Conquering Those Growing Pains
Most children will develop at least one ear infection before age 4, when their eustacian tubes are more vulnerable to blockage. Children with infections often cry, pull on their ears, have trouble hearing, or complain of an earache. The infection might clear up nearly as fast without an antibiotic, research now shows, and an over-the counter pain reliever might be just as effective in relieving symptoms. "If a child has a little pain, a little fever, but is still behaving normally, give them some pain medication and see how they do," says Margaretha Casselbrant, a pediatrician and chief of the division of pediatric otolaryngology at the Children's Hospital of Pittsburgh. "If they don't get better in 24 hours, take them to see the doctor."
But parents shouldn't dawdle if the child is very sick-he or she has a fever or is vomiting, for example-or is less than 6 months old. Chronic ear infections can cause balance, hearing, speech, and learning problems if they're not treated. Some of these children may still need minor surgery to have tubes put in their ears to drain fluid.
Prevention remains a puzzle
Special diets. Anti-mite detergent. Hypoallergenic sheets. There are many schools of thought on how parents might keep their young children from getting asthma. "People come to me and ask me, 'Should I have a pet or should I not have a pet?'" says Fernando Martinez, director of the Arizona Respiratory Center and member of a National Institutes of Health advisory panel now working on an update of asthma treatment guidelines. The data, he says, are inconclusive. "I say do whatever your heart tells you."
Indeed, despite lots of effort, no one has yet figured out what works to head off asthma, which inflames the airways and obstructs breathing and, according to the Centers for Disease Control and Prevention, afflicts 9 million children. Inhaled corticosteroids, the most common asthma treatment, are often prescribed to reduce wheezing in high-risk kids-those who also have eczema, a parent with asthma, or allergies to airborne substances-before they get asthma. Many doctors have wondered if these drugs, given at an early age, might have a preventive effect. "Most of the lung function loss that occurs in persistent wheezers occurs before age 6," says Theresa Guilbert, a professor at the University of Arizona, who recently studied the practice in toddlers and showed that it doesn't work.
In May, Guilbert and colleagues reported in the New England Journal of Medicine that 2- and 3-year-old preasthmatic tots treated for two years with inhaled corticosteroids did experience a reduction in wheezing while taking the medication. But any benefits stopped when the treatment did. The results may argue for continuing to use the drugs to treat symptoms but in as low a dosage as possible to avoid hampering a child's growth, a possible side effect. According to Martinez, the two most important measures parents can take to prevent asthma are breastfeeding their children and protecting them from exposure to cigarette smoke.