FitSugar

Partner Yoga Pose: Double Child

FitSugar — Thu, 17 Jan 2008 11:45:00 -0800

While it's true that many Partner Yoga poses can help you get a deeper stretch, another benefit is the emotional support you share. Energy can be passed and received between you, so doing a pose with someone can instill a sense of joy and serenity. This one, called Double Child, will help to relieve stress and calm the mind.

Partner one (blue shirt) and partner two (tan shirt) kneel down on a mat with their feet touching.
Both partners come into Child's Pose and hold hands.
They remain here for at least five breaths, allowing the lower back, hips, and shoulders to release.
After they've had enough, both partners slowly sit up.

I know this pose doesn't look like much, but it's one of those things that you just have to try. Once both partners allow themselves to relax completely, they'll feel the amazing effects.

Source

Children Carrying Cell Phones on the Rise

babysugar — Tue, 09 Mar 2010 09:00:00 -0800

Is your child reachable at all times? A new study says there's a good chance he is. According to Mediamark Research and Intelligence, one in five children between the ages of 6-11 carries a cell phone. That number has nearly doubled over the past five years with boys accounting for a significant portion of the increase.

When we asked our readers about their views on the mobile phones a year and a half ago, half of LilSugar readers said their tots didn't carry one. As the world continues to shift to more mobile means of communication, and as more parents see the device as a means for providing their tykes with more freedom, many mamas are shifting their views on the lil pieces of technology and opting for phones that they can control.

Have you changed your view on giving your child a cell phone?

How Men Trick Women Into Becoming Pregnant

TresSugar — Mon, 25 Jan 2010 11:15:24 -0800

The idea of man messing with his partner's birth control sounds terrible but not too common - yet it's not terribly uncommon. A study conducted last year among 1,300 16 to 29-year-old women found 15 percent reported birth control sabotage.

Not surprisingly a man who gets in the mood by puncturing holes in condoms is also likely to physically abuse women. Of the 53 percent who reported physical or sexual violence from a partner, 35 percent also had partners who either tampered with birth control or coerced them to get pregnant. In fact, among women who were victims of both violence and coercion, the risk of unintended pregnancy doubled.

So what exactly are these men doing? Here are some stories from Know More, Say More, a site that explores the connection between reproductive health and violence.

[He] deliberately sabotaged the condoms - pretending that they’d slipped or broken, when in fact he would purposely remove the condom before ejaculating.

He always refused to wear a condom and would act offended when I suggested he use one.

To read more stories, read more.

He said the pill made women want to have sex all the time, and that I’d start to cheat on him and sleep with random boys because I wouldn’t need to use a condom any more.

[A] whole rows of pills would disappear. When Carollee called her boyfriend on the disappearing birth control, he responded that he “knew” she wanted to have his child.

Factor in that men who refuse to not only help pay for abortions, but also threaten physical or emotional violence if a woman does not keep the baby, and it gives a whole new meaning to unwanted pregnancy.

Source: Flickr User SpentPenny

Desperate Housewives Rundown, "You Gotta Get a Gimmick"

BuzzSugar — Mon, 11 Jan 2010 08:30:00 -0800

After a cataclysmic plane crash and a series of odd flash forwards, we're finally getting back to normal on Desperate Housewives. If "normal" includes a Susan Delfino striptease, that is. I thought this week had a nice balance of the goofier antics that we love the show for, along with more serious subject matter as Lynette tries to cope with the loss of her unborn child and Gaby reflects on her own self-loathing.

Are you ready to break it all down by character? Just read more.

Susan: Following last week's death of her ex-husband Karl, Susan attends the reading of his will and ends up with his lucrative secret business - a strip joint named Double D. She scouts it out, and upon talking to a dancer named Destiny, Susan discovers that Mike patronizes the place (to do their plumbing, so he says). She gets on Mike's case, and he lashes back, telling her she can't tell him what to do. To prove a point, Susan gets on the pole herself and strips in front of Double D's customers. Mike promises to never go back.

Gaby: Gaby and Carlos are trying to get Juanita into an exclusive private school, but the head of the program only seems to be interested in their daughter for her Mexican heritage. Problem is, Juanita doesn't even realize that she is Mexican. Gaby and Carlos begin to question whether they've deprived their daughter of their cultural background, so when she gets in, Carlos wants her to attend a school in a more Hispanic area instead. Gaby raises a fuss because she's ashamed of her past growing up Mexican and poor, but ultimately they decide to tell Juanita about their history.

Lynette: In typical fashion, Lynette doesn't want to allow herself any time to grieve after the death of one of her twins last week. When Tom offers to step in for her at work until she recuperates, she immediately feels threatened of being replaced at her job. Carlos tells her that Tom suggested that she might want to stay at home with the new baby. Reeling from this news, Lynette faces Tom, and he says that he thought she'd want to spend time with this new child given all that she's gone through. Lynette is falling to pieces, but it's obvious that Tom is also having a hard time. If they don't lean on each other soon, you can tell that things are only going to get darker for him in the episodes to come.

Bree: Bree admits to her church pastor that she had an affair with Karl, and he suggests that she try a penance of sorts by caring for a now handicapped Orson. Just one thing: Orson doesn't want her back anymore. Bree tries to appeal to him, but when he won't listen, she takes him back by force - right out of the McCluskeys' home, where he was planning on staying (by the way, how funny but gross was that line about the McCluskeys' naked floor?!). Orson finally agrees to stick with Bree, but he asks her to wait on him hand and foot.

Danny: No sign of Angie in this episode, but Danny pops up in a side storyline with Julie. Ana confesses to Julie that she has the hots for Danny, so Julie suggests that they all go to a comic open mic night for Eddie. Ana seizes the chance to come on to Danny; he responds by saying she's too conceited, and she bites back by bringing up his suicide attempt. A new teen romance on Wisteria Lane, perhaps?

Did you enjoy this week's episode? I think we know where most of the storylines are headed from here - eg, you can tell that Orson is out to make Bree's life miserable - but what do you think is going to happen with Lynette and Tom? They're one of my favorite TV couples, so I hate to see them face yet another challenge to their relationship (even if it does make for an interesting plot). Oh, and how about the exchange with Mrs. McCluskey and Lee talking about their mutual fantasy over Tom's khaki shorts? Loved it!

Speed Read! Lindsay Looks Into India's Child Trafficking

TresSugar — Mon, 11 Jan 2010 09:30:24 -0800

Preview released for Lindsay Lohan's documentary on child trafficking - PopSugar
Federal trial of California's gay marriage ban begins today - SF Chronicle
New way to tackle breast cancer: update Facebook status with bra color - Lemondrop
Northern Ireland's leader to step down after wife's affair with teen - LA Times
Disgraced ex-governor Rod Blagojevich says he's blacker than Barack - NPR
Can religion survive feminism? - DoubleX

Mom-Me Time: Pick Up a Copy of The Help

babysugar — Mon, 16 Nov 2009 11:30:49 -0800

If mama's got a few minutes to herself and is looking for something that will take her mind to another world, she needs not look further than this gold and purple hardback book. The Help ($12) is a quick read that will steal her attention and her affection and leave her wanting more. Kathryn Stockett's first novel, the book about the relationships between mothers and the women that help them (nannies in particular) will have mommy laughing out loud, tearing up in the eyes, dog-earring pages with special passages and thinking about how she relates to some of the closest people in her life.

Just pages into the lengthy text and I was hooked. Unlike any book I've read in recent times, the characters in these pages immediately come to life and fully color the imagination. You can picture their hair, dream up their clothes and hear their voices like they're sitting on the bus right next to you. While they may be fictional muses, I wish I could meet them, thank them, reprimand them and have a tall glass of sweetened iced tea with them. Though the book is set back in the early '60s, some of the conversations and lessons are timeless. For the rest of my review, read more.

Centered around the lives of three caretakers, the hired "help" who tend to high society's children may occasionally be called "mama" as they often forge a closer bond with the child than his own mother. And while some women may have their best friends to rely on, the housekeeper frequently knows and cares more than her "best" friends -the phrase "dirty laundry" having a double meaning when it comes to life behind closed doors. In the end, it is a story about women taking extraordinary measures to right some wrongs, even if it means risking it all. Of all the lessons to be learned from this rich novel, the golden rule speaks loudest - "Do unto others as you would have them do unto you." Maybe that's why she wrapped it in a glowing cover.

Before this goes to the theaters, which it surely will, buy it, read it and gift it to everyone you know. It will not disappoint.

Share your favorite books, products, toys and trends with other parents. Join our Product Reviews group over in the LilSugar community!

Otitis media

FitSugar — Wed, 08 Oct 2008 17:35:25 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the eustachian tubes, which connect the middle ear to the nose, become blocked with fluid. With the infection, mucus, pus, and bacteria can also pool behind the eardrum, causing pressure and pain. Ear infections usually begin with a cold. Although adults can get ear infections, they are most common in infants and young children. That's because a child's eustachian tubes are narrower and shorter than an adults, and it's easier for fluid to get trapped in the middle ear. Ear infections usually clear up on their own. Although it was common for doctors to give antibiotics to children with ear infections, now guidelines from the American Academy of Pediatricians suggest taking a wait-and-see approach for the first 72 hours.

With a severe ear infection, pressure may build up and cause the eardrum to rupture. Pus and blood may drain out. This usually relieves pain and pressure, and in most cases the eardrum heals on its own.

Signs and Symptoms

There are two main types of ear infections: acute otitis media (AOM), and otitis media with effusion (OME), where fluid remains trapped in the ear even after the infection is gone.

Acute otitis media causes pain, fever, and difficulty in hearing. If a child is too young to talk, signs of an ear infections can include crying, irritability, trouble sleeping, and pulling on the ears.

Other symptoms that may be associated with an ear infection include sore throat (pharyngitis), neck pain, nasal congestion and discharge (rhinitis), headache, and ringing (tinnitus), buzzing, or other noise in the ear.

Causes

Blockage of the eustachian tubes may be caused by:

Respiratory infection (cold)
Allergies
Exposure to cigarette smoke
Infected or overgrown adenoids (tonsils)
For infants, being fed lying down (drinking a bottle while lying on the back)

Ear infections occur most often in the winter. They are not contagious, but a cold may spread among a group of children and cause some of them to get ear infections.

Risk Factors

Age (children between six and 18 months are most likely to get ear infections)
Attending daycare
Recent illness (such as a cold or sinus infection)
History of allergies (like hay fever, also called allergic rhinitis, or sinusitis)
Exposure to secondhand smoke
Having family members who are prone to ear infections
Using a pacifier

Diagnosis

The doctor will ask questions about whether you (or your child) have had ear infections in the past and ask you to describe the current symptoms. He or she will use an otoscope to look inside the ear. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or filled with pus. The doctor will also check for any sign of perforation (hole or holes) in the eardrum.

Your doctor may also do other tests:

Tympanometry, which uses a small handheld instrument to measure changes in air pressure in the ear and can indicate if the eardrum is ruptured

Reflectometry, in which a small instrument is placed near the ear and makes a sound, allowing the doctor to see if fluid is present behind the eardrum.

A hearing test may be recommended if your child has had persistent ear infections.

Preventive Care

You can reduce your child's risk of ear infection. Here are some tips:

Don't expose your child to secondhand smoke.
Keep your child away from other children who are sick.
Always hold your infant in an upright, seated position during bottle feeding.
Breastfeeding for at least six months can make a child less prone to ear infections.
Don't use a pacifier.
The pneumococcal vaccine (Prevnar) prevents infections such as pneumonia and meningitis, and studies show it slightly reduces the risk of ear infections.

Treatment Approach

The goals for treating ear infections include curing the infection, relieving pain and other symptoms, and preventing future ear infections. If a bacterial infection is present, your doctor may prescribe antibiotics (see section entitled Medications).

However, most ear infections clear up on their own. Because antibiotics tend to be overused for treating ear infections, the Academy of Pediatricians and the American Academy of Family Physicians guidelines suggest taking a wait-and-see approach for 72 hours if

The child is older than six months
Are otherwise healthy
Have mild symptoms or an unclear diagnosis.

Your doctor may suggest using an over-the-counter pain reliever (see Medications). There are also alternative ways to treat the symptoms of ear infections and to prevent persistent and recurrent ear infections. For example, herbal ear drops and homeopathic remedies can be helpful for treating or preventing ear infections.

Before giving any medication to a child, whether over-the-counter, and herbal remedy, or a dietary supplement, you should talk to your pediatrician.

Lifestyle

Applying a warm, moist cloth over the affected ear may help relieve pain.

Medications

Antibiotics - If your doctor prescribes antibiotics, be sure to give your child the entire course. The antibiotic most often prescribed for an ear infection is amoxicillin, unless your child is allergic to penicillin. If that's the case. there are several others for your doctor to choose from.
Ear drops - If your child has recurring ear infections, a perforated eardrum, or develops infection after ear tubes have been placed (see Surgery and Other Procedures), your doctor may prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time (like a few months). If your child doesn't have ear tubes in place and doesn't have any drainage from the ear, your doctor may also prescribe anesthetic ear drops to relieve pain.
Ibuprofen, acetaminophen - Ask your doctor about using over-the-counter oral medications for pain and/or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children under 18 should not take aspirin, due to the risk of developing a rare but serious illness called Reye's syndrome.

Surgery and Other Procedures

Drainage tubes (myringotomy) - If your child has recurring ear infections that don't respond to antibiotics or if the fluid in the child's ear affects his hearing, your doctor may suggest putting in drainage tubes. During this surgery, which requires general anesthesia, the surgeon inserts a small drainage tube through the eardrum. Fluid behind the eardrum can drain out, equalizing the pressure between the middle and outer ear, which should improve your child's hearing. The tubes usually come out on their own as your child grows and the drainage holes heal.

If ear infections persist after age 4, your doctor may suggest having your child's adenoids (tonsils) removed.

Nutrition and Dietary Supplements

Because supplements (like those described below) may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. If you think your child has an ear infection, you should always talk to your doctor - don't try to treat the child yourself.

Lactobacillus - A probiotic or "friendly" bacteria, it may help reduce the number of colds your child gets (and thus reduce the number of ear infections). One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds.
Xylitol – A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may help fight a type of bacteria that's associated with ear infections. In one study, children who chewed sugarless gum sweetened with xylitol reduced their risk of developing and ear infection by more than a third. However, children in the study were given the gum five times a day, which makes it hard to be compliant. Another study found that taking xylitol three times per day didn't work. More research is needed.
Elimination diet - Some doctors believe food allergies contribute to chronic ear infections. Your doctor may ask you to try an elimination diet, which cuts out common food allergens such as wheat or dairy. If symptoms improve, you gradually add back the foods until an ear infection returns. Then you are able to identify and avoid the particular food.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner. Before giving any herbs to a child to treat an ear infection, talk to your pediatrician.

Herbal ear drops (Calendula officinalis, Hypericum perfoliatum, Verbascum thapsus, Allium sativum) - A few studies suggest that ear drops containing calendula, mullein, St. John's wort, and garlic were as effective at relieving pain as prescription ear drops. However, using oily ear drops can make it hard for the doctor to examine your child's middle ear, so always talk to your doctor first before using them.
Echinacea (Echinacea purpurea) - Although it has not been studied for ear infections, some doctors may suggest echinacea to help prevent recurring ear infections. Only give echinacea to a child under your doctor's supervision.
Belladonna (Atropa belladonna) - Belladonna is used as a homeopathic remedy for ear infections (see Homeopathy). Although herbal belladonna is toxic, it is safe when prescribed by a homeopath because homeopathic solutions use extremely diluted amounts. Do not use belladonna without the supervision of a trained homeopath.

Homeopathy

Although not many studies have examined the effectiveness of specific homeopathic therapies in general, there have been several studies evaluating homeopathy for ear infections. Some of the homeopathic remedies included in such studies or that a professional homeopath might consider for the treatment of ear infections are listed below. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Aconitum - for throbbing ear pain that comes on suddenly after exposure to cold or wind; and in children with high fever and whose ears have a bright red coloring
Belladonna - for sudden onset of infection with piercing pain that often spreads to the neck, flushed face including reddened ears, agitation (even impaired consciousness and nightmares), wide-eyed stare, high fever, and swollen glands; this remedy is most appropriate for children who feel relief when sitting upright and from warm compresses to the ear; this remedy should not be used in children whose symptoms have persisted for more than 3 days
Chamomilla - for intense ear pain and extreme irritability and anger (including screaming); this remedy is most appropriate for children who are difficult to comfort unless being rocked or carried by a person who is walking back and forth
Hepar Sulphuricum - for sharp pains and a smelly, yellowish-green discharge that occur in the middle and late stages of an ear infection, particularly when the child is extremely moody and clearly angry; this remedy is most appropriate for individuals whose symptoms are worsened by cold air and improved by warmth
Lycopedium - for right-side ear pain that is worse in the late afternoon and early evening; the child will generally say that his ears feel stuffed up and he may hear a ringing or buzzing sound; the appropriate individual tends to be insecure and need others around, although the personality type may act like a bully as a defense mechanism
Mercurius - good for chronic ear infections; for acute or chronic pain that is worse at night and may extend down into the throat; relief comes from nose blowing; and the appropriate child may sweat or drool a lot and have bad breath
Pulsatilla - for infection following exposure to cold or damp weather; the ear is often red and may have a yellowish/greenish discharge; ear pain worsens when sleeping in a warm bed and is relieved somewhat by cool compresses; this remedy is most appropriate for children who tend to be gentle, weepy, and mildly whiny and are easily soothed by affection
Silica - for chronic or late stage infection when the child feels chilly, weak and tired; sweating may also be present.

Other Considerations

Warnings and Precautions

If you think your child has an ear infection, especially if your child is under 2, call your pediatrician.

Let your doctor know if your child's symptoms (pain, fever, or irritability) do not get better within 24 to 48 hours.

If severe pain suddenly stops, it may indicate a ruptured eardrum.

Swimming and diving underwater may make an ear infection worse. If your child has a ruptured eardrum, he should avoid swimming or diving completely. If your child has ear tubes, use earplugs or cotton balls coated with petroleum jelly when swimming to prevent infection.

Prognosis and Complications

Generally, an ear infection is a simple, non-serious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. Permanent hearing loss is extremely rare, but the risk increases if the child has a lot of ear infections. Other potential complications include:

Ruptured or perforated eardrum (usually heals on its own)
Chronic, recurrent ear infections
Enlarged adenoids or tonsils
Mastoiditis (an infection of the bones around the skull)
Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections; very rare

Supporting Research

Altunç U, Pittler MH, Ernst E. Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials. Mayo Clin Proc. 2007 Jan;82(1):69-75. Review.

Barnett ED, Levatin JL, Chapman EH, et al. Challenges of evaluating homeopathic treatment of acute otitis media. Pediatr Infect Dis J. 2000;19(4):273-275.

Bitnun A, Allen UD. Medical therapy of otitis media: use, abuse, efficacy and morbidity. J Otolaryngol. 1998;27(suppl 2):26-36.

Bizakis JG, Velegrakis GA, Papadakis CE, Karampekios SK, Helidonis ES. The silent epidural abscess as a complication of acute otitis media in children. Int J Pediatr Otorhinolaryngol. 1998;45:163-166.

Blazek-O'Neill B. Complementary and alternative medicine in allergy, otitis media, and asthma. Curr Allergy Asthma Rep. 2005 Jul;5(4):313-8. Review.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:118-123.

Brown CE, Magnuson B. On the physics of the infant feeding bottle and middle ear sequela: ear disease in infants can be associated with bottle feeding. Int J Pediatr Otorhinolaryngol. 2000;54(1):13-20.

Cohen R, Levy C, Boucherat M, Langue J, de la Rocque F. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr. 1998;133:634-639.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 127-129.

Eskola J, Kilpi T, Palmu A, et al. Pneumococcal conjugate vaccine against acute otits media. NEJM. 2001;344(6):403-409.

Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J ClinChiropractic Pediatr. 1997;2(2):167-183.

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005657. Review.

Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? Br Homeopath J. 2001;90(4):178-179.

Friese KH. Acute otitis media in children: a comparison of conventional and homeopathic treatment. Biomedical Therapy. 1997;15(4):462-466.

Gehanno P, Nguyen L, Barry B, et al. Eradication by ceftriaxone of streptococcus pneumoniae isolates with increased resistance to penicillin in cases of acute otitis media. Antimicrob Agents Chemother. 1999;43:16-20.

Hatakka K, Blomgren K, Pohjavuori S, Kaijalainen T, Poussa T, Leinonen M, et al. Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study. Clin Nutr. 2007 Jun;26(3):314-21. Epub 2007 Mar 13.

Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001;322(7298):1327.

Ilicali OC, Keles N, Deger K, Savas I. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999;125(7):758-762.

Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in chiildren: a preliminary ransomized placebo-controlled trial. Pediatr InfectDis J. 2001;20(2):177-183.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 171-172.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:243-245.

Kemper AR, Krysan DJ. Reevaluating the efficacy of naturopathic ear drops. Arch Pediatr Adolesc Med. 2002;156(1):88-89.

Klein JO.Changes in management of otitis media: 2003 and beyond. Pediatr Ann. 2002;31(12):824-826, 829.

Klein JO. Pneumococcal vaccines for infants and children – past, present, and future. Curr Clin Top Infect Dis. 2002;22:252-265.

Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-799.

Stathis SL, O'Callaghan DM, Williams GM, Najman JM, Andersen MJ, Bor W. Maternal cigarette smoking during pregnancy is an independent predictor for symptoms of middle ear disease at five years' postdelivery. Pediatrics. 1999;104(2):e16.

Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double-blind randomised trials. Br Med J. 1996;313:1180-1184.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 78-81.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 178-179.

Wright ED, Pearl AJ, Manoukian JJ. Laterally hypertrophic adenoids as a contributing factor in otitis media. Int J Pediatr Otorhinolaryngol. 1998;45:207-214.

Review Date:
12/18/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Ear infections

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

In This Report

Highlights
Introduction
Causes
Risk Factors
Symptoms
Prognosis
Diagnosis
Prevention
Treatment
Home Remedies
Medications
Surgery
Resources
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Ear Infections

Middle ear (otitis media) infections are very common in young children. They include:

Acute otitis media (AOM) is an inflammation caused by bacteria that travel to the middle ear from fluid trapped in the Eustachian tube. Children with AOM exhibit signs of an ear infection including pain, fever, and tugging at the ear.
Otitis media with effusion (OME) refers to fluid that accumulates in the middle ear without obvious signs of infection. OME usually produces no symptoms, but some children will have difficulty hearing or complain of “plugged up” ears.

Prevention

Preventing colds and influenza (“flu”) is the best way to prevent ear infections. Make sure children wash their hands frequently and receive an influenza vaccine annually. The pneumococcal vaccine is also very helpful for preventing ear infections.

Treatment

Most ear infections resolve without antibiotic treatment.
For most children with AOM, doctors recommend waiting 48 - 72 hours before prescribing antibiotics. However, children younger than 6 months should receive immediate antibiotic treatment. Parents can give children 6 months and older ibuprofen or acetaminophen to help relieve pain.
Antibiotics are not helpful for most cases of OME. Doctors usually monitor children with OME for 3 months to see if their condition improves. Some children with hearing loss and developmental problems may eventually need surgery. Inserting tubes into the ear drum (tympanostomy) is the usual surgery for this problem.

Introduction

The ear is the organ of hearing and balance. It has three parts: the outer, middle, and inner ear.

The outer ear collects sound waves, which move through the ear canal to the tympanic membrane, commonly called the eardrum.
The tympanic membrane, or ear drum, is lined with mucus. When incoming sound waves strike this membrane, it vibrates like a drum, and converts the sound waves into mechanical energy.
This energy echoes through the middle ear. The middle ear is a complex structure filled with air and made of tiny bones. These bones vibrate to the rhythm of the eardrum and pass the sound waves on to the inner ear.
The inner ear is filled with fluid. Here, hair-like structures stimulate nerves to change sound waves into electrochemical impulses that are carried to the brain, which senses these impulses as sounds.
The inner ear also contains three semi-circular canals that function as the body's gyroscope, regulating balance.
The Eustachian tube, an important structure in the ear, runs from the middle ear to the passages behind the nose and the upper part of the throat. This tube helps equalizes the air pressure in the middle ear to the outside air pressure. Problems here are primary factors in most cases of ear infection.

The ear consists of external, middle, and inner structures. The eardrum and the three tiny bones conduct sound from the eardrum to the cochlea.

Acute Otitis Media (AOM). An inflammation in the middle ear is known as "otitis media." AOM is a middle ear infection caused by bacteria that traveled to middle ear from fluid build-up in the Eustachian tube. AOM may develop during or after a cold or the flu.

Middle ear infections are extremely common in children, but they are infrequent in adults.
In children, ear infections often recur, particularly if they first develop in early infancy.

Otitis Media with Effusion (OME). This condition occurs when fluid, called an effusion, becomes trapped behind the eardrum in one or both ears, even when there is no infection. In chronic and severe cases, the fluid is very sticky and is commonly called "glue ear."

It is usually not painful. Sometimes the only clue that it is present is a feeling of stuffiness in the ears, which can feel like "being under water."
It may impair children's hearing.
Children who are susceptible to OME can have frequent episodes for more than half of their first 3 years of life.
Most episodes will resolve within 3 months, but 30 - 40% of children may have recurrent episodes. Only 5 - 10% of episodes last longer than 1 year.

Chronic Otitis Media. This condition refers to persistent fluid behind the tympanic membrane without any infection present. It is called suppurative chronic otitis when there is persistent inflammation in the middle ear or mastoids, or chronic rupture of the eardrum with drainage.

Swimmer’s Ear (Acute Otitis Externa). Acute otitis externa (AOE) is an inflammation or infection of the outer ear and ear canal. It can be triggered by water that gets trapped in the ear. The trapped water can cause bacteria to breed. AOE can also be precipitated by overly aggressively scratching or cleaning ears or when an object gets stuck in the ears.

In 2006, the American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) issued their first guidelines for management of AOE. A key recommendation is that AOE should be treated with topical (not oral) antibiotics. For pain relief, over-the-counter remedies such as acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) usually help, but in severe cases opioid drugs may be prescribed. With eardrops, most cases of AOE will clear up within 2 - 3 days.

Causes

Bacteria. Certain bacteria are the primary causes of acute otitis media (AOM). They are detected in about 60% of cases. The bacteria most commonly causing ear infections are:

Streptococcus pneumoniae (also called S. pneumoniae or pneumococcus) is the most common bacterial cause of acute otitis media, causing about 40 - 80% of cases in the U.S.
Haemophilus influenzae, the next most common culprit, is responsible for 20 - 30% of acute infections.
Moraxellacatarrhalis is responsible for 10 - 20% of infections.
Other bacteria include Streptococcus pyogenes and Staphylococcus aureus.

Viruses. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. It is not the direct infecting organism, however. But other viruses, such as respiratory syncytial virus (RSV, a virus responsible for childhood respiratory infections) and influenza (flu), may be the actual causes of some ear infections. Increasing evidence suggests that both viruses and bacteria play a role in ear infections. Viruses can increase middle ear inflammation and interfere with antibiotics’ efficacy in treating bacterial-causes ear infections. HIV or other immunocompromised states also increase the risk for ear infections.

Acute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to infections by specific organisms in the middle ear. The infection typically evolves as follows:

The primary setting for ear infections is in a child's Eustachian tube, which runs from the middle ear to the nose and upper throat. The Eustachian tube is shorter and smaller in children than adults, and therefore more vulnerable to blockage. It is also more horizontal in younger children and therefore does not drain as well.
Changes in middle ear pressure occur in about two-thirds of children with colds. Colds and respiratory infections are caused by viruses, such as the rhinovirus. Viruses play an important role in many ear infections, and can set the scene for a bacterial infection.
However, many bacteria normally thrive in the passages of the nose and throat. Most are not harmful. In fact, some can even block harmful bacteria from getting out of control. An additional defense system in the airways, such as mucus, prevents the harmful bacteria from spreading and infecting deeper passages, such as those in the ear.
If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly. Fluid builds up. The defense systems described above become inefficient, and the fluid becomes a breeding ground for bacteria and subsequent infection.

Respiratory viruses may also contribute directly to the infection. Allergens can also produce inflammation and blockage in the Eustachian tube, which creates an environment favorable to bacteria.

The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as asthma, allergies, and sinusitis. For example, the same bacteria are often responsible for both ear infections and sinusitis. In one study, 38% of children with ear infections also had sinusitis, and other studies have reported that nearly half of children with OME have concurrent sinusitis. Data indicate that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute otitis media.

Medical or Physical Conditions that Affect the Middle Ear. Any medical or physical condition that reduces the ear's defense system can increase the risk for ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections. Inborn structural abnormalities, such as cleft palate, increase risk. Genetic conditions, such as Kartagener's syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk. Children with Down syndrome or Fetal Alcohol Syndrome may also be at increased risk due to anatomical abnormalities.

Otitis media with effusion (OME) may occur spontaneously following an episode of acute otitis media. Susceptibility to OME may also be due to an abnormal or malfunctioning Eustachian tube that causes a negative pressure in the middle ear, which allows fluid to leak in through capillaries.

Risk Factors

Acute ear infections account for 15 - 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees the doctor. Furthermore, the rate of acute otitis media has been rising over the past decades.

Acute Otitis Media (AOM). About two-thirds of children will have a least one attack of AOM by age 3, and a third of these children will have at least 3 episodes. Boys are more likely to have infections than girls.

AOM generally affects children ages 6 - 18 months. The earlier a child has a first ear infection, the more susceptible they are to recurrent episodes (for instance, 3 or more episodes within a 6-month period).

As children grow, however, the structures in their ears enlarge and their immune systems become stronger. By 16 months, the risk for recurrent infections is rapidly declining. After age 5, most children have outgrown their susceptibility to any ear infections.

Otitis Media with Effusion. OME is very common in children aged 6 months to 4 years, with about 90% of children having OME at some point. More than 50% of children have OME before the age of 1, and more than 60% by age 2.

Ear infections are more likely to occur in the fall and winter. The following conditions also put children at higher risk for ear infection:

Allergies. Some experts believe that an increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. Studies indicate that 40 - 50% of children over 3 years old who have chronic otitis media also have allergic rhinitis (hay fever). Allergies can cause inflammation in the airways, which may contribute to ear infections. Allergies are also associated with asthma and sinusitis. However, a causal relationship between allergies and ear infections has not been definitively established.
Enrollment in day care. Although ear infections themselves are not contagious, the respiratory infections that precipitate them can pose a risk for children with close and frequent exposure to other children. Some experts believe that the increase in ear and other infections may be due to the higher attendance of very small children, including infants, in day care centers beginning in the 1970s.
Exposure to second-had cigarette smoke. Parents who smoke pose a significant risk for both otitis media with effusion (OME) and recurrent acute otitis media (AOM) in their children. (Passive smoking does not appear to be a cause of initial ear infections, however.)
Being bottle-fed as infants. Babies who are bottle-fed may have a higher risk for otitis media than breastfed babies. The American Academy of Pediatrics recommends breastfeeding for at least the baby's first 6 months.
Pacifier use. Several studies have found that the use of pacifiers place children at even higher risk for ear infections. Sucking increases production of saliva, which helps bacteria travel up the Eustachian tubes to the middle ear.
Obesity. Obesity has been associated with the occurrence of OME.
Having siblings with recurrent ear infections.
Anatomical abnormalities of upper airways.

Symptoms

Symptoms of acute otitis media usually develop suddenly and can include:

Pain or discomfort in the ear. However, it is difficult to determine if an infant or child who hasn't yet learned to speak has an ear infection. Some children may indicate pain if they have trouble swallowing food and rejecting it. Some parents believe that tugging on the ear indicates an infection, but this gesture is more likely to indicate pain from teething.
Coughing
Nasal congestion
Fever
Irritability
Sleeplessness
Loss of appetite
Vomiting
Diarrhea
Listlessness

If the ear infection is severe, the tympanic membrane may rupture, causing the parent to notice pus draining from the ear. (This usually brings relief from pain.) Pus in the ear may cause hearing loss in some children.

Fevers and colds often make children irritable and fussy, so it is difficult to determine if acute otitis media is present as well. Symptoms are not apparent in about a third of children with acute middle ear infection.

OME often has no symptoms at all. Some hearing loss may occur, but it is often fluctuating and hard to detect, even by observant parents. The only sign to a parent that the condition exists may be when a child complains of "plugged up" hearing. Other symptoms can include loud talking, not responding to verbal commands, and turning up the television or radio.

Older children with OME may have difficulty targeting specific sounds in a noisy room. In such cases, some parents or teachers may attribute their behavior to lack of attention or even to an attention deficit disorder. OME is often diagnosed during a regular pediatric visit.

Prognosis

Doctors should carefully evaluate ear infections in infants fewer than 3 months old, and consider more serious infections, such as meningitis.

While severe cases of recurrent acute otitis media or persistent otitis media with effusion (OME) are associated with impaired hearing for a period of time, the long-term consequences resulting from this hearing loss may not be significant in most children.

Hearing loss in children may temporarily slow down language development and reading skills. However, results from a high quality study strongly indicate that uncomplicated chronic middle ear effusion poses no danger for developmental delays. Researchers evaluated children who had either prompt insertion of ear tubes to drain fluid when they were younger than age 3, or delayed insertion of tubes many months later. When the children were tested at ages 9 - 11, researchers found no differences in speech and language, auditory processing, attention, behavior, social skills, and academic achievement. As the majority of chronic ear effusion cases eventually clear up on their own, many experts now recommend against surgical intervention for most children.

Occasionally, patients with chronic otitis media develop involvement of the inner ear. In these situations hearing loss can potentially be permanent. Most of these patients will also have problems with vertigo.

Serious complications or permanent physical injuries from ear infections are very uncommon, but may include:

Structural damage. Certain children with severe or recurrent otitis media may be at risk for structural damage in the ear, including erosion of the ear canal.
Cholesteatomas. Cysts in the ear called cholesteatomas are an uncommon complication of recurrent or severe ear infections.
Calcifications. In rare cases, even after a mild infection, some children develop calcification and hardening in the middle and, occasionally, in the inner ear. This may be due to immune abnormalities.

Before the introduction of antibiotics, mastoiditis (an infection in the bones located in the skull), was a serious, albeit rare, complication of otitis media. This condition is difficult to treat and requires intravenous antibiotics and drainage procedures. Surgery may be necessary.

If pain and fever persist in spite of antibiotic treatment of otitis media, the doctor should check for mastoiditis. Most cases of mastoiditis are generally not associated with ear infections.

If an infection of the mastoid air cells cannot be controlled with antibiotics, surgery may be needed.

Impaired Balance. Some studies have indicated that children with chronic OME have problems with motor development and balance.

Facial Paralysis. Very rarely, a child with acute otitis media may develop facial paralysis, which is temporary and usually relieved by antibiotics or possibly drainage surgery. Facial paralysis may also occur for patients with chronic otitis media and a cholesteatoma (cyst in the middle ear). Surgery is often necessary to correct this condition.

Diagnosis

The doctor should be sure to ask the parent if the child has had a recent cold, flu, or other respiratory infection. If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the doctor should rule out any other causes. These may include, but are not limited to, the following:

Otitis media with effusion. OME is commonly confused with acute otitis media. It must be ruled out because it does not respond to antibiotics.
Dental problems (such as teething).
Infection in the outer ear. Symptoms include pain, redness, itching, and discharge. Infection in the outer ear, however, can be confirmed by wiggling the ears, which will produce pain. (This movement will have no significant effect if the infection is in the middle ear.)
Foreign objects in the ear. This can be dangerous. A doctor should always check for this first when a small child indicates pain or problems in the ear.
Viral infection can produce redness and inflammation. Such infections, however, are not treatable with antibiotics and resolve on their own.
A parent's or child's attempts to remove earwax.
Intense crying can cause redness and inflammation in the ear.

Instruments Used for Examining the Ear. An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and may not cause symptoms.

The doctor first removes any ear wax (called cerumen) in order to get a clear view of the middle ear.
The doctor uses a small flashlight-like instrument called an otoscope to view the ear directly. This is the most important diagnostic step. The otoscope can reveal signs of acute otitis media, bulging eardrum, and blisters.

An otoscope is a tool that shines a beam of light to help visualize and examine the condition of the ear canal and eardrum. Examining the ear can reveal the cause of symptoms such as an earache, the ear feeling full, or hearing loss.

To determine an ear infection, the doctor should always use a pneumatic otoscope. This device detects any reduction in eardrum motion. It has a rubber bulb attachment that the doctor presses to push air into the ear. Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum's movement.
Some doctors may use tympanometry to evaluate the ear. In this case, a small probe is held to the entrance of the ear canal and forms an airtight seal. While the air pressure is varied, a sound with a fixed tone is directed at the eardrum and its energy is measured. This device can detect fluid in the middle air and also obstruction in the Eustachian tube.
A procedure similar to tympanometry, called reflectometry, also measures reflected sound. It can detect fluid and obstruction, but does not require an airtight seal at the canal.

Neither tympanometry nor reflectometry are substitutes for the pneumatic otoscope, which allows a direct view of the middle ear.

Findings Indicating AOM or OME. A diagnosis of AOM requires all three of the following criteria:

History of recent sudden symptoms. Symptoms may include fever, pulling on the ear, pain, irritability, or discharge (otorrhea) from the ear.
Presence of fluid in the middle ear. This may be indicated by fullness or bulging of the eardrum or limited mobility.
Signs and symptoms of inflammation. These may include redness of the eardrum as well as assessment of the child's discomfort. Ear pain that is severe enough to interfere with sleep may indicate inflammation.

AOM (fluid and infection) is often difficult to differentiate from OME (fluid without infection). It is important for a doctor to make this distinction as OME does not require antibiotic treatment. In patients with OME, an air bubble may be visible and the eardrum is often cloudy and very immobile. A scarred, thick, or opaque eardrum may make it difficult for the doctor to distinguish between acute otitis media and OME.

Parents can also use a sonar-like device, such as the EarCheck Monitor, to determine if there is fluid in their child's middle ear. EarCheck uses acoustic reflectometry technology, which bounces sound waves off the eardrum to assess mobility. When fluid is present behind the middle ear (a symptom of AOM and OME), the eardrum will not be as mobile. The device works like an ear thermometer and is painless. Results indicate the likelihood of the presence of fluid and may help patients decide whether they need to contact their child's doctor. However, it is not recommended that children be treated with antibiotics based on the findings using this device.

On rare occasions the doctor may need to draw fluid from the ear using a needle for identifying specific bacteria, a procedure called tympanocentesis. This procedure can also relieve severe ear pain. This is most often performed by an ear, nose, and throat (ENT) specialist, and usually only in severe or recurrent cases. In most cases, tympanocentesis is not necessary in order to obtain an accurate enough diagnosis for effective treatment.

Hearing tests performed by an audiologist are usually recommended for children with persistent otitis media with effusion. A hearing loss below 20 decibels usually indicates problems.

Determining Impaired Hearing in Infants and Small Children. Unfortunately, it is very difficult to test children under 2 years old for hearing problems. One way to determine hearing problems in infants is to gauge the baby's language development:

At 4 - 6 weeks most babies with normal hearing make cooing sounds.
By around 5 months, infants should be laughing out loud and making one-syllable sounds with both a vowel and consonant.
Between 6 - 8 months, babies should be able to make word-like sounds with more than one syllable.
Usually starting around 7 months, and by 10 months, babies babble (making many word-like noises).
Around 10 months, babies can identify and use some term for a parent, such as dada, baba, or mama.
Babies speak their first word usually by the end of their first year.

If a child's progress is significantly delayed beyond these times, a parent should suspect possible hearing problems.

Determining Impaired Hearing in Older Children. Hearing loss in older children may be detected by the following behaviors:

They may not respond to speech spoken beyond 3 feet away.
They may have difficulty following directions.
Their vocabulary may be limited.
They may have social and behavioral problems.

Prevention

The best way to prevent ear infections is to prevent colds and flu.

Good Hygiene. Colds and flus are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash their hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleaners that contain an alcohol-based gel are also effective for everyday use and may even kill cold viruses. (They are less effective, however, if extreme hygiene is required. In such cases, alcohol-based rinses are needed.) Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia and has been associated with ear infections. Wiping surfaces with a solution that contains 1 part bleach to 10 parts water is very effective in killing viruses.

The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control (CDC) recommend annual influenza vaccination for all children 6 months to 5 years of age. Preventing influenza (the "flu') may be a more important protective measure against ear infections than preventing bacterial infections. For example, studies report that children who are vaccinated against influenza experience a third fewer ear infections during flu season than unvaccinated children.

Flu Vaccines. Flu vaccines produce an immune response that attacks the active virus. Vaccines are typically given by injection, usually between October and December. Antibodies to the influenza virus generally develop within 2 weeks of vaccination, and immunity peaks within 4 - 6 weeks, then gradually wanes. An intranasal vaccine called FluMist is approved for children ages 2 years and older. FluMist is made from a live but weakened influenza virus; flu shots use inactivated (not live) viruses. Children younger than 2 years old, and children younger than age 5 who have asthma or recurrent wheezing, should not receive FluMist.

Possible side effects include:

Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
Soreness at the Injection Site. Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 - 2 days afterward.
Flu-like Symptoms. Other side effects include mild fatigue and muscle aches and pains. They tend to occur between 6 - 12 hours after the vaccination and last up to 2 days. These symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.

Antiviral Drugs. Antiviral drugs are available to treat influenza. One such drug, oseltamivir (Tamiflu), is approved for use in children age 1 year and older. Studies report significant reduction in symptoms and in the incidence of ear infections with this drug. In another study, when the antiviral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle ear abnormalities were reduced by more than half, to 32%. This drug is available for children older than 7 years for treatment of influenza, but no research has determined its value for preventing or treating otitis media in children.

[For more information, see In-Depth Report #94: Colds and influenza.]

Preventive Antibiotics. Antibiotics have been used to prevent bacterial infections in children with recurrent ear infections (4 or more episodes a year). Studies suggest, however, that overall they only prevent 1 episode a year, and are not generally recommended for prevention, except for specific situations.

Pneumococcal Vaccine. The pneumococcal conjugate vaccine (PCV) protects against S. pneumoniae (also called pneumococcal) bacteria in children, the most common cause of middle ear infections, pneumonia, and other respiratory infections. It is included in the Recommended Childhood Immunization Schedule and is specifically approved for preventing otitis media. High quality evidence indicates these vaccinations could result in over 1.5 million fewer office visits, over 20% fewer procedures for tube implants, and significantly fewer antibiotic prescriptions. The recommended schedule of pneumococcal immunization is four doses, given at 2, 4, 6, and 12 - 15 months of age.

Still, the pneumococcal vaccine does not completely protect against otitis media. The current pneumococcal vaccine does not protect against all subtypes of S. pneumoniae. Also, other types of bacteria can cause the problem. Scientists are working on developing a new type of pneumococcal vaccine that combines S. pneumoniae and H. influenzae strains that are not influenced by the currently available H. influenzae vaccine. Researchers hope this investigational vaccine may eventually help prevent middle ear infection caused by these organisms.

Healthy Diet. Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system.

Probiotics ("Good" Bacteria). Researchers are studying the possible protective value of certain strains of lactobacilli, bacteria found in the intestines. Some of these strains, particularly acidophilus, are used to make yogurt. Studies have been mixed on probiotics’ benefits for preventing ear infections.

Xylitol. Xylitol, a sugar alcohol produced naturally in birch, strawberries, and raspberries, has properties that fight Streptococcal pneumonia bacteria. A few studies have reported that children who chew gum or swallow a syrup containing xylitol experience fewer ear infections, but other studies have not shown that xylitol is helpful.

Parents or others should not smoke around children. Several studies have found that children who live with smokers have a significant risk for ear infections.

Breastfeeding offers protection against many early infections, including ear infections. Mother's milk provides immune factors that help protect the child from infections. Also, infants are held during breast-feeding in a position that allows the Eustachian tubes to function well. In addition, a 2006 study suggested that breastfeeding can help protect even those children who are genetically susceptible to ear infections.

If possible, new mothers should breast-feed their infants for at least 4 - 6 months. According to the American Academy of Pediatrics, exclusively breast-feeding for a baby’s first 6 months helps to prevent ear and other respiratory infections. For bottle-fed babies, to improve protection mothers should not lay babies down with their bottle; they should hold the infants in the same way they would to breast-feed them.

Treatment

Treatments for ear infections cost the U.S. $3 - 4 billion each year, and many of these treatments, particularly heavy antibiotic use and surgical procedures, are often unnecessary in many children.

Experts continue to argue about the best approach for treating ear infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME).

Until recently, nearly every American child with an ear infection who visited a doctor received antibiotics. In one region of the U.S., more than 70% of children received antibiotics before they were 7 months old, and the most common reason for these medications was acute otitis media.

Major studies now indicate that antibiotics are unnecessary in most cases of acute otitis media. Between 80 - 90% of all children with uncomplicated ear infections recover within a week without antibiotics. Likewise, receiving antibiotics for an acute ear infection does not seem to prevent children from having fluid behind the ears after the infection is cleared up. Antibiotics are rarely recommended for otitis media with effusion.

Antibiotic Resistance. The intense and widespread use of antibiotics is leading to a serious global problem of bacterial resistance to common antibiotics. In the U.S., nearly a quarter of S. pneumoniae are currently resistant to at least three antibiotics. High rates of resistance strains are even being observed in infants. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are the most heavily prescribed.

Watchful Waiting for AOM. Because of the high rate of antibiotic resistance, and the fact that non-severe AOM usually resolves on its own without antibiotics, many pediatric guidelines recommend a “watchful waiting” period before antibiotics are prescribed. Current guidelines released by the American Academy of Pediatrics and the American Academy of Family Physicians recommend an initial observation period of 48 - 72 hours for select children. Pain relief can initially be given with acetaminophen (Tylenol), ibuprofen (Advil), or topical benzocaine drops.

If there is no improvement or symptoms worsen, parents can schedule an appointment with the child's doctor to determine if antibiotics are needed. (Parents should contact the doctor within the first 24 hours if their child is 6 months or younger and has fever or other severe symptoms.) Another option is to ask the doctor for a Safety Net Antibiotic Prescription (SNAP) that can be filled if symptoms do not improve within 48 - 72 hours

While children with non-severe AOM given antibiotics may recover slightly more quickly, they often have a high number of side effects and antibiotic-resistant bacterial strains. Studies have found that giving parents the option of delaying antibiotic treatment helps to reduce the unnecessary use of antibiotics without causing any health problems for the children. Unfortunately, surveys indicate that although medical guidelines recommend watchful waiting, few doctors regularly practice it.

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) guidelines and recent evidence support the following recommendations:

Accurate diagnosis of AOM including differentiation from OME.
Children fewer than 6 months of age should receive immediate antibiotic treatment.
Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen.
An initial observation period of 48 - 72 hours is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment. (Most children do improve within 72 hours.)
For children aged 6 months - 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe. For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis. Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2° F (39° C).
Antibiotic prophylaxis may be recommended for recurrent acute otitis media. Which children should be treated this way, as well as which antibiotics and for how long, have not been clearly determined.

The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME in 2004. These guidelines include the following treatment recommendations:

Watchful Waiting for OME. The child is typically monitored for the first 3 months. Antibiotics are not helpful for most patients with OME. For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. About 75 - 90% of OME cases that result from AOM resolve within 3 months. If OME last longer than 3 months, a hearing test should be conducted. Even if OME lasts for longer than 3 months, the condition generally resolves on its own without any long term effects on language or development and intervention may not be necessary. The doctor will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss.

Drug Treatment. It is important for parents to recognize that persistent fluid behind the eardrum after treatment for acute otitis media does not indicate failed treatment. Antibiotics, decongestants, antihistamines and corticosteroids do not help and are not recommended for routine management of OME. These drugs are not effective for OME, either when used alone or in combination. Antihistamines and decongestants may cause more harm than good by provoking side effects such as stomach upset and drowsiness. At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established.

Surgery. The decision to pursue surgery must be determined on an individual basis. Children with OME lasting longer than 4 months may be considered candidates for surgery if they have:

Hearing loss greater than 40 dB
Hearing loss between 21 - 39 dB (Children in this group may be observed or considered for surgery)
Hearing loss of 20 dB or less, when speech, language, or developmental problems are observed
OME and structural damage to the ear canal, eardrum, or middle ear

Tympanostomy (the insertion of tubes into the eardrum) is the first choice for surgical intervention. Adenoidectomy (removal of adenoids) plus myringotomy (removal of fluid), with or without tube insertion, is sometimes recommended as a repeat surgical procedure. (Myringotomy alone is not recommended for OME treatment. Between 20 - 50% of children who undergo this procedure may have OME relapse and need additional surgery). Tube insertion may be advised for children younger than 4 years of age. Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.

Tonsillectomy (removal of tonsils) is not recommended for OME treatment.

Home Remedies

Careful monitoring of the child's condition (watchful waiting) along with home remedies may be a viable alternative to antibiotic treatment for many children with a first episode of acute otitis media. However, in some situations parents should contact their medical professional immediately:

Seek immediate medical attention for high fever, severe pain, or other signs of complications.
Parents of infants should contact their doctor immediately if they have any fever, regardless other symptoms.

Before antibiotics, parents used home remedies to treat the pain of ear infections. Now, with current concern over antibiotic overuse, many of these remedies are again popular.

Depending on regional cultures, parents may have pressed a warm water bottle or warm bag of salt against the ear. Such old-fashioned remedies may still help to ease ear pain.
Due to the high risk of burns, ear candles should not be used to remove wax from ears. There is no evidence to indicate that these candles are safe or effective for treatment of AOM or other ear conditions.

Herbal remedies are not standardized or regulated, and their quality and safety are largely unknown. Parents should never give their child herbal remedies, including oral remedies, without approval from a doctor.

Valsalva's Maneuver. A simple technique called the Valsalva's maneuver is useful in opening the Eustachian tubes and providing occasional relief from the chronic stuffy feeling accompanying otitis media with effusion. It may also be useful for unplugging ears during air travel descent as well. It works as follows:

The child takes a deep breath and closes the mouth.
The child then blows the nose gently while, at the same time, pinching it firmly shut.
The parent should be sure to instruct the child not to blow too hard or the eardrum could be harmed.

Do not use this technique if an infection is present.

A number of pain relievers are available to help relieve symptoms.

Either acetaminophen (Tylenol) or ibuprofen (Advil) is the pain-reliever of choice in children.
Older children may be able to take prescription pain relievers that contain codeine if the pain is severe.
Eardrops containing anesthetics (Auralgan) are also available by prescription. Auralgan provides short-acting pain relief and may help children endure ear discomfort until an oral pain reliever takes effect. Parents should check with a doctor before using them. Eardrops could cause damage in children who have a ruptured eardrum. This might be indicated by fluid drainage from the ear canal.

Note: Aspirin and aspirin-containing products are not recommended for children or adolescents. Reports of Reye syndrome, a very serious condition, have been associated with aspirin use in children who have chicken pox or flu.

Many non-prescription products are available that combine antihistamines, decongestants, and other ingredients, and some are advertised as cold remedies for children. Researchers have found little or no benefits for acute otitis media or for otitis media with effusion using decongestants (either oral or nasal sprays or drops), antihistamines, or combination product. Their use is not recommended for AOM or OME. Recent research has questioned the general safety of these products and they are currently banned for use in children under age 2 years.

Swimming can pose specific risks for children with current ear infections or previous surgery. Water pollutants or chemicals may exacerbate the infection, and underwater swimming causes pressure changes that can cause pain. The following precautions should be taken:

Children with ruptured acute otitis media (drainage from ear canal) should not go swimming until their infections are completely cured.
Children with AOM that is not ruptured should not dive or swim underwater.
Some doctors recommend that children with implanted ear tubes should use earplugs or cotton balls coated in petroleum jelly when swimming to prevent infection. Others say earplugs are only necessary if the child will be diving underwater. Parents should consult their child's doctor.

Medications

When antibiotics are needed, a number of different classes are available for treating acute ear infections. Amoxicillin is a penicillin antibiotic and the drug of first choice. Other antibiotics are available for children who are allergic to penicillin or who do not respond within 2 - 3 days.

Duration. If a child needs antibiotics for acute otitis media, experts recommend they be taken for the following periods of time:

A 10-day course of antibiotics is usually recommended for children younger than 6 years of age, and for those with severe AOM.
Antibiotic therapy for 5 - 7 days is recommended for children 6 years of age or older with mild-to-moderate symptoms.

Parents should be sure their child finishes the entire course of therapy. Failure to finish is a major factor in the growth of bacterial strains that are resistant to antibiotics.

What to Expect. Earaches usually resolve within 24 hours after taking an antibiotic, although about 10% of children who are treated do not respond. This may occur when a virus is present or if the bacteria causing the ear infection is resistant to the prescribed antibiotic. A different antibiotic may be needed.

In some children whose treatment is successful, fluid will still remain in the middle ear for weeks or months, even after the infection has resolved. During that period, children may have some hearing problems, but eventually the fluid almost always drains away. Antibiotics should not be used to treat residual fluid.

Follow-Up. Your child should return to the doctor's office:

Two to 3 weeks after therapy, if initial therapy cleared up the infection and the child is less than 15 months old, or has risk factors for reinfection
Three to 6 weeks after treatment, if initial therapy cleared up the infection and the child is older than 15 months old and has no specific risk factors
Within 48 hours of taking the last antibiotic dose if signs of infection are still present (for example, there is still pus in the ear)

When suspecting complications, consult with an ear, nose, and throat specialist (otolaryngologist) . This specialist may perform a tympanocentesis or myringotomy, procedures in which fluid is drawn from the ear and examined for specific organisms. But, this is reserved for severe cases.

The selection of an antibiotic is determined in part by the severity of the child's condition as well as a history of response/non-response to antibiotic therapy. Treatment decisions take into account whether the child's condition is severe or non-severe.

Amoxicillin is generally recommended for first-line treatment of AOM. The combination drug amoxicillin-clavunate is prescribed for patients who have severe pain or a fever higher than 102.2° F(39° C). Other drug classes may be prescribed if a child is allergic to penicillin or does not respond to the initial therapy.

The following treatment guidelines provide general recommendations based on the severity of a child's AOM.

First-line treatment for non-severe AOM:

Amoxicillin 80 - 90 mg/kg per day orally. Amoxicillin is a penicillin antibiotic.

If the patient has an allergy or a history of non-response to penicillin drugs, one of the following antibiotics may be prescribed:

Azithromycin or clarithromycin. These drugs are in the macrolide class and are administered orally.
Cefdinir, cefuroxime, or cefpodoxime. These drugs, classified as cephalosporins, are taken by mouth. They may cause reactions in penicillin-allergic patients.

If the patient does not respond to amoxicillin or alternative antibiotic drugs after 48 - 72 hours, one of the following drugs may be prescribed:

Amoxicillin-clavulanate, clindamycin, or ceftriaxone. Ceftriaxone is injected intramuscularly. The other two drugs are administered orally. Each of these drugs is a different type of antibiotic. Amoxicillin-clavulanate (Augmentin) is classified as a penicillin; ceftriaxone (Rocephin) is a cephalosporin; clindamycin (Cleocin) is a lincosamide.

First-line treatment for severe AOM:

Amoxicillin-clavulanate (Augmentin). This antibiotic is known as an augmented penicillin. It works against a wide spectrum of bacteria and is administered orally.

Second-line treatment for severe AOM:

Ceftriaxone. Ceftriaxone (Rocephin) is an injectable cephalosporin that may be prescribed as an alternative to amoxicillin-clavulanate, especially for children who have vomiting or other conditions that hamper oral administration.
Tympanocentesis or clindamycin. Patients with severe AOM who have failed to respond to amoxicillin-clavulanate after 48 - 72 hours may require the withdrawal of fluid from the ear (tympanocentesis) in order to identify the bacterial strain causing the infection. If tympanocentesis cannot be performed, clindamycin may be prescribed orally to treat penicillin-resistant pathogens that have not responded to prior drug therapy.

The most common side effects of nearly all antibiotics are gastrointestinal problems, including cramps, nausea, vomiting, and diarrhea. This can be a significant problem in infants and small children. One study reported that giving such children a soy-based formula that contained fiber (Isomil DF) was helpful in reducing these side effects.
Amoxicillin use during infancy may lead to enamel defects and discolorations of permanent teeth.
Allergic reactions can also occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
Some drugs, including certain over-the-counter medications, interact with antibiotics. Parents should tell the doctor about all medications their children are taking.

Surgery

A tympanostomy involves the insertion of tubes to allow fluid to drain from the middle ear. The procedure involves:

A general anesthetic (asleep, no pain). Children typically recover completely within a few hours.
Myringotomy (removal of fluid) is performed first.
After myringotomy, the doctor inserts a tube to allow continuous drainage of the fluid from the middle ear.

Click the icon to see an illustrated series detailing ear tube insertion.

Postoperative Effects. Tympanostomy is a simple procedure, and the child almost never has to spend the night in the hospital. Acetaminophen (Tylenol) or ibuprofen (Advil) is sufficient for any postoperative pain in most children. Some children, however, may need codeine or other powerful pain relievers.

Generally, the tubes stay in the eardrum for at least several months before coming out on their own. On rare occasions, they will need to be surgically removed.

Complications. Otorrhea, drainage of secretion from the ear, is the most common complication after surgery and can be persistent in some children. It is usually treated with antibiotic eardrops. One study suggests that wearing earplugs may help the problem.

More serious complications from the operation are very uncommon, but may include:

General anesthetic risks. Rarely, allergic reactions or other complications, such as throat spasm or obstruction, may occur. The risk is highest in children who have other medical conditions, most commonly upper respiratory infections, lung disease, or GERD. Anesthetic-related risks are nearly always easily treated.
Tube blockage. Sometimes the tubes become blocked from sticky secretions or clotted blood after the operation.
Persistent eardrum perforation. This condition occurs when the eardrum does not close after the tubes have come out. It is the most common serious complication, but it is very rare.
Scarring can also occur, particularly in children who need more than one procedure, but it almost never affects hearing.
Small keratin (skin cell) containing cysts called cholesteatomas develop around the tube site in around 1% of patients.

Success Rates. Hearing is almost always restored following tympanostomy. Failure to achieve normal or near-normal hearing is usually due to complicated conditions, such as preexisting ear problems or persistent OME in children who have had previous multiple tympanostomies. Persistent fluid is the main reason for continued impaired hearing. Only a small percentage of hearing loss cases can be attributed to complications of the operation itself.

Earplugs as a Precaution. Many doctors feel that children should use earplugs when swimming while the tubes are in place in order to prevent infection. Others feel that as long as the child does not dive or swim underwater, earplugs may not be necessary. Parents should talk to their child's doctor about this subject. Cotton balls coated with petroleum jelly are effective alternatives to ear plugs. Children do not need to wear earplugs while showering.

Follow-Up. Eventually, the tubes fall out as the hole in the eardrum closes. This may happen after several months or more than a year later. It is painless. In fact, the patient and parents may not even be aware that the tubes are out.

About 20 - 50% of children may have OME relapse and need additional surgery that involves adenoidectomy and myringotomy. Tube reinsertion may be recommended for children younger than 4 years of age.

Myringotomy is used to drain the fluid and may be used (with or without ear tube insertion) in combination with adenoidectomy as a repeat surgical procedure if initial tympanostomy is not successful. It is not effective as a sole surgical procedure. Myringotomy involves the following steps:

The surgeon makes a very small incision in the eardrum.
Fluid is sucked out using a vacuum-like device.
The fluid is usually examined for identifying specific bacteria.
The eardrum heals in about a week.

Adenoids are collections of spongy lymph tissue in the back of the throat, similar to the tonsils. Removal of the adenoids, called adenoidectomy, is usually only considered for OME if a pre-existing condition exists such as chronic sinusitis, nasal obstruction, or chronic adenoiditis (inflammation of the adenoids). Unless these conditions exist, adenoidectomy is not recommended for treatment of OME.

Adenoidectomy plus myringotomy (removal of fluid) may be performed if an initial tympanostomy (tube insertion) procedure is unsuccessful in resolving OME. This combination procedure works best in children ages 4 years or older. Tube insertion is recommended for children under 4 years of age. It is not necessary to perform an adenoidectomy along with tube insertion for children under 4 years of age.

Click the icon to see an image of the adenoids.

Laser-assisted myringotomy is a technique that is being investigated as an alternative to conventional tympanostomy and myringotomy. At present, there is not enough evidence to say whether it is as good as ear tubes, the standard procedure. Some clinical trials have suggested that the success rate for laser-assisted myringotomy is half that of standard tympanostomy/myringotomy. Many insurance companies consider laser-assisted myringotomy to be an investigational procedure and will not pay for it.

Resources

www.nidcd.nih.gov -- National Institute on Deafness and Other Communication Disorders
www.aap.org -- American Academy of Pediatrics
www.entnet.org -- American Academy of Otolaryngology, Head and Neck Surgery

References

American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004 May;113(5):1412-29.

American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents -- United States, 2007. Pediatrics. 2007 Jan;119(1):207-8.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004 May;113(5):1451-65.

Belshe RB, Edwards KM, Vesikari T, Black SV, Walker RE, Hultquist M, et al. Live attenuated versus inactivated influenza vaccine in infants and young children. N Engl J Med. 2007 Feb 15;356(7):685-96.

Dohar J, Giles W, Roland P, Bikhazi N, Carroll S, Moe R, et al. Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acidin acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2006 Sep;118(3):e561-9.

Griffin GH, Flynn C, Bailey RE, Schultz JK. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003423.

Hautalahti O, Renko M, Tapiainen T, Kontiokari T, Pokka T, Uhari M. Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. Feb 2008;134(2):128-132.

Leach AJ, Morris PS. Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004401.

Little P. Delayed prescribing -- a sensible approach to the management of acute otitis media. JAMA. 2006 Sep 13;296(10):1290-1.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007 Jan 18;356(3):248-61.

Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet. 2006 Mar 4;367(9512):740-8.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007 Dec 1;76(11):1650-8.

Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am. 2006 Dec;39(6):1237-55.

Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S4-23.

Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S24-48.

Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet. 2006 Oct 21;368(9545):1429-35.

Ruohola A, Meurman O, Nikkari S, Skottman T, Salmi A, Waris M, et al. Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis. 2006 Dec 1;43(11):1417-22.

Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41.

Review Date:
2/19/2008
Reviewed By:
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

adam.com

Weight problems and children

admin — Thu, 04 Sep 2008 18:50:23 -0700

Overview

Alternative Names
Information

Illustrations

Childhood obesity

HEALTH GUIDE REFERENCE FROM A.D.A.M

Alternative Names

Children and weight problems

Information

In the U.S., at least one out of five kids is overweight. The number of overweight children continues to grow. Over the last two decades, this number has increased by more than 50% and the number of "extremely" overweight children has nearly doubled.

A doctor determines if children are overweight by measuring their height and weight. Although children have fewer weight-related health problems than adults, overweight children are at high risk of becoming overweight adolescents and adults. Overweight adults are at risk for a number of health problems including heart disease, diabetes, high blood pressure stroke, and some forms of cancer.

Did You Know That...

Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes, also known as adult-onset diabetes.
Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease.
One of the most severe problems for obese children is sleep apnea (interrupted breathing while sleeping). In some cases this can lead to problems with learning and memory.
Obese children have a high incidence of orthopedic problems, liver disease, and asthma.
Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. In rare cases, a medical problem, such as an endocrine disorder, may cause a child to become overweight. Your doctor can perform a careful physical exam and some blood tests, if necessary, to rule out this type of problem.

Genetic Factors: Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
Lifestyle: A child's total diet and his or her activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child spends approximately 24 hours each week watching television-time that could be spent in some sort of physical activity.

TALK TO YOUR DOCTOR

If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. doctors will measure your child's weight and height to determine if your child's weight is within a healthy range. A doctor will also consider your child's age and growth patterns to determine whether your child is overweight. Assessing overweight in children is difficult because children grow in unpredictable spurts. Based on your child's height and weight, they will calculate a body mass index (BMI). If your child's BMI is greater than 95% of children their age and gender, they are considered to be overweight

For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.

BE SUPPORTIVE

One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that he or she has a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.

FOCUS ON THE FAMILY

Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.

INCREASE YOUR FAMILY'S PHYSICAL ACTIVITY

Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:

Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.

The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.

TEACH YOUR FAMILY HEALTHY EATING HABITS

Teaching healthy eating practices early will help children approach eating with the right attitude-that food should be enjoyed and is necessary for growth, development, and for energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat.

DON'T PLACE YOUR CHILD ON A RESTRICTIVE DIET

Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons. Limiting what children eat may be harmful to their health and interfere with their growth and development.

To promote proper growth and development and prevent overweight, parents should offer the whole family a wide variety of foods from each of the food groups.

Most of the foods in your diet should come from the grain products group (6-11 servings), the vegetable group (3-5 servings), and the fruit group (2-4 servings). (See chart for suggested serving sizes.)
Your diet should include moderate amounts of foods from the milk group (2-3 servings) and the meat and beans group (2-3 servings).
Foods that provide few nutrients and are high in fat and sugars should be used sparingly. Fat should not be restricted in the diets of children younger than 2 years of age.

EXAMPLES OF ONE SERVING

Bread, cereal, rice, pasta

1 slice of bread
1 ounce of ready to eat cereal
1/2 cup of cooked cereal, rice, or pasta

Milk, yogurt, cheese

1 cup of milk or yogurt
1 1/2 ounces of natural cheese
2 ounces of processed cheese

Vegetables

1 cup of raw vegetables or 1/2 cup of frozen leafy leafy vegetables (cooked)
1/2 cup of other vegetables - cooked or chopped raw
3/4 cup of vegetable juice

Meat, poulty, fish, beans, nuts

2-3 ounces of cooked lean meat, poultry, or fish
1/2 cup of cooked dry beans or 1 egg counts as 1 ounce of lean meat
2 tablespoons of peanut butter or 1/3 cup of nuts count as 1 ounce of meat

Fruits

1 medium apple, banana, or orange
1/2 cup of chopped, cooked, or canned fruit
3/4 cup of fruit juice

Serving sizes are for children and adults ages 2 years and older. A range of servings is given for each food group. The smaller number is for children who consume about 1,300 calories a day, such as 2-4 years of age. The larger number is for those who consume about 3,000 calories a day, such as boys 15-18 years of age.

CUT DOWN ON FAT

Reducing fat is a good way to cut calories without depriving your child of nutrients. Simple ways to cut the fat in your family's diet include eating lowfat or nonfat dairy products, poultry without skin and lean meats, and lowfat or fat-free breads and cereals.

Making small changes to the amount of fat in your family's diet is a good way to prevent excess weight gain in children: however, major efforts to change your child's diet should be supervised by a health professional.

In addition, fat should not be restricted in the diets of children younger than 2 years of age. After that age, children should gradually adopt a diet that contains no more than 30 percent of calories from fat by the time the child is about 5 years old.

DON'T OVERLY RESTRICT SWEETS OR TREATS

While it is important to be aware of the fat, salt, and sugar content of the foods you serve, all foods -- even those that are high in fat or sugar -- have a place in the diet (in moderation, of course). However, children should be taught to limit high-calorie soft drinks and foods such as candy and deserts, and salty snacks such as potato chips and french fries.

GUIDE CHOICES RATHER THAN DICTATE FOODS

Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.

ENCOURAGE YOUR CHILD TO EAT SLOWLY

A child can detect hunger and fullness better when eating slowly.

EAT MEALS TOGETHER AS A FAMILY

Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.

INVOLVE CHILDREN IN FOOD SHOPPING AND PREPARING

These activities offer parents hints about children's food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.

PLAN FOR SNACKS

Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at mealtimes. You should make snacks as nutritious as possible, without depriving your child of occasional chips or cookies, especially at parties or other social events. Below are some ideas for healthy snacks.

EXAMPLES OF HEALTHY SNACKS

Fresh, frozen, or canned vegetables and fruit served either plain or with lowfat or fat-free cheese or yogurt
Dried fruit, served with nuts or sunflower or pumpkin seeds
Breads and crackers made with enriched flour and whole grains, served with fruit spread or fat-free cheese
Frozen desserts, such as nonfat or lowfat ice cream, frozen yogurt, fruit sorbet, popsicles, water ice, and fruit juice bars

Warning: Children of preschool age can easily choke on foods that are hard to chew, small and round, or sticky, such as hard vegetables, whole grapes, hard chunks of cheese, rasins, nuts, and seeds, and popcorn. It's important to carefully select snacks for children in this age group.

DISCOURAGE EATING WHILE WATCHING TV

Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.

DON'T USE FOOD TO PUNISH OR REWARD

Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.

MONITOR MEALS OUTSIDE THE HOME

Find out more about your school lunch program, or pack your child's lunch to include a variety of foods. Also, select healthier items when dining at restaurants.

SET A GOOD EXAMPLE

Children are good learners, and they learn best by example. Setting a good example for your kids by eating a variety of foods and being physically active will teach your children healthy lifestyle habits that they can follow for the rest of their lives.

ADDITIONAL HELP

If you need to make changes to your family's eating and exercise habits, but are finding it difficult, a registered dietitian (RD) may be able to help. Your doctor may be able to refer you to an RD, or you can call the National Center for Nutrition and Dietetics of The American Dietetic Association at 800-366-1655 and ask for the name of an RD in your area.

If your efforts at home are unsuccessful in helping your child reach a healthy weight and your doctor determines that your child's health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program. To locate a weight-control program for your child, you may want to contact a local university-based medical center.

Look for the following characteristics when choosing a weight-control program for your child. The program should:

Be staffed with a variety of health professionals. The best programs may include RDs, exercise physiologists, pediatricians or family doctors, and psychiatrists or psychologists.
Perform a medical evaluation of the child. Before being enrolled in a program, your child's weight, growth, and health should be reviewed by a doctor. During enrollment, your child's weight, growth, and health should be monitored by a health professional at regular intervals.
Focus on the whole family, not just the overweight child.
Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those developed for children 8 or 12 years of age in terms of degree of responsibility of the child and parents.
Focus on behavioral changes.
Teach the child how to select a variety of foods in appropriate portions.
Encourage daily activity and limit sedentary activity, such as watching TV.
Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to overweight.

The overall goal of a successful treatment program should be to help the whole family focus on making healthy changes to their eating and activity habits that they will be able to maintain throughout life.

Created by the National Institute of Health. NIH Publication No. 97-4096 and NIH Word on Health, June 2002

Review Date: 10/23/2007

Reviewed By: Daniel Rauch, M.D., FAAP., Director, Pediatric Hospitalist Program, New York University School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_001999

Third Time's a Charm: No Ridiculous Pregnancy Comments

LilSugar — Sun, 04 Oct 2009 04:00:54 -0700

People say the most ridiculous things to pregnant women. While expecting my daughter and son, my jaw constantly dropped at the rude, crude and absent-minded things people said to me...with a straight face. BabySugar encountered the same nonsense while she was with child. But, it appears that the third time is the charm since I can really only recall two off comments people have made to me in the past 40 weeks. The first was about a month ago when I was shopping for a friend's wedding gift and the glass saleswoman told me to sit down before my water broke. She then told me to double check with my doctor because she was sure I was having twins. Thanks lady. The next was a few days later when I ran into an acquaintance who told me she was less than half my size when she had her daughter. "Good for you," was all I could muster as a response.

But those two doozies aside, this has been a low-key pregnancy with lots of perks - like complimentary beverages and servers at my favorite cafes betting on the sex of my baby. Who knew baristas were so into procreating? While stopping to pick up water spiked with a little green tea and a coffee for my husband, three different coffee clerks at separate Starbucks locations gave me free drinks! To hear other sweet gestures I've experienced this time around, read more.
Then, at the farmers market, when I purchased a baguette from a booth, the cashier told me she couldn't possibly charge a lady bringing a baby into the world for bread. In addition to the nice gestures, I haven't been the recipient of much unsolicited advice either. I attribute that to the fact that since I'm traveling with two other kiddos in tow, they either understand I don't have time to chat it up with strangers or they are writing me off as a woman who obviously didn't take the advice offered years ago. Either way, I'm good with it!

Did you experience this during subsequent pregnancies? Share your experiences here and join the Pregnancy Posse over in our LilSugar community!