Posts Tagged ‘Smartman Daily’

The ear drum game — on ear infections

December 14, 2009  |  General  |  No Comments

Here is a recent article of mine published by Smartman Daily.

Most dads with a toddler have experienced the ear drum game. For the minority who haven’t, it goes something like this. Your child has a cold for a few days, but otherwise seems fine. Suddenly she spikes a high fever and clearly hurts somewhere. You take her to the doctor. He takes a very quick look–only seconds, it seems–at her ears and pronounces that she has an ear infection. By the age of three, eighty percent of all children will have had one, and half will have had more than one. Here are answers to six important questions about this common condition.

#1: How can a doctor be sure your child has one?
Here’s a trade secret–frequently we aren’t. If you ask five pediatricians to look in a child’s ear, you may well get five different opinions. This is why medical students call it the ear drum game–it seems whatever they say about a child’s ear, their instructor will say the opposite. Sometimes the diagnosis is obvious. The ear drum is inflamed and bulges outward from the pressure behind it. That pressure comes from infected fluid clogging up the normally air-filled middle ear cavity. Those are the easy ones. The tougher ones are ear drums that are somewhat red, a bit distorted in their shape, perhaps a little less mobile than usual. In those children doctors are often swayed by other things–fever, if the child seems to be pulling at her ears, if she has had past ear infections. These cases are judgment calls, but doctors often follow our old saying that “common things are common,” so we tend toward diagnosing ear infection if it is a borderline case.

#2: Where do ear infections come from?
The middle ear, the place where sound waves bouncing off the ear drum get passed along to the brain so a child can hear, is normally free of germs. There is a tube connecting the middle ear to the back of the nose, there to let air in and out. You can feel this happening when your ears pop going up and down in an airplane. The nose is normally thick with germs. The connecting tube has ways of keeping the germs out of the middle ear, but when those defenses break down the germs pounce on the opportunity, crawl up the tube, and cause an ear infection. The most common cause of tube malfunction is a viral respiratory infection, which is why an ear infection so frequently follows a cold. The tendency for the tube to malfunction also runs in families, which is why frequent ear infections do the same.

#3: Why do we treat ear infections with antibiotics?
An ear infection means germs in the middle ear, but often a child’s body can handle the germs without help. After all, children have been getting ear infections for eons and antibiotics have only been around for a half-century or so. Sometimes these germs aren’t even bacteria, so antibiotics would be of no use anyway. The practice among most American physicians over the past decades has been to treat all ear infections with antibiotics. The reason was to reduce the chances of a child getting one of the uncommon complications that can happen, and the number of these complications has dropped significantly in the antibiotic era.

#4: Okay, but do ear infections always need antibiotics?
For children over six months, the answer is no. The antibiotics-for-all approach has always been questioned by some doctors, especially for children older than two. These doctors reserve antibiotics for children whose symptoms last more than a day or so. This is a decision that should involve parents. Most want antibiotics, and there is nothing wrong with that–it is standard practice. But if you don’t want them, at least right away, another acceptable approach is to get a prescription for the antibiotic, but not fill it unless your child’s symptoms persist. More and more physicians and families are opting for this. Antibiotics are not risk-free. Either way, it’s a good idea to treat the ear pain and fever with medicines like ibuprofen (Motrin) or acetaminophen (Tylenol).

#5: What about prevention?
We know some things are associated with ear infections, and they share the property of contributing to malfunction of the tube between the middle ear and the nose. Exposure to tobacco smoke is one, because it irritates the lining of the nose. Another is putting a child to bed with a bottle, because every time a child swallows the tube opens wider. If the child is lying on her back, the nose bacteria have an easier time of reaching the middle ear.
Sometimes doctors prescribe a low dose of a daily antibiotic for a child who has had many infections. The more controversial kind of prevention is placing a plastic tube through the ear drum to connect the middle ear directly with the outside world. These so-called pressure equalization tubes work by helping keep the middle ear free of the fluid that gives bacteria a hospitable place to grow. If your child has a lot of ear infections, your doctor may recommend these. Besides talking to your doctor, you can learn more about the generally accepted reasons for placing tubes at several authoritative sites, such as here.

#6: Why do ear infections generally go away when a child gets older?
By the time a child gets to school-age, ear infections are uncommon. This is because, as the skull grows, the connecting tube gets longer and less straight, putting a useful mechanical obstacle in the way of germs trying to get up the tube to reach the ear. Additionally, older children get fewer colds than toddlers. So, if your child has a lot of ear troubles, take heart in the fact things will certainly get better over time.

Five ways to annoy your pediatrician (and get better medical care for your child)

October 12, 2009  |  General  |  1 Comment

Here’s a recent piece I wrote for an excellent site aimed at fathers — Smartman Daily.

Fifty years ago it was nearly always mothers who brought children to the doctor. Things are different now. A child’s father is as likely to be the one to make the trip (and put up with those long spells in the waiting room). Whichever parent brings the child in, chances are the visit requires taking time off from work. Insurance co-pays continue their relentless increase, but one of the biggest costs to families is a hidden one–your time. So here are five ways you can make the trip to the pediatrician more efficient and useful to you and your child. One or more of these might annoy your pediatrician, but don’t be dissuaded. You’re not being a pest–you’re being a good dad.

1. Ask the doctor to explain exactly what he is doing during the examination. If you’ve watched carefully as a doctor examines your child, you’ve probably noticed it’s not a random process. There is a method to it. We’re looking for specific things when we shine a light down the throat, feel the front of the neck, or push on sore bellies. These things are often not mysterious, and parents can learn about them, too. No, you shouldn’t be using a stethoscope to listen to your child’s chest or an otoscope to look into his ears, but there is a lot of practical information you can glean from understanding how a doctor’s physical examination proceeds and why. So don’t be afraid to ask the doctor to show you what he’s up to. If you do, you’ll get much better at describing your child’s problems. That will help speed things up at the next visit to the pediatrician-and reduce the risk that the doctor will overlook something important.

2. Insist that the doctor gives a precise and understandable explanation of his conclusions. Making a medical diagnosis is a mixture of science-based decisions, educated guesses, and occasionally just speculation. When the doctor tells you what she thinks, ask her why–and how solid her conclusion is. Pin her down. If you don’t understand what she is saying–if her answer is full of jargon, for example–ask her again. Have her draw a picture or two, if necessary. Ask the doctor to think out loud for you about her decision-making. If you do that over the course of several visits, and pay attention to the process, you can actually learn yourself how to make some simple medical decisions. I’m not suggesting you try to practice medicine on your child. But the more you know about how doctors decide things, the more productive your doctor visits will be. You might even avoid a visit or two in the future.

3. Take notes during the visit, and review them with your doctor. We doctors take notes when we talk to parents, so why shouldn’t you take notes when you talk to them? It’s the best way to avoid misunderstanding. In particular, make sure you have the correct spelling of whatever condition or disorder the doctor describes to you. If he uses anatomical terms, make him spell those, too. You can then use this information to do a little research yourself afterward.

4. Tell the doctor you’re going to do some research of your own. Some doctors get annoyed when parents come to the appointment with a packet of information they found on the Internet. It’s true that there is a lot of misinformation out there-and this is precisely why a savvy parent should quiz the doctor about what Internet resources she recommends. Many doctors these days have handouts for parents suggesting where to look, but many also do not. So ask, then go yourself and learn. Sites maintained by children’s hospitals or organizations, such as the American Academy of Pediatrics or the American Academy of Family Physicians are examples of reliable sites.

5. Ask the doctor about e-mailing one another. Many doctors have embraced the benefits of electronic medicine. E-mail can be a huge time-saver both for you and for your doctor. From my perspective, e-mail is better than getting constant telephone calls that interrupt whatever I’m doing. If your doctor seems resistant to emailing with you, press him a little. You probably can save yourself the time and expense of a few office visits.

Doing any or all of these things may annoy your pediatrician. Yet medical practice in general needs some new ways of doing things, since at least part of the reason we are in the middle of so much health care turmoil stems from the traditional ways medicine is practiced. The way to think of your visit to the doctor is a team meeting of equal partners in your child’s care. Acting on these suggestions means that you are doing your part to educate your fellow team member, your doctor. Good doctors learn from parents all the time!