What to Expect the Toddler Years (217 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
TUBES FOR TODDLERS
Tube insertion (myringotomy with tympanostomy) should be considered a treatment of last resort for the child with persistent fluid in the ears (research suggests that there is little reason to insert tubes for repeated ear infections). This surgical procedure is performed under general anesthesia, usually by a pediatric ear, nose, and throat specialist (otolaryngologist). A tiny tube is inserted through the eardrum to drain accumulated fluids from the inner ear. Hospitalization for a few hours or overnight is required. The tube falls out on its own after 9 to 12 months, sometimes sooner, and often inhibits future infections. But there are risks, which should be discussed fully with the child’s doctor, and probably a specialist as well, and weighed against possible benefits before a decision is made to go forward. Long-term benefits are unclear.
If tubes are inserted, care must be taken to be sure that they don’t become a conduit for infection; check with your child’s doctor before allowing underwater swimming or submerging in the tub, because water might enter the ear under these conditions. Many children use tot-size ear plugs to protect the tubes when bathing or swimming.
TITIS MEDIA WITH EFFUSION, OR SEROUS OTITIS MEDIA
Symptoms.
Usually, hearing loss (temporary, but it can become permanent if the condition continues untreated for many months). Sometimes, clicking or popping sounds on swallowing or sucking; a feeling of fullness or ringing in the ears; or no noticeable symptoms at all.
Season.
Year-round.
Cause.
Fluid in the middle ear, which may or may not contain bacteria; sometimes, a lingering viral infection may be involved.
Method of transmission.
Not person-to-person; usually follows an acute middle-ear infection.
Duration.
Weeks, months, or even years.
Treatment.
Watchful waiting for 3 months; if fluid persists, hearing tests and antibiotics. If there is no improvement after 6 months, and especially if hearing is affected, tympanostomy tubes may be recommended (see box, above). Recent research suggests that giving steroids with the antibiotics will clear persistent fluid in the ears and reduce or eliminate the need for tympanostomy tubes. Ask your child’s doctor about this treatment.
If you are concerned about your child’s hearing, you may want to consult a hearing specialist.
When to call the doctor.
As soon as you note any signs of hearing loss.
Prevention.
Periodic ear exams, tympanostomy tubes, low-dose prophylactic antibiotics. Treating cold symptoms with decongestants is probably ineffective, but flu shots seem to help.
Complications.
Possibly, hearing loss, and the verbal, developmental, and emotional issues that often go along with it.
INUSITIS
Symptoms.
Though sinusitis is uncommon in children under two, in secondary infection symptoms are: cold symptoms that have continued for more than 10 days, with discharge that is clear, thick and yellowish, or whitish; a cough during the day as well as at night; swelling around the eyes on rising in the morning. Sometimes, bad breath, fever, headache behind or over the eyes (though head and face pain are more common in children over five). There is no fever when sinusitis is the result of allergy or an injury rather than infection.
Season.
Mostly fall and winter for infections secondary to colds; spring, summer, and fall for cases due to allergy.
Cause.
Usually bacteria; also allergy or injury.
Method of transmission.
Not transmitted directly.
Duration.
Most cases begin to improve 10 to 14 days into therapy. With chronic sinusitis, symptoms may not improve for 3 to 4 weeks.
The sinuses may become inflamed by allergy or infected during a cold. In a young child, the frontal sinuses (above the eyes) are not fully developed.
Treatment.
Antibiotics to treat an infection. When antibiotic therapy isn’t effective, the affected sinuses may need to be irrigated and drained; in rare instances, surgery may be necessary. Antihistamines and decongestants for sinusitis in children are not generally recommended. Elimination of allergen is effective when cause is allergy.
When to call the doctor.
At any signs of acute sinusitis.
Prevention.
Removal of known allergens from child’s environment (see page 706), if the sinusitis is allergy-related.
Complications.
Rarely, the infection spreads to the central nervous system. Call the doctor
immediately
if there is swelling or redness around your child’s eyes, severe headache, sensitivity to light, or increasing irritability.
ORE THROAT
Symptoms.
Inflamed tonsils and/or throat, producing pain and difficulty swallowing, and sometimes, fever. A scratchy, sore throat often accompanies a cold. A toddler with a strep infection may have low-grade fever, with irritability, loss of appetite, and swollen glands (see page 576). Older children are more likely to experience high fever, more severe sore throat, and difficulty swallowing with strep.
Season.
Late fall, winter, and spring.
Cause.
Allergy; cold virus or other virus; group A
Streptococcus
bacteria or other bacteria.
TONSILS AND ADENOIDS: TAKING THEM OUT IS NO LONGER IN
At one time, tonsillectomy was as predictable a part of childhood as losing those two front teeth. At some point, virtually every child had tonsils removed (usually along with adenoids). It was believed that this surgical procedure would reduce the risk of sore throats, ear infections, and other upper respiratory illnesses. Now it’s recognized that for most children, tonsils help to prevent illness rather than cause it. These bits of tissue in the throat are actually lymph nodes that serve an important role in the immune system. Like lymph nodes elsewhere in the body, the tonsils enlarge when fighting infection nearby; they usually shrink again when the infection is gone.
Today the fact that tonsils and/or adenoids are enlarged is no longer automatically a reason for their removal. Often the doctor will recommend giving them time to shrink on their own or will treat them with antibiotics in hope of reducing the swelling. (Sometimes treating an allergy will gradually reduce the size of enlarged adenoids.)
There are times, however, when surgery is warranted. According to the American Academy of Pediatrics, surgery may be recommended when:
The enlarged tonsils and/or the adenoids are interfering significantly with breathing during sleep, causing diminished oxygenation of the blood and retained carbon dioxide. Early symptoms may include: daytime drowsiness and exhaustion day after day in spite of adequate rest; loss of concentration; and behavioral changes such as hyperactivity. Longstanding airway obstruction may lead to stresses on the heart.
The enlarged tonsils are interfering significantly with swallowing. (This is rare and should be documented by a swallow study before surgery is recommended.)
The enlarged adenoids are interfering significantly with breathing, making speech sound hyponasal and causing distorted pronunciation.
A child has had repeated strep throat or viral infections causing sore throat (seven in a year, five in each of 2 years, three in each of 3 years).
Tonsillitis or swollen glands have become chronic (for at least 6 months) despite antibiotic treatment. This is rare and should be fully worked up for other sources of sore throat before referral is made for tonsillectomy.
An abscess forms around or behind the tonsil. (If the abscess can be drained as an outpatient, a tonsillectomy won’t be done unless there is a history of repeated throat infections. If the patient goes to the operating room for drainage, elective tonsillectomy is reasonable.)
Adenoidectomy is a consideration for those children undergoing their first set of ear tubes who also have chronic nasal obstruction or drainage, for children undergoing their second set of tubes, and for children whose ear infections continue to recur in spite of the insertion of tympanostomy tubes (see page 610).