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Tuesday, August 21, 2012

Ear Wax: Both Good and Bad

Ear Wax Removal NOT Recommended
We make ear wax, also known as cerumen. Many people are annoyed by wax buildup, but it has a purpose! Wax grabs all the dust, dirt, and other debris that gets into our ears. It also moisturizes the ear canal ~ without it our ears become itchy. It even has special properties that prevent infection. That's all good stuff, so don't be too frustrated with a little wax!

Most often the wax moves from the inner part of the ear canal to the outer edge of the canal on its own.  It is amazing to me how our bodies are put together so perfectly: it is designed so the wax is made deep in the canal, then skin cells and wax migrate to the outer edge of the canal, taking with them debris! Some people naturally make dry wax, others make wet wax. This can be due to genetics and other factors. The important thing to remember with this is how your wax tends to build up and how to best keep it from building up.

If wax builds up it can cause pain, itching, ringing in the ear, dizziness, decreased hearing, and infection.  Inappropriate cleaning with hard and/or sharp objects (such as an cotton swabs or paperclips) can increase the risk of infection or even perforation of the ear drum.  Even special cotton swabs made "safe for ears" can push wax deeper and cause a solid collection of wax plugging up the canal.

How can parents help babies and kids keep their ears clean?

Routine bathing with clean warm water allowed to run into the ear followed by a gentle wiping with a cloth is all that is needed most of the time. 
Ear drops made for wax removal with carbamide peroxide can be put in the ear as long as there is no hole in the ear drum or tubes.  The oily peroxide acts to grab the wax and bubble it up. Then rinse with clean warm water and a soft cloth (see syringe tips below). If there is excessive buildup, daily use of drops for 3-5 days followed by weekly use of the drops to prevent more buildup is recommended. (For particularly stubborn wax, using drops 2-3 times/day for 3-5 days initially can help.)
Make your own solution of 1:1 warm water:vinegar and gently irrigate the ear with a bulb syringe.  
Mineral oil or glycerin drops can be put in the ear. Let a few drops soak for a few minutes and then rinse with warm water and a soft cloth. 
Occasional use of a syringe to gently irrigate the ear can help. Using the bulb syringe:

  • First, be sure it is clean! Fungi and bacteria can grow within the bulb ~ you don't want to irrigate the ear with those!  While they can be boiled, they are also relatively inexpensive and easily available, so frequent replacement is not a bad idea.
  • Use only warm water /fluids in the ear (about body temperature or just above body temperature is good). Cold fluids will make the person dizzy and possibly nauseous! If using drops first, put the bottle in warm water or rub it between your hands a few minutes (as if rubbing hands together to warm them, but with the bottle between the hands). Don't overheat the fluid and risk burning the canal!
  • Have the child stand in the tub or shower.
  • Pull up and back gently on the outer ear to straighten out the canal.
  • Aim the tip slightly up and back so the water will run along the roof of the canal and back along the floor. Do NOT aim straight back or the water will hit the eardrum directly and can impact hearing. 
  • Don't push the water too fast ~ a slow gentle irrigation will be better tolerated. If they complain, recheck the angle and push slower. If complaining continues, bring them to the office to let us do it to be sure there isn't more to the story.
  • Refill the syringe and repeat as needed until the wax is removed. 
  • Use a soft cloth to grab any wax you can see and dry the ear when done. Some people like to use a hair dryer set on low to dry the canal. Just be sure to not burn the skin! 

If wax continues to be a problem, we can remove it in the office with one of two methods:
After inspecting the ear canal carefully with an otoscope (or as I call it with the kids: my magic flashlight), we can use a curette (looks like a spoon or a loop depending on provider's preference and wax type) to go behind the wax and pull it out.  This is often the fastest method in the office, but is not always possible if the wax is too flaky or impacted into the canal leaving no room for the curette to pass behind the wax.  It should only be done by trained professionals... don't attempt this at home!
If the wax is plugging up too much of the canal, the canal is very tender, or if the wax is particularly flaky and breaks on contact with the loop, we will let the ear soak in a peroxide solution then irrigate with warm water. This process takes longer but is better tolerated by many kids and they think it is fun to "shower their ear".  We often must follow this with the curette to get the softened wax completely out. 
My biggest tips:
Not Safe!

  • Never use cotton tipped swabs, pipe cleaners, pencils, fingernails, or anything else that is solid to clean the ear! (Note: I still don't recommend them if the package says "safe" ~ they aren't!)
  • Don't put liquid in the ear canal if there is a hole in the ear drum (tubes are included in this). Pus draining from the ear is a sign that there might be a hole.
  • Ear candles are not a safe solution. Burns are too big of a risk!
  • The ear canal is very sensitive, especially if wax buildup has been there a while and has caused an infection of the skin in the canal.  Anything put into the ear can increase any pre-existing pain. 
  • If the skin is friable from prolonged wax and/or infection there is often bleeding with cleaning. If you notice this at home, your child should have the ears evaluated in our office. We will look for holes in the ear drum, scratches on the skin in the canal, and signs of infection needing antibiotic.
  • Some people who suffer from itchy ears can help themselves by NOT cleaning their ears so much!
  • Earwax usually can be left alone. Only try to clean it out if there are signs of problems with it (ear pain, ringing in the ears, decreased hearing, etc). If kids don't tolerate removal with the methods above, bring them in for us to take a good look. There might be more to the story that needs to be addressed. 
  • If there is significant ear pain, pus or bleeding from the ear, or an object in the ear, bring your child in to the office to have us assess and treat.

UPDATE:

In January of 2017, the American Academy of Otolaryngology-Head and Neck Surgery Foundation issued updated AAP-endorsed guidelines regarding wax buildup. Check out this list of Do's and Don'ts from the guidelines.

Monday, August 13, 2012

Parenting when you're angry: Keep Cool

Picture Source: Shutterstock
One of the biggest problems I've had disciplining my kids is letting them see I'm angry. And from talking with many parents over the years, I know I'm not alone. It is only natural to lose your temper and yell when mad, right?

The problem is obvious. We all see it. When we yell, other's yell back. That is also natural.

So if you yell, the kids yell. Or otherwise show you they are angry. It can get pretty ugly, right?

One of the best things I ever did when I was losing my temper and my husband wasn't around to give me a reprieve: I put myself in Time Out. I went to my room, closed the door, and sat on my bed. The kids (who had been fighting with each other) worked together outside my room, talking about what was happening nicely and quietly with each other. They bonded instead of fighting. They were a little scared and very confused. I got some peace and quiet while they worked through their problem. It was wonderful. I only did that once or twice, I'm not sure why I didn't do it more often.'

Everyone gets angry. That is okay. It is human and natural. How we react to the anger and what we do about it is what makes a difference. Yelling, hitting, belittling, blaming others, or otherwise mismanaging anger can have devastating consequences and generally makes the situation worse. No one can think when angry, and showing anger typically makes the others involved angry.

So what can we do to keep situations under control without showing anger?


  • Time Out. This is typically given to the child in trouble, but certain circumstances might help if everyone gets a time out, as above.  Time away from talking, glaring, or otherwise communicating can give everyone time to simply calm down.
  • Change the situation. If appropriate, changing the activity is a simple way to get everyone in a better mood.
  • Take deep breaths. Exaggerate the deep breathing. This physiologically helps your mood and gives you time to sort your thoughts, and also shows the kids that you are trying to manage your anger. This modeling can help them to remember to take deep breaths when they are angry too.
  • Count. This draws attention to the problem once kids realize that you count when they need to change choices and gives everyone time to problem solve.
  • Take turns. If you have someone else who can take over (spouse, parent, friend) when you are losing control, find a way to ask for help. My husband and I would relieve each other a lot when the kids were younger. Sometimes simply having the change of person would calm the child. Because this parent was not already angry with the situation, they were better able come up with a solution.
  • Lead by example. Choose words carefully. Don't hit. Don't name call. Don't blame. Keep voice level neutral. Speak in a calming voice. Avoid gestures or facial expressions that show anger or distain. Take deep breaths to "think." Show your child how to handle bad situations without poor behavior.
  • Get their attention first before giving directions. Get on eye level with your child. Ask that they look at you when talking. Put a gentle hand on their shoulder. Don't yell for attention, but calmly wait a few seconds for it before speaking. Sometimes a whisper gets attention better than a yell.
  • Use humor if appropriate. This DOES NOT mean to make fun of your child. That is horribly damaging to self esteem. It means to try something funny to get your child's attention. 

Make a baby doll "talk" about what is going to happen next: "I'm going to splash in the bath." or "Look at me brush my teeth."
Put pajama pants on your head and ask the child to show you what you're doing wrong. They just might get dressed to show you!
Come up with a silly stress dance to shake out the worries and stress. 

  • Think about the root of the problem. When kids act out it often isn't just because of the action itself. Are they tired or hungry? In need of attention? Sad about a loss? Being bullied? Afraid of failure? Or is their behavior really okay but you are stressed and sleep deprived and over reacting? Addressing the root problem will typically help the day to day issues.
  • Talk through your thoughts out loud. "Those words you just said hurt my feelings. I am now sad." If you are frustrated at another person when your kids are around, model good behavior of handling a negative situation without yelling or fighting. 
  • Smile. It really works. Smiling can actually change your mood and relieves stress, as described by Karen Kleiman in this article.
  • Apologize if you make a mistake. It is okay for a parent to admit fault in a situation. Saying something as simple as "I'm sorry I yelled. I was very disappointed in your choice but I should not have yelled and lost my temper." This will earn respect from your kids and teach them that they can apologize when they are wrong too!
  • Keep a journal. This often can help us see our own situation more clearly. What triggers our anger and what can we do? It is easier to think about this when we aren't mad and come up with a plan for the next time the situation arises.
  • Family meetings are a great way to talk about behavior in a non-threatening manner and at a time that everyone is in a good mood. You can discuss situations that have happened and ask kids what they think they could have said or done differently to change the outcome. (One rule with this: they can only change themselves, no one else!) Roll play situations that come up frequently, such as sharing toys or getting a chore done. Let them figure out good ways to handle common problems, don't give answers. Talking about what's happening the following week, such as a dentist appointment and soccer practice, helps kids get a perspective and internally plan. 
  • Make a list of appropriate things to do when angry. 
The list might include many options, such as: Yell into a pillow. Squeeze a stress ball. Pray. Deep breaths. Whatever comes to mind that might help.
Keeping the list in an easily accessed area can help older kids and parents find ways out of their anger. (It's hard to think when angry, so the list really does help!)
  • Choose words carefully. Starting sentences with "I feel" instead of "You" are less hurtful. "I feel sad when I see toys on the floor when no one is playing with them because they weren't put away," instead of "You left your toys out again and that makes me sad." Hear the difference? Same general point, but much less inflammatory and judgmental.
  • And never forget prevention of problems! Routines are important, especially eating regularly and sleeping adequately (kids and parents). Tired, sick, and hungry is a recipe for disaster! Praise the positives. It is easy to see problems, but be sure to give kudos when due, even for the small stuff. Never underestimate the power of praise and attention!

Saturday, August 4, 2012

Will "Standing" Hurt a Baby's Legs?

photo source: www.blog.rv.net/2009/01/pj-workout
I am surprised how often I am asked if having a baby "stand" on a parent's lap will make them bow legged or otherwise hurt them.

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Allowing babies to stand causing problems is one of those tales.  If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs it will not harm the baby. Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them.  Supported standing can help build strong trunk muscles.

Other fun activities that build strong muscles in infants:

  • Tummy time: Place baby on his tummy on a flat surface that is not too soft. Never leave baby here alone, but use this as a play time. Move brightly colored or noisy objects in front of baby's head to encourage baby to look up at it. Older siblings love to lay on the floor and play with baby this way!
  • Lifting gently: When baby is able to grasp your fingers with both hands from a laying position, gently lift baby's head and back off the surface. Baby will get stronger neck muscles by lifting his head. Be careful to not make sudden jerks and to not allow baby to fall back too fast.
  • Kicking: Place baby on his back with things to kick near his feet. Things that make a noise or light up when kicked make kicking fun!  You can also give gentle resistance to baby's kicks with your hand to build leg muscles.
  • Sitting: Allow baby to sit on your lap or the floor with less and less support from you. An easy safe position is with the parent on the floor with legs in a "V" and baby at the bottom of the "V". When fairly stable you can put pillows behind baby and supervise independent sitting. 
  • Chest to chest: From day one babies held upright against a parent's chest will start to lift their heads briefly. The more this is done, the stronger the neck muscles get. This is a great cuddle activity too! 
What were your favorite activities to help baby grow and develop strong muscles?