What does it mean when your child scratches her ears?

If water gets into your baby's ear, turn her on her side and lightly massage the front of the ear so that the water flows out of the ear canal, advised Dr Lynne Lim, a senior consultant ear, nose and throat surgeon at Mount Elizabeth Medical Centre.
If water gets into your baby's ear, turn her on her side and lightly massage the front of the ear so that the water flows out of the ear canal, advised Dr Lynne Lim, a senior consultant ear, nose and throat surgeon at Mount Elizabeth Medical Centre.PHOTO: ST FILE

Specialists offer tips on how to spot ear infections, and explain why they occur

Ear infections are common in babies and toddlers. Here are tips on what to look out for and what to expect when your child gets one.

LOOK OUT FOR WARNING SIGNS

Is your little one scratching or hitting her ears? She could be feeling the pressure caused by an infection or fluid build-up in the ears, said Dr Lynne Lim, a senior consultant ear, nose and throat surgeon at Mount Elizabeth Medical Centre.

She may be unsteady while crawling, sitting up or walking. Watch for fever, crankiness or discharge from the ears, said Dr Christelle Tan, a specialist in paediatrics at Raffles Specialists.

Hearing problems may be another telltale sign. For example, your baby may be less responsive to sounds that normally startle her, Dr Tan said.

If the infection occurs only on one side, she may turn towards the opposite side when you call her as the sound would appear louder in the ear with normal hearing, she added.

But these symptoms are not always obvious, especially if the infection is mild. "Most cases of fluid trapped in the middle ear arise from a cold or flu and it may not be painful. Your child may not complain of any hearing problem, so it may be missed," said Dr Lim.

A BOUT OF COLD RAISES THE RISK

In most children, ear infections typically occur when fluid is trapped in the middle ear (the part located behind the eardrum) and is infected by germs. This can happen when the Eustachian tube (the narrow passageway connecting the back of the nose and throat to the middle ear) becomes blocked - for example, when your child has a cold or an untreated nasal allergy.

In a March 2016 study in Pediatrics, researchers followed 300 babies and found nearly every ear infection diagnosed manifested after a bout of the common cold.

Other factors that can raise your baby's risk include drinking from a bottle or sippy cup while lying down, reflux issues or exposure to second-hand smoke, experts said.

It may also occur in the outer ear canal when small objects as well as infected water and debris (from swimming in dirty water, for example) get trapped in there, or when you clean your baby's ear canal too aggressively, Dr Lim said.

YOUNGER CHILDREN AT RISK

Ear infections are generally more common between the ages of one and six, peaking in the first two years of life, Dr Lim said.

By the age of three, about two-thirds of all children would have suffered at least one bout of it, Dr Tan added.

Compared to adults, younger children have a shorter, narrower and more horizontal Eustachian tube. This makes it easier for infections from the throat to spread to the ear, as well as more vulnerable to blockage, Dr Tan explained.

In addition, your baby's immune system is still developing.

IT TENDS TO COME BACK

Some children may suffer from repeated infections up to four times a year. It typically takes one to three months to clear, Dr Lim said, so it is technically possible for your child to nurse ear infections all year round. Beyond the age of six, recurrent episodes tend to be less common, Dr Tan said.

GET IT TREATED PROMPTLY

If your baby has a severe ear infection, or is not getting better and has a high fever, her doctor may start her on antibiotics.

An untreated infection can affect your baby's hearing development, which is why it is important to get it treated promptly, Dr Lim said.

Studies show that even periodic or mild hearing loss can lead to speech delays that affect school performance later in life.

"When left untreated, recurring ear infections would mean the child may not be hearing well ... which has been shown to affect the development of the hearing brain," Dr Lim said.

"Sometimes, after treatment, the child may continue to have auditory hearing issues that make her appear inattentive. She hears sound, but her brain does not process the information."

In rare cases, leaving a severe ear infection untreated might even lead to a brain infection.

DITCH EAR PICKS, COTTON BUDS

Refrain from "cleaning out" your little one's ears - it's not necessary as they're naturally self-cleaning.

Digging your baby's narrow ear canal using an ear pick or cotton bud can push debris and wax farther in, traumatising the skin and causing an infection to set in, Dr Lim warned.

Likewise, dirty bath or pool water can cause an infection when it is trapped in the ear canal.

If water gets into your baby's ear, turn her on her side and lightly massage the front of the ear so that the water flows out of the ear canal, Dr Lim advised.

BREASTFEED AND VACCINATE TO PREVENT EAR INFECTIONS

In the March 2016 Pediatrics study, babies who were exclusively breastfed for at least six months were less likely to develop an ear infection.

Another effective mode of protection is to vaccinate your child against bugs that can cause ear infections, Dr Tan said. They include the pneumococcal vaccine, haemophilus influenzae vaccination and the influenza vaccine.

•This article first appeared in Young Parents magazine. Young Parents, published by SF Magazines, is available in digital and print formats.

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A version of this article appeared in the print edition of The Straits Times on October 17, 2017, with the headline 'What does it mean when your child scratches her ears?'. Print Edition | Subscribe