. Heat (applied with a heating pad set on low, warm compresses, or a hot-water bottle filled with
warm
water) or cold (applied with an ice bag or ice wrapped in a wet washcloth) can also be used to relieve pain until the doctor is reached. Elevating the child’s head during sleep may also be helpful (see page 837). Do not use ear drops unless the doctor prescribes them for this particular illness; do not use them at all
if there is a puncture. And do not rely on these remedies alone. Because of the risk of serious complications, OM requires medical treatment. Although some physicians will wait 2 or 3 days to treat ear infections (in the hope they will clear on their own), the great majority begin antibiotic therapy promptly and treat for a minimum of 10 days (stopping the medication sooner, even if the patient feels fine after a day or two, can lead to a rebound of the infection and eventually to a chronic problem). The doctor may culture a sample of cells drawn from the middle ear in order to pinpoint the culprit microorganism if a child does not seem to be responding to treatment (many doctors check the ears again after 72 to 96 hours of antibiotic therapy) or if it is deemed necessary for another reason. Sometimes, in order to drain infected fluid from the ear, a bulging eardrum may be perforated by the doctor in a procedure called a
myringectomy.
The incision heals in about 10 days, but may require special care until then.

Most toddler ear infections occur in the middle ear, the tiny chamber (A) at the end of the outer ear canal.

At the end of the course of treatment, the doctor will probably want to recheck your child’s ears. Though the infection may clear quickly on antibiotics, in about 1 in 10 children, the ears remain filled with fluid for 3 months or more following the resolution of the infection (see otitis media with effusion, page 610).

When to call the doctor.
During regular office hours if you suspect an ear infection. Call again if your child isn’t feeling better after 48 hours of treatment or seems to be getting worse, or if he or she refuses or vomits the antibiotic. Call immediately if there has been an injury to your child’s ear, or if ear pain continues and is so bad that your child is screaming, develops a stiff neck or severe headache, seems very sick, or is having unusual difficulty balancing when walking.

Prevention.
It’s not clear whether the use of decongestants during colds and flu is effective in reducing the incidence of otitis media. It is clear, however, that protecting a child from exposure to second-hand tobacco smoke and weaning from the bottle (if the child drinks lying down) can reduce the incidence. Treating allergies that may be contributing to repeated episodes of otitis media may also be helpful (see page 703). Switching from group day care to home day care or
home care may, in some cases, also reduce the number of episodes, since a child in group care will be exposed to many more colds.

When a child has had repeated middle-ear infections (three episodes in 6 months, or four in a year), a low-dose, preventative (or prophylactic) regimen of antibiotics may be given for 3 to 6 months to discourage recurrence. Or the antibiotic may just be given at the height of the otitis media season or when the child has a cold (the antibiotics won’t do anything for the cold, but they can help prevent secondary ear infections). When prophylactic antibiotics fail to prevent repeat infections, the insertion of tubes (see box, page 610) may be considered. When large adenoids are blocking the eustachian tube, removal of the adenoids may be effective. Most children outgrow the tendency to frequent ear infections by age four or five.

Complications.
Otitis media with effusion (see page 610). Thanks to antibiotics, other complications, such as mastoid infection, are extremely rare.