A Common Problem
At 7 months, our daughter got her first ear infection. It lasted eight months. Eve screamed and wailed. She slept upright in a baby car seat -- wedged into her crib -- and we plied her with bubblegum-pink antibiotics. The infection was a continuous loop, rebounding every time a prescription lapsed. The drugs bestowed thrush and diarrhea. Herbal remedies, massage, warm compresses, and eardrops didn't budge the infection.
Neither did the specialist whom we begged for ear tubes. "Wait," he counseled. Sure enough, one day it vanished, though I have no idea why.
Ear infections didn't run in our families. Eve was in daycare, but a scrupulously well-scrubbed one. She was breastfed. Yet, somehow, the middle ear was her weak spot -- harboring a stubborn infection that frustrated and baffled us. It didn't seem normal. But, it turns out, it was.
"Why do some babies and young children get sick over and over again? I get asked that question all the time," says David W. Kimberlin, MD, a pediatric infectious disease specialist at the University of Alabama at Birmingham. "The answer is, it's normal for young kids to have quite a few colds, ear infections, or gastrointestinal upsets in a single year," he says. "Children have an immature immune system. And they're encountering all the viruses, bacteria, and other antigens in the world for the first time."
Dr. Kimberlin, who has three children of his own under the age of 6, has recently gained a new appreciation for the issue. "The number of normal sicknesses a child can have is astonishing," he says. "That doesn't make it any easier for the family, but it might reduce the worry."
But why does your kid get four ear infections, while the neighbor's toddler skates by with just one? Why does one child vomit regularly, while another barely spits up? Is it mere coincidence, or are some kids particularly vulnerable to specific illnesses? We asked the experts to help us explore this mystery. Here's what we found out about some common childhood conditions.
What's normal: Five or six a year is average; eight to 10 is in the normal range.
What's not: A cold with a fever that lasts more than five days; difficulty breathing (beyond a stuffy nose); a cold that lasts more than 10 days.
Why your child may be vulnerable: Since there are more than 100 viruses that trigger the common cold, it's no wonder young kids fall prey to continual rounds of sniffles, sneezes, and coughs, says Preeti Jaggi, MD, an infectious disease specialist at Children's Memorial Hospital, in Chicago. Plus, if your child is in daycare, he'll be exposed to more of these nasty cold bugs at an earlier age.
Some cold-prone kids may also have a genetically active immune system that reacts more strongly to viruses. Still others may have an immune system that's been coddled by a hyperclean home.
"That's the hygiene hypothesis," says Dr. Kimberlin. "Children's immune systems are designed to learn from exposure to all sorts of things. But researchers increasingly believe that our modern environment may be too clean. As a result, kids aren't building the immunity needed to resist certain illnesses."
Kids with upper respiratory allergies may also get more colds than normal, he adds. The reason? An inflammation of the upper respiratory system can make a child more susceptible to cold germs, or make cold symptoms more pronounced.
Some endless rounds of runny noses may simply be a case of bad timing: Newborns inherit short-term common-cold immunity from their mom, but it wears off after about six months. This leaves summer-born babies without protection just as the winter sneeze season kicks into gear.
Advice for parents: Make sure kids get lots of sleep. If they're eating solid foods, include plenty of fruits and veggies in their diet. In adults, low levels of vitamin C have been linked to harsher colds.
Also, don't smoke in the house, or even better, try to quit. Exposure to secondhand smoke -- even the burnt-tobacco by-products that cling to clothing and furniture -- irritates airways and dulls immunity, raising the risk of a child's cold becoming something worse. For instance, secondhand smoke exposure is responsible for 150,000 to 300,000 cases of bronchitis and pneumonia each year in kids up to 18 months of age.
What's normal: At least one bout of croup by age 3.
What's not: When breathing becomes a serious struggle for your child.
Why your child may be vulnerable: Up to half of all kids who've had one episode of croup -- a viral infection that leads to swollen airways, a scary-sounding "barking cough," and late-night home treatments in a steamy bathroom or outdoors in the cold air -- will go through it again, researchers estimate.
Why? Reasons range from physical anatomy and gender to race, genetics, and prematurity. Experts aren't sure why, but croup rates are 43 percent higher in boys than in girls, and 85 percent lower in African-American children than in Caucasian kids. A better-understood risk: being born with a narrower-than-usual voice box (larynx) and windpipe (trachea). The tiniest portion of the windpipe, the subglottal trachea, swells during croup.
Pediatricians are also realizing that the breathing tubes that premature infants often require may scar the delicate lining of the trachea, leading to more croup as they grow. Asthma and a family history of allergies also heighten a child's risk.
For some kids, a recurrent croupy cough isn't even prompted by a viral infection: Muscle spasms start the process.
Advice for parents: Skip the cough syrup, since it won't reach the larynx or trachea. And never try to open your child's airways with your finger. The best home treatment? Time in a steamy bathroom (turn on the shower). Or if that doesn't work, try moist, cold air. Call your pediatrician -- or 911 -- if your child's breathing worries you.
What's normal: Two infections a year in children birth to 3.
What's not: Fever and ear pain that persist for more than two days.
Why your child may be vulnerable: Little kids are more prone to middle-ear infections -- also known as acute otitis media (AOM) -- than are older kids and adults because their eustachian tubes (which drain the ears) are shorter, thinner, and more horizontal. During a cold, these tubes swell, trapping fluid in the middle ear, which becomes a perfect breeding ground for bacteria and viruses.
Children who have extra-short or extra-slim tubes are at even greater risk of getting AOM, says Margaret Fisher, MD, chair of Monmouth Medical Center's pediatric department, in Long Branch, New Jersey. Kids with a certain type of bone structure may have problems as well.
"The flatter the middle of a child's face, the less the eustachian tube will be angled," says Dr. Fisher. Living with a smoker and inhaling secondhand smoke raises a child's risk of ear infection by 13 percent. And lying flat while drinking a bottle or inheriting low levels of maternal antibodies to pneumococcal bacteria also increase the odds.
There's yet another reason for the uptick in AOM. "One of the most worrisome trends of the past few decades has been the emergence of antibiotic resistance among the 'big three' bacteria that cause most cases of AOM," says Ali Andalibi, PhD, a researcher in the department of cell and molecular biology at the House Ear Institute, in Los Angeles. Researchers have found that between 25 and 95 percent of these germs are currently resistant to penicillin, and some are resistant to other antibiotics as well.
Advice for parents: If your pediatrician suggests watchful waiting -- a pain-and-fever reliever but no antibiotics for 48 to 72 hours -- consider this approach. "Most kids get better with or without antibiotics," Dr. Kimberlin says. "Some kids need them. But antibiotic overuse is leading to serious problems."
If your child has had three ear infections in a six-month period, or four in one year (with the most recent in the past month), talk to your doctor about whether she should get ear tubes, says Anthony Magit, MD, associate clinical professor of pediatrics and otolaryngology at the University of California, San Diego School of Medicine.
What's normal: One or two cases a year is average; up to three episodes is within the normal range.
What's not: Diarrhea that lasts more than five days; dehydration.
Why your child may be vulnerable: The loose bowels of babyhood and early toddlerhood can be impressive both in their number and explosive power. Most are caused by the highly contagious rotavirus. This feisty misery-spreader can live for up to seven hours on a countertop and survive for nearly half an hour on your hands if you touch an infected surface. A smidgen of diarrhea contains 100 billion rotavirus particles, while it takes just 10 to pass the infection along. So imagine the yucky probabilities.
It's all too easy for rotavirus to be passed around in your own home, and far easier at daycare. (Fortunately, washing hands with soap deactivates the virus.)
But don't blame all loose bowels on viral invaders. "Some antibiotics, such as Augmentin, Biaxin, and Zithromax, can speed up transit time in the bowels," Dr. Fisher notes. "And for young toddlers, the most common cause of frequent diarrhea is diet. Too much fruit juice makes the bowels pull in extra water." Other dietary causes include lactose or soy intolerance.
Advice for parents: Limit fruit juice, since it has little nutritional value, says Dr. Fisher. Also, go easy on milk; if your child has had a bout of diarrhea, her gastrointestinal system may be hypersensitive for a while.
What's normal: Two or three episodes a year is average. Babies may spit up once a day.
What's not: Repeated vomiting on any given day.
Why your child may be vulnerable: True vomiting -- usually a reaction to infection, food poisoning, or stress -- is different from a baby's everyday spit-up, Dr. Fisher says. The gastrointestinal system of some babies takes extra time to mature, and they'll experience wet burps or gastroesophageal reflux. "This is normal," she notes.
But if your baby or toddler vomits fiercely after each feeding, she may have a condition known as pyloric stenosis, a thickening of the valve between the tummy and intestines that keeps the stomach contents from emptying. Some babies and preschoolers gag easily while eating or having their teeth brushed, causing them to vomit.
Other preschoolers (and elementary school kids) could have cyclic vomiting syndrome. This condition involves intense vomiting for several hours or even days, followed by weeks or months of peace.
Advice for parents: If your pediatrician can't diagnose the cause of your child's vomiting, consider consulting a pediatric gastroenterologist.
What's normal: One episode a year.
What's not: Drooling or great difficulty swallowing.
Why your child may be vulnerable: As many as one in 10 kids with strep -- a bacterial infection of the tonsils caused by highly contagious Streptococcus pyogenes bugs -- don't respond to the first course of antibiotics prescribed by a doctor.
So even though these kids have been treated, the infection never gets knocked out. Some children need longer treatment to get rid of the strep bacteria; others, a different antibiotic.
Sometimes kids come in close contact with a carrier who has no symptoms but can pass the infection along. And if your child gets her first infection during peak strep season (spring and fall), she's more likely to become reinfected, because bacteria thrive during those months, causing infections to be three times more prevalent than in winter or summer.
Parents may contribute to repeat infections, too. Strep symptoms heal quickly with treatment, leading many parents to stop giving medication early: One study found that while 80 percent of families claimed they'd administered every dose of antibiotics, 50 percent had stopped after just three days. Full treatment is necessary to wipe out all of the strep bacteria.
Doctors are swift to treat strep throat in order to prevent rare yet serious complications such as heart-damaging rheumatic fever. But the most accurate test -- a throat culture -- takes two days to yield results. A rapid antigen test offers results in minutes but can fail to detect strep about 20 percent of the time. For these reasons, doctors may overdiagnose and overprescribe antibiotics to be on the safe side. Bottom line? Your child may not have strep at all.
Advice for parents: Ask for a 10-day course of antibiotics, and make sure your child takes all of it. "Studies have shown that a seven-day course of penicillin is much less likely to eradicate the strep germ than is a 10-day course," says Richard J. Schmidt, MD, a fellow in pediatric otolaryngology at the Nemours/Alfred I. duPont Hospital for Children, in Wilmington, Delaware.
When strep keeps coming back with a vengeance, some doctors are suggesting an old standby: tonsillectomy. Repeat infections can create pockets of hard-to-kill bacteria on the tonsils.
What's normal: Getting it once.
What's not: Two bouts in one year, or three or more during childhood.
Why your child may be vulnerable: Pneumonia -- an infection and inflammation of the air sacs in the lungs -- accounts for a whopping 13 percent of infections in kids under 2.
Recurring pneumonia could be a sign of an underlying illness such as asthma, gastroesophageal reflux, or even cystic fibrosis, neurological problems, or an immune deficiency, says Raj Padman, MD, chief of the division of pulmonology at the Nemours/Alfred I. duPont Hospital for Children.
Sometimes, the cause is just a tiny item -- a candy or a bead -- that has been accidentally breathed into the lungs and remains lodged there. (Canadian doctors recently reported on the case of a 2-1/2-year-old whose recurrent pneumonia was apparently caused by a tiny bit of greenery from a Christmas tree that he had inhaled into his lungs as a baby.) But about 10 percent of repeat pneumonia has no known cause, researchers say.
Advice for parents: Ask your pediatrician or a family doctor for a referral to a pediatric pulmonologist. This specialist can perform lung-function tests and lung scans to help detect and solve your child's problem.
Sari Harrar is a health writer in Quakertown, Pennsylvania, and the mother of one.
Originally published in American Baby magazine, March 2005.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.