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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Ear Infections

Ear infections are one of the more common childhood illnesses, generally affecting children between 3 and 8 years old. Earache in children is most frequently caused by otitis media or an inflammation of the middle ear. It is often a painful complication of an URTI, such as the common cold, or of a throat infection, such as pharyngitis or tonsillitis (Collins, 2003; Oberklaid & Kaminsky, 2010).


Why are young children prone to ear infections?

The middle ear (situated behind the eardrum), is connected to the nose and throat by means of the Eustachian tube. This tube is responsible for:

·                Equalising pressure on both sides of the eardrum.

·                Draining fluid from the middle ear that tends to accumulate during a cold.

·                Preventing viral and bacterial infections harbouring in the nose and throat from entering the middle ear (Leary, 1990).


In young children, the Eustachian tubes are short and narrow, allowing infectious organisms from the nose and throat to enter the ear. With a cold, these small tubes become inflamed and blocked, causing a fluid build-up in the middle ear (University of Iowa Hospitals & Clinics, 2008).


Fluid trapped anywhere in your child’s upper respiratory system (ear, nose, throat) may become infected. This infected fluid collects behind the eardrum, causing pressure and intense pain. If the pressure is severe, the eardrum may rupture, allowing the fluid to drain into the external ear canal. Although this relieves the pressure and pain symptoms, the infection still needs to be treated so that the perforated area of the eardrum is able to heal (Leary, 1990).


Unfortunately, some children do have repeated ear infections and this may result in a thick, glue-like secretion building up in the middle ear. ‘Glue ear’ usually affects your child’s hearing because sounds cannot be transmitted to the organs of the inner ear. The resultant hearing loss has an impact on language development (Collins, 2003).


Ear infections require immediate medical attention because if they occur too often or for too long they may result in a ruptured eardrum, scarring and permanent hearing loss, which in turn impedes your child’s language development, social skills, confidence and school performance. Also, recurrent ear infections make your child unhappy at a time when he is generally graduating from one developmental milestone to another. After initial treatment, follow-up consultations with your doctor are important to prevent ear infections from coming back (Leary, 1990; Oberklaid & Kaminsky, 2010; University of Iowa Hospitals & Clinics, 2008).


Otitis media



·         Pain (mild earache to intense throbbing)

·         Waking at night, crying

·         Rubbing or pulling on the ear

·         Fever and vomiting

·         Decreased sensitivity to sound or partial hearing loss

·         Irritability

·         Discharge from the ear

·         Dizziness or loss of balance due to fluid build-up in the middle ear

·                Feelings of fullness or pressure in the ear (Collins, 2003; University of Iowa Hospitals & Clinics, 2008)


How to recognise an ear infection in your child

Older children who have a command of language are able to tell you that their ear hurts. Recognising that your baby has an ear infection is more difficult. The following are signs of otitis media in infants:

·         Cold symptoms

·         A thick, yellow discharge from the nose or eyes

·         A cranky, irritable baby

·         Ear pulling is an unreliable sign in infants because babies enjoy playing with their ears.

·                Ear infections are more easily discerned at night because when your baby lies flat, the infected fluid presses against his eardrum, causing pain. Infants with otitis media often sit or stand up in their cots, as this allows the infected fluid to drain away from the eardrum and eases the pain. You will find that your baby is also more comfortable when you hold him in an upright position.

·                Some mothers are able to notice a change in their child’s personality if he suffers from recurrent ear infections.

·                Diminished hearing often resulting in behavioural changes (Leary, 1990).



Your doctor will examine your child’s ears using an instrument called an auriscope, to try to establish the cause of the problem. He may also perform a painless procedure known as a tympanometry, to measure how mobile the eardrum is and to help diagnose whether the ear is normal. If your child suffers from frequent ear infections or your doctor suspects that he may have glue ear, a hearing test may be organised. If there is a discharge, your doctor may take a sample and send it to the laboratory for testing, to help identify the infection (Collins, 2003; Oberklaid & Kaminsky, 2010).



·                Viral ear infections are generally not treated with antibiotics and need to run their  course. However, if there is no improvement within 48 hours antibiotics are recommended.

·                Bacterial infections require antibiotic treatment immediately.

·                Liquid paracetamol or ponstan may be given to your child in appropriate doses to                reduce pain, fever and inflammation.

·                Allow your child to sleep in an upright position propped against cushions or hold him in your arms, so that the fluid can drain away from the eardrum. This will help to relieve pressure and pain.

·                Your doctor may prescribe analgesic drops, which act as a local anaesthetic, to give your child temporary pain relief.

·                Place a hot water bottle filled with warm water and wrapped in a towel on your child’s ear to soothe the pain.

·                Older children may be given exercises by your doctor to open their Eustachian tubes and ‘pop their ears’.

·                In the case of recurrent infections, your doctor may prescribe a ‘prevention regime’ consisting of daily decongestants or antibiotics to prevent relapse, while the Eustachian tube grows and the middle ear drains effectively.

·                If a thick, glue-like substance is present in the middle ear, it may require surgical removal by means of a myringotomy, which involves opening the eardrum.

·                Recurrent ear infections may also be treated by placing tiny tubes or grommets into the eardrum, to help drain fluid away from the middle ear. Grommets usually fall out on their own within 6-12 months. Underwater swimming or diving should be avoided by children with ear tubes. Unfortunately, grommet operations have become ‘fashionable’ in South Africa and you should therefore obtain the assurance of your doctor that the operation is essential before consenting to this procedure (Collins, 2003; Leary, 1990; Raising Children Network, 2006-2010; Sujata de, 2007; University of Iowa Hospitals & Clinics, 2008).


Preventing ear infections

Although ear infections are common in children, there are certain things parents can do to lessen the frequency and severity of the infection:

·                Research has shown that breast-fed infants have fewer ear infections.

·                Children under the age of 2 should not lie flat when nursing from a bottle.

·                If your child suffers from allergies, ensure that they are properly treated and under control because allergies may result in fluid accumulating in the middle ear.

·                Second-hand smoke increases your child’s risk for developing ear infections.

·                Try to limit contact with anyone who has a cold, sore throat or the flu.

·                Ensure that your child receives the recommended vaccinations so he is protected from infections he may be exposed to.

·                Although ear infections are not contagious in and of themselves, the colds leading to them are. In order to reduce the spread of germs, and therefore reduce the risk of ear infections, parents should ensure that:

o   Children use disposable tissues once and then throw them away properly.

o   Children are taught to cover their mouth or nose when coughing or sneezing.

o   Children do not share food, drink or toys that they have put in their mouths, if   

                                    they are sick.

o   Dirty toys are washed in warm soapy water and all surfaces, especially those in 

                                      play areas, are disinfected regularly.

o   Children are taught to wash their hands, especially after coughing or sneezing into them (University of Iowa Hospitals & Clinics, 2008; The Capital Region of Otitis Media Project, 2000).


Hearing problems

Hearing problems are often first noticed by a child’s parents. Babies with hearing impediments may fail to respond to sounds and may seem uninterested in people and playing. Impaired hearing prevents them from connecting with the outside world and it is therefore imperative to have their hearing checked. If there is a problem, the earlier it is identified, the more your child can be helped. In older children, hearing difficulties may manifest at school with a deterioration in their school performance. Other signs of hearing problems include:

·         Delayed speech development

·         Decreased response to usual sounds

·         A generally cranky or ill-tempered child

·         Unexplained changes in personality, usually following a cold or ear infection

·                Allergic children are more prone to fluid accumulation in the middle ear and are at a higher risk for developing ear infections


Hearing problems may develop

·                Due to an accumulation of fluid behind the eardrum, causing the Eustachian tubes to become blocked (otitis media).

·                During or shortly after air travel, due to barotrauma.

·                If your child has glue ear. This usually results in partial hearing loss and hearing may be worse at certain times rather than others. Children who have glue ear may seem inattentive and have slow language or learning development.

·                If earwax is blocking the external ear canal (Collins, 2003).


How to check your child’s hearing

There are 4 main problems that may develop due to hearing loss:

             1.         The inability to hear soft sounds.

             2.         Important parts of particular speech sounds may not be heard.

3.         Voices may become juxtaposed with background noise, making it difficult to separate  


             4.         Loud sounds may become intolerable (Australian hearing, 2010).


The earliest hearing test that parents can administer at home, with children of 3 and older, is known as the whisper test. This test helps to identify differences in hearing between one ear and the other. Place your hand over one of your child’s ears and whisper in a tone that is just loud enough for you to hear your own whisper, in his other ear. Ask him basic questions, such as ‘what is your name?’ or ask him to repeat numbers. Alternatively, hold a wristwatch a few inches from your child’s ear and ask him to follow the tick-tock of the watch. If your child is prone to frequent ear infections, use these tests to check his hearing periodically, both when he has an infection and when your doctor says his ears are normal. This will make it easier for you to establish when and if his hearing is impaired (Leary, 1990).


If you suspect your child’s hearing is diminished, it is important to have his hearing checked. An audiologist may perform the following tests:

·                The Infant Distraction Test provides a general indication of a hearing problem. While your child sits on your lap, one ‘tester’ stands behind him making sounds, while another observes his reactions.

·                Visual Reinforcement Audiometry (VRA) is generally used with children between 6 months and 3 years. A machine known as an audiometer plays sounds in different volumes and frequencies through loudspeakers. Your child is encouraged by means of visual reinforcement, such as a toy lighting up, to respond to the sounds and turn towards the source. This test can establish the quietest sounds your child can hear and is able to test each ear individually by means of small earphones.

·                Play Audiometry can be performed from 2½ years old. Once again, an audiometer is used and your child is shown how to respond to the sounds by performing a simple task, such as placing pegs on a board.

·                Pure Tone Audiometry can be used with children of 3 years and above. The test is able to pick up progressive deafness, mild or one-sided problems, and helps to identify children with glue ear. Sounds consisting of 4 frequencies are played through headphones and your child is asked to respond by pressing a button when he hears them.

·                Bone Conduction Audiometry helps distinguish whether hearing loss is due to mild middle ear problems. A small vibrating device will be placed behind your child’s ear so that sound is transferred through the bone directly to the inner ear.

·                The Speech Discrimination Test assesses your child’s ability to hear words at the quietest level without any visual cues. Preschool children may be asked to identify objects or toys, while older children may be asked to repeat words or sentences.

·                Tympanometry assesses the flexibility of the eardrum. If the eardrum is rigid, vibrations from sound waves are unable to pass through the middle ear and into the inner ear. This test can be performed on children of all ages and helps identify chronic middle ear problems, such as glue ear (deafness research UK, 2009).



Swimmer’s ear

Swimmer’s ear or otitis externa is an infection of the lining of the ear canal caused by various bacteria or fungi. The lining of the ear canal consists of secretory glands and surface cells, which produce a waterproof, waxy coating to protect the ear from invading germs. External ear infections occur when this lining is broken down. They most commonly occur during the swimming season and are not contagious (Leary, 1990; The Nemours Foundation, 1995-2010).



·                Over-zealous wax removal, especially when using cotton tipped applicators or sharp objects such as hair pins or paper clips that irritate or scratch the lining of the ear canal.

·                Prolonged contact with water when swimming or diving may wash away the protective coating of the ear canal and provide a warm, moist environment for bacteria to grow.

·                Otitis externa sometimes occurs in a person with a middle ear infection, when pus collected in the middle ear drains through a hole in the eardrum, into the ear canal (Leary, 1990; The Nemours Foundation, 1995-2010).



·         Itching in the ear canal is often the first sign of otitis externa.

·         Severe pain that worsens when you press on the pinna or the outside of the ear.

·         The outer ear may become red or swollen.

·         The lymph nodes around the ear may be painful and enlarged.

·         There may be pus from the ear opening.

·                Hearing is usually normal unless the infection also involves the eardrum or the ear canal is blocked due to wax or drainage.

·         Slight fever (Leary, 1990; The Nemours Foundation, 1995-2010).



It is important to consult your doctor so that he can establish the severity of the infection, prevent it from spreading further, and determine whether it is in the middle ear, outer ear or both.

·                Otitis externa is generally treated for 7-10 days with ear drops containing antibiotics to fight the infection, corticosteroids to reduce the inflammation, and sometimes a topical anaesthetic to ease the pain.

·                If the ear canal is blocked due to wax or drainage, your doctor may need to clean your child’s ears, to allow the drops to penetrate the ear canal.

·                If the ear opening is very swollen, your doctor may insert a cotton wick into the ear canal, to carry the drops more effectively into the ear.

·                If the infection is affecting the eardrum, oral antibiotics may be prescribed.

·                A culture may be taken from the discharge of your child’s ear, to help identify the infection.

·                Pain medication such as paracetamol and ponstan may be used.

·                Place a heating pad or warm cotton cloth on your child’s ear to soothe the discomfort (Leary, 1990; The Nemours Foundation, 1995-2010).


How to prevent swimmer’s ear

·                Keep all objects out of the ear canal. This includes ear plugs because although they are effective, they commonly irritate the ear canal and increase the risk of otitis externa. If wax is a problem, consult your doctor to remove it in an appropriate manner.

·                Keep your child’s ears as dry as possible, using a clean towel after bathing, showering or swimming. Show them how to tilt their heads to one side to allow water to drain out of the ear by means of gravity.

·                If water remains in the ear, roll a small piece of absorbent paper between your fingers and insert it a short distance into the canal to absorb the residual water.


Recurrent external ear infections may be treated with preventative eardrops (usually containing a mild acetic acid solution) to be used after swimming. These drops are contra-indicated in children with grommets or those with a hole in their eardrum (Leary, 1990; The Nemours Foundation, 1995-2010).