A sick tummy got your baby down? It may be time for a change of juice. Researchers have found that children recover more quickly from diarrhea when they drink white grape juice than when they stick to those high chair standards, apple and pear. They’re also less likely to
experience a recurrence on the white grape. Apparently, the sugar and carbohydrate
composition of white grape juice is better for the digestive system (and a lot less challenging in the laundry department than its purple cousin). Apple and pear juices naturally contain sorbitol (an indigestible carbohydrate that can cause gas, bloating, and discomfort) and a higher amount of fructose than glucose, while white grape juice is sorbitol free, and has an even balance of fructose to glucose.
Before switching to white grape juice, though, discuss it with the doctor, who might recommend water or rehydration liquids instead. In some cases, too much of any type of juice can cause tummy troubles.
No symptoms at all, other than the fluid in the ear
Season: All year round, but much more common in winter.
Cause: Usually bacteria or viruses, but allergy can also cause middle ear inflammation. Babies and young children may be most susceptible because of the shape and size of their eustachian tubes;
because they are more likely to get respiratory infections, which usually precede ear infections;
because they have immature immune response; or because they are often fed while lying on their backs. The eustachian tubes, which drain fluids from the ears down the back of the nose and the throat and keep the middle ear ventilated with air, are shorter in a baby than in an adult, so germs can easily travel through them into the middle ear. And because the tubes are horizontal rather than vertical (as in adults), drainage is poor, especially in infants who spend a lot of time on their backs. The small
diameter also makes the tubes more subject to blockage (by swelling from allergy or from an infection, such as a cold, by a malformation, or by enlarged adenoids). This blockage causes fluid buildup, which makes an excellent breeding place for infection-causing bacteria, causing serous otitis media.
Method of transmission: Not direct (you can’t “catch” an ear infection), but children in day care may be more vulnerable simply because they get more colds, which can lead to ear infections. There may be a family disposition to ear infections.
Incubation period: Often follows a cold or the flu.
Duration: Can be as short as a few days; can become chronic.
Treatment: Ear infections require consultation with a doctor; do not try to treat on your own.
Treatment may include:
Antibiotics, when deemed necessary (sometimes they absolutely are necessary, sometimes they aren’t; see below). When antibiotics are prescribed, always give for the full time prescribed—
usually five or ten days—to avoid reinfection, chronic infection, or antibiotic resistance.
Decongestants are not usually helpful.
Watchful waiting in situations that do not require immediate antibiotic treatment. Research has shown that most uncomplicated cases of acute otitis media clear up within four to seven days without treatment. Ask your doctor whether antibiotics are absolutely necessary for your baby’s particular infection.
Ear drops, if doctor recommended.
Baby acetaminophen or ibuprofen for pain and/or fever.
Heat applied to the ear in the form of a heating pad set on low, a hot-water bag filled with warm water, or warm compresses (see page 758)—any of which can be used while you are trying to reach the doctor.
Myringotomy (minor surgery to drain fluid from the infected ear through a tiny incision in the eardrum) if the eardrum appears about to burst; incision will heal in about ten days, but may require special care until then. Another option is laser myringotomy, a newer treatment in which the doctor creates a tiny hole in the eardrum using a handheld laser, allowing the fluid in the ear to drain.
Insertion of a tiny tube to allow air into the middle ear, when fluid (serous otitis media; SOM) doesn’t respond to antibiotic therapy. This is done under general anesthesia and is a last resort for cases that don’t respond to other treatments. Usually a tube (which could be considered an
“artificial eustachian tube”) is tried if fluid has remained in one ear for six months—or in both ears for four months—with no improvement. The tube falls out after six to eight months, sometimes sooner. Risks must be weighed against benefits before resorting to tubes, the long-term benefits of which are unclear.
Periodic ear exams until the ear (or ears) is back to normal, to be sure the condition has not become chronic.
Elimination or treatment of allergies related to repeated ear infections.
Dietary changes: Extra fluids for fever. If antibiotics are prescribed, whole milk yogurt with active cultures (if dairy products have been introduced) can help prevent stomach distress often caused by such medications.
Prevention: A sure way to prevent otitis media is not yet known. Recent research, however, suggests that the following may reduce the risk of ear infections in babies:
Overall good health through adequate nutrition and rest, and regular medical care Breastfeeding for at least six months, preferably the entire first year
Flu shot, pneumococcal vaccine (see page 232)
A more upright feeding position, especially when a baby has a respiratory infection Using angled bottles, instead of the traditional straight ones
A slightly elevated sleeping position when a baby has a cold (put a couple of pillows under the head of the mattress, not under baby’s head)
Having baby suck on a bottle or pacifier during takeoffs and especially landings, when most ear problems occur because of air pressure changes
Limiting the use of a pacifier during the day, and taking a pacifier out of your baby’s mouth once he or she is asleep
Low-dose prophylactic (given to prevent infection) antibiotics for children with frequent ear infections during the height of the otitis media season, or just when the child comes down with a cold, to prevent a secondary ear infection
Smoke-free living space (secondhand smoke can lead to more congestion, which can lead to SOM)
Home child care rather than group day-care situations, where children are more likely to come down with otitis media
Complications:
Among others:
Chronic otitis media with hearing loss
Mastoid infection (a rare condition in which the mastoid bone of the skull becomes infected) Meningitis, pneumonia
When to call the doctor: Initially, as soon as you suspect your baby may have an earache. Again if symptoms do not seem to begin clearing within two days, or if baby seems worse. Even if no ear infection is suspected, call if baby suddenly doesn’t seem to be hearing as well as usual.
Chance of recurrence: Some babies never have an ear infection, others have one or two in infancy
and then no repeats, and still others have them repeatedly on into toddlerhood and the preschool years.
Conditions with similar symptoms: A foreign object in the ear, swimmer’s ear, and referred pain from respiratory infection can mimic an earache. Teething sometimes causes referred pain to the ear.
GASTROESOPHAGEAL REFLUX (GER)
There has been an apparent dramatic increase in the number of babies with GER recently—not because more babies are developing the condition but because more are being correctly diagnosed.
Doctors believe that many babies who were labeled colicky in the past were actually suffering from GER. It’s a common condition in babies under a year of age, and even more common in premature babies.
Symptoms: GER is similar to heartburn (acid reflux) in adults. The acid in the stomach backs up into the esophagus or even up to the back of the throat, causing frequent spitting up or vomiting and
irritation of the esophagus, indicated by unrelenting crying and discomfort. Symptoms include:
Sudden or inconsolable crying, severe pain, and arching during feeding Excessive spitting up or vomiting
Extremely forceful vomiting Vomiting hours after eating
Erratic feeding patterns such as refusing food or constant eating or drinking Slow weight gain
Poor sleep habits Gagging or choking
Frequent burping or hiccupping Difficult or noisy swallowing Excessive drooling
Sometimes:
Chronic coughing, recurrent croup Frequent red or sore throat
Frequent ear infections
Respiratory problems including wheezing, labored breathing, asthma, bronchitis, pneumonia, and apnea
Season: Any time.