Ear, Nose, and Throat Issues
Colds
That stuffy nose, sore throat, runny nose and fever illness, typically called a “cold”, usually lasts 7-10 days in children. The worst symptoms show up on days 3 to 5 of illness. Medications are only given to help your child feel better, as colds commonly resolve on their own.
Fever
Children younger than 3 months of age with a temperature higher than 100.4 degrees (from a thermometer in their bottom) should be evaluated immediately by their doctor. Children older than 3 months of age, with a fever between 101-104 may be monitored at home if they are drinking well and peeing. For more information on adequate fluid intake visit our page on oral rehydration. If the fever lasts longer than 5 days or gets higher than 104 in this age group you should seek a full medical evaluation.
Cough
Usually the cough from a cold brings up mucus. It is usually worst on days 3-5 of the cold and begins to improve by days 7-10 of the illness. It should not make it hard to breathe or to drink. For children older than 1 year, use 1 spoonful of honey every 2 hours as needed to gain control of coughing to help them feel better. Under 1 year of age, there is no known safe medicine for cough. If you have not noticed improvement in cough by day 14 of the cold, discuss this with your healthcare provider.
Nasal Congestion
For babies younger than six months, a stuffy nose can make it hard to drink and even make it hard to breathe. If your baby has a hard time breathing or drinking, get them seen by a doctor. Nasal stuffiness is typically worst on days 3-5 of illness and improves by days 7-10. To help relieve your child’s stuffiness you can use nasal saline drops or a spray. Also, for children under 6 months of age, right after using the nasal saline you can suction the mucus from the nose with a nosefrida or bulb suction. For older children, greater than 12 years of age, an over-the-counter nasal decongestant or nasal sinus rinse might be recommended by your healthcare provider.
Sore Throat
This can be managed by taking either tylenol or ibuprofen. Under 3 months of age, tylenol should only be given if recommended by your healthcare provider. Ibuprofen should never be given to a baby less than 6 months of age. If your child’s sore throat makes it hard to drink enough fluids, you should seek medical attention. Sore throats are usually worse on days 3-5 of illness and then get better quickly.
Allergic Runny Nose (Rhinitis)
Runny nose due to allergy can usually be treated. If you know what triggers the runny nose, try to avoid it. For example, in people with a cat allergy, just staying away from cats or places where cats live works the best.
When you can’t avoid the triggers, medications can help a lot. Depending on what is causing the allergy and how it affects your child, you might try:
Saline spray or rinse in the nose to clear out the dust or pollen
Antihistamines (pills or as a nasal spray) to block the allergy reaction
Corticosteroids (usually as a daily nasal spray) to decrease inflammation
You usually have to use these every day for a week before they start to work
Prescription nasal sprays to dry up the nose
Allergy shots may be an option and should be discussed with your primary care physician.
For severe runny nose or nasal obstruction/congestion that does not respond to medications, your ENT specialist may recommend office procedures or surgery to help.
Tonsillitis
Any infection of the tonsils is called tonsillitis. It might be caused by a virus or it might be caused by bacteria. Infections caused by bacteria can be treated with antibiotics; viral infections can’t.
Children with tonsillitis often have a fever of 101 degrees or more, a sore throat, headache, stomachache, and tender swollen glands in the front of the neck. Typically there is no cough.
A bacteria that often causes tonsillitis is called strep. Since strep can also infect the heart or kidneys, your doctor may choose to do a rapid strep test, which gives results in five minutes. If it is positive, strep is present and you should definitely get an antibiotic. If it is negative, your infection most likely is due to either a virus or some non-strep bacteria and antibiotics are optional.
If your child has been diagnosed with strep, they are contagious to other children that are 2 years or older until 12 hours after their first dose of antibiotics. Please call us if your child has been exposed and develops these symptoms within 5 days of the exposure. Generally, children are able to return to school once the fever is gone and they are drinking well.
Tonsil removal has been shown to be helpful in treating tonsil infections if the child has had 7 infections in 1 year, 5 infections in 2 consecutive years, or 3 infections in 3 consecutive years.
Lump on the head or neck
Lumps on a child’s head or neck are common and can cause a lot of concern and anxiety for parents. Children under the age of 4 often get these lumps due to their frequent viral illnesses. Most lumps are caused by the body’s lymph nodes filtering an infection such as a virus. In general, a normal node feels like a pea under the skin, the node is round, and you can move it around under the skin.
A normal lymph node does not hurt to touch and there is no redness or swelling surrounding it. On the other hand, if you feel a lump that is larger than an almond and you notice that it is hard to move or is sore, you should bring your child in for a full evaluation. Normal lumps or nodes, as above, typically resolve over 3-6 months and require no treatment or medication.
Another common lump occurs near the outer edge of the eyebrow and is caused by a cyst. Bring it to our attention and we can arrange for it to be removed.
Ear Infections
Ear infections occur at any age, but are most common in the first 3 years of life. They are caused by a virus that causes swelling inside the nose and ears. When the ears are unable to drain fluid out into the back of the nose then a bacterial infection can get started in the ear. While colds and viruses can’t be treated by antibiotics, a bacterial infection of the ear can be treated with antibiotics to speed healing and decrease complications.
Typically, children with an ear infection will have moderate to severe pain of the ear and a fever of 101 or greater. Your doctor may choose to not use an antibiotic if the infection is only in one ear, has mild or absent pain, or the child does not have a fever. Pain is managed with regular ibuprofen or tylenol. The first sign of an ear infection is typically moderate ear pain and fever and not drainage. If you do see drainage please seek medical attention.
Ear tubes are considered for ear infections when there have been 3 infections in a 6 month period or 6 infections in a year. Ear tubes decrease the chance of your child developing future ear infections, hearing problems, speech problems, and antibiotic-resistant infections.
Nose Bleeds
Nosebleeds can happen at any age and while they can be provoke anxiety, they are very safe. To stop a bloody nose, raise your head above the level of your heart, pinch your nose for ten minutes and apply ice packs to your neck and forehead. Call your doctor if the nosebleed doesn’t stop in fifteen minutes. If you have frequent nosebleeds, moisturize your nose nightly with saline nasal spray or saline gel (available at most drugstores) and get NasalCease to use as packing. Follow the label directions. If these preventive measures don’t stop your nosebleeds, see your doctor to be sure you don’t have high blood pressure, a blood clotting problem, or a growth in the nose.
Sometimes if nosebleeds continue to happen despite regular moisturization, an ENT doctor may recommend using a chemical to seal the vessel causing the nose to bleed. Speak with your ENT or Primary Care Physician to see if this is an option.
Swimmer's Ear
Swimmer’s ear usually appears in children older than age 5 who are regularly dunking their heads in a pond or pool. They often have one ear that hurts, swelling and drainage from the ear canal, and pain with tugging the outer. Prescription ear drops treat the infection and decrease pain. Have your child keep their ears dry for 5 days to decrease the chance of the infection coming back. If your child does not have ear tubes or a hole in their eardrum, you can use special ear drops after swimming to help prevent swimmer’s ear. These drops can be made at home with a 50:50 mixture of white vinegar and rubbing alcohol or they can be purchased at a store. Two to four drops of the preventative mixture in both ears after swimming dry the ears out and help prevent infection.
