Eyes

Allergy

Definition An allergic reaction of the eyes, usually from pollen The eyes are itchy and watery Symptoms of Eye Allergies Itchy eyes (sometimes feels like burning or stinging) Increased tearing (watery eyes) Red or pink eyes Mild swelling of the eyelids No discharge or a sticky, stringy, mucus discharge No pain or fever Triggers of Eye Allergies Cause. An allergic reaction of the eyes to allergic substance. The medical name for this is allergic conjunctivitis. The allergic substance is called an allergen. Most allergens float in the air. That's how they get in the eyes. Here are the common ones: Pollens. Trees, grass, weeds and molds are the most common pollens. Tree pollens come in the spring. Grass pollens come in the summer. Weed pollens come in the fall. Pollens cause seasonal allergies. You can't avoid pollens because they are in the air. Most eye allergies continue through the pollen season. They can last 4 to 8 weeks. Pollens cause seasonal eye allergies. Pets. Allergens can also be from cats, dogs, horses, rabbits and other animals. Pet allergens are in the air. They can also get in the eyes from the hands. Most people don't keep a pet that they are allergic to. They only have sporadic allergy symptoms when they are exposed to a pet. These symptoms usually last a few hours. If you own the pet, your child will have symptoms all the time. House Dust. House dust contains many allergens. It always contains dust mites. If your humidity is high, it will contain mold. If someone with a cat visits you, they will bring cat dander with them. House dust causes year round, daily symptoms. The medical name for this is perennial eye allergies. When To Call Call Doctor Within 24 Hours You think your child needs to be seen Sacs of clear fluid (blisters) on whites of eyes Eyelids are swollen shut (or almost shut) Discharge on eyelids that does not go away with allergy medicines Call Doctor During Office Hours Eyes are very itchy after taking allergy medicines for more than 2 days Diagnosis of eye allergy never made by a doctor You have other questions or concerns Self Care at Home Mild eye allergy Care Advice What You Should Know About Eye Allergies: An eye allergy most often is caused by pollen that gets in the eye. The eyes can itch, burn or sting. All of these symptoms can go away with allergy eye drops. Eye allergies are common. They occur in 10% of children. Here is some care advice that should help. Wash Allergens Off the Face: Use a wet washcloth to clean off the eyelids and face. Rinse the eyes with a small amount of warm water. Tears will do the rest. Then put a cold wet washcloth on the itchy eye. Prevention: Wash the hair every night because it collects lots of pollen. Oral Allergy Medicines: If the nose is also itchy and runny, your child probably has hay fever. Hay fever is allergic symptoms of both the nose and eyes. Give your child an allergy medicine by mouth. This should get rid of the nose and the eye symptoms. Most often, eye drops will not be needed. A short-acting allergy medicine (such as Benadryl) may be helpful. No prescription is needed. They need to be given every 6 to 8 hours. The bedtime dosage is especially helpful for healing the lining of the nose. Long-acting allergy medicines (such as Zyrtec) can also be used. Again, no prescription is needed. This kind of medicine has 2 advantages over Benadryl. They cause less sedation and last up to 24 hours. Give allergy medicine every day. Do this until pollen season is over (about 2 months for each pollen). Antihistamine Eye Drops (Ketotifen) for Pollen Allergies - 1st Choice: Usually, an oral allergy medicine will control the allergic symptoms of the eye. If the eyes remain itchy and poorly controlled, buy some Ketotifen antihistamine eye drops. Ask your pharmacist to suggest a brand (such as Zaditor). No prescription is needed. Age: Approved for 3 years and older. Dose: 1 drop every 12 hours in both eyes. For severe allergies, the use of ketotifen eye drops every day will help the most. Use these eye drops until pollen season is over. Older Antihistamine/Vasoconstrictor Eye Drops - 2nd Choice: Often, the eyes will feel much better after the allergic substance is washed out. Also, putting a cold wet washcloth on them usually makes the eyes feel better. If not, this type of eye drop can be used for added relief. Ask your pharmacist to suggest a brand (such as Visine-A). The A stands for antihistamine. No prescription is needed. Avoid vasoconstrictor eyedrops without an allergy medicine in them. These are eye drops without an A in the name, such as plain Visine. Reason: They only treat the redness, not the cause. Dose: 1 drop every 8 hours as needed. Do not use for over 5 days. (Reason: Will cause red eyes from rebound effect) Downside: Doesn't work as well as Ketotifen eye drops. Eye Drops: How to Use For a cooperative child, gently pull down on the lower lid. Put 1 drop inside the lower lid. Then ask your child to close the eye for 2 minutes. Reason: So the medicine will get into the tissues. For a child who won't open his eye, have him lie down. Put 1 drop over the inner corner of the eye. If your child opens the eye or blinks, the eye drop will flow in. If he doesn't open the eye, the drop will slowly seep into the eye. Contact Lenses: Children who wear contact lenses need to switch to glasses for a while. This will help the eye heal faster. What to Expect: If you know the cause of the allergy symptoms, try to avoid it. This is the case with animal allergies. The symptoms will not come back if there is no contact. But, you can't avoid pollens because they are in the air. Most eye allergies continue through the pollen season. They can last 4 to 8 weeks. Call Your Doctor If: Itchy eyes aren't better in 2 days with allergy treatment You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Foreign Object

Definition A foreign object becomes stuck in the eye Also included are small particles such as dirt The main symptoms are irritation, pain, tears, and blinking Types of Foreign Objects in the Eye Blowing Dust. Small particles such as sand, dirt, sawdust, or other grit. Can be blown into the eye on a windy day. Eyelash. An eyelash is a common finding. Dry Mucus. A loose piece of dried mucus (sleep) can feel like something is in the eye. Sharp Object (Serious). A piece of glass from a shattered glass ornament is an example. High Speed Objects (Serious) such as a metal chip from a hammer or lawnmower. A plastic fragment or small rock thrown from a weed-wacker are other examples. When To Call Go to ER Now Sharp object in the eye Object is a piece of chemical Object hit eye at high speed. Examples are a metal chip from hammering, lawnmower, or explosion. Object is stuck on the eyeball. Caution: do not try to remove it. Tearing or blinking do not stop after washing the eye You can't get the object out Call Doctor or Seek Care Now You think your child has a serious injury Child feels like object still there after eye has been washed out Vision not back to normal after eye has been washed out You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Yellow or green pus occurs You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours You have other questions or concerns Self Care at Home Minor object or small particles in the eye (such as an eyelash or dirt). Reason: most likely can be removed at home. Care Advice What You Should Know About An Object or Small Particles in the Eye: The object (or particles) will always stay in the front part of the eye. Some parents worry that it can get lost behind the eyeball. This will not happen. The space beyond the eyelids goes back ¼ inch (6 mm) and then stops. In other words, it's a dead end. Here is some care advice that should help. Lots of Particles (such as Dirt or Sand) - Treatment: Clean around the eye and face with a wet washcloth first. Reason: So more particles won't get in. Put that side of the face in a pan of warm water. Have your child try to open and close the eye while in the water. Do it several times. For younger children, fill a glass or pitcher with warm tap water. Pour the water into the eye while holding your child face up. The eyelids must be held open during the rinsing. This process often needs the help of another person. Particle in a Corner of the Eye - Treatment: Try to get it out. Use a moistened cotton swab or the corner of a moistened cloth. Particle Under the Lower Lid - Treatment: Pull the lower lid out by pulling down on the skin above the cheekbone. Touch the particle with a moistened cotton swab. If that doesn't work, try pouring water on the particle. Do this while holding the lid out. Particle Under the Upper Lid - Treatment: If the particle can't be seen, it's probably under the upper lid. This is the most common hiding place. Try having your child open and close the eye several times while it is submerged in a pan or bowl of water. If you have an eye cup, use it. If this fails, pull the upper lid out. Then, draw it over the lower lid while the eye is closed. When the eye is opened, the particle may come out. The lower lid may sweep the particle out from under the upper lid. Contact Lenses: Children who wear contact lenses need to switch to glasses for a while. Reason: To prevent damage to the cornea. What to Expect: The pain, redness and tearing usually pass after the object is removed. It may take 1 to 2 hours for these symptoms to fully go away. Call Your Doctor If: You can't get the object or particles out Feels like object is still there 2 hours after taken out Tearing and blinking do not stop after you take out the object Vision is not normal after the eye has been washed out You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Pus or Discharge

Definition Yellow or green discharge (pus) in the eye The eyelids are stuck (matted) together with pus after sleep After being wiped away, the pus comes back during the day Often caused by a bacterial eye infection Causes of Eye with Pus Bacterial Conjunctivitis. This is a bacterial infection of the eye. The main symptom is eyelids stuck together with pus after sleep. Can be present in 1 or both eyes. A few viruses can cause pus in the eyes, but most don't. Viral Conjunctivitis. This is a viral infection of the eyes. Main symptom is pinkness of the white parts of the eyes. The eyes are also watery. Most often, there is no pus. Usually on both sides. Normal Discharge. A small amount of dried mucus only in the corner of the eye. It may not even be pus. A collection of mucus can be cream colored. Often due to an irritant that got in the eye from dirty hands. Needs no treatment except wiping it away with warm water. Blocked Tear Duct. Present in 10% of newborns. Main symptom is a constant watery eye. Tears fill the eye and run down the face. This happens even when not crying. The eye is not red and the eyelid is not swollen. The wet eye may get secondary infections. This will cause the eyelids to become matted with pus. Foreign Object in Eye (Serious). Small particles such as sand, dirt or sawdust can be blown into the eyes. The grit often gets stuck under the upper eyelid. If not removed, the eye reacts by producing pus. The main clue is an eye infection that does not respond to antibiotic eyedrops. Older children complain of feeling something in the eye. Eyelid Cellulitis (Serious). This is a deep infection of the eyelid and tissues around it. The main symptom is a red, swollen, very tender eyelid. The eye can be swollen shut. Usually only on one side. This can be a problem caused by bacterial conjunctivitis. The eye infection spreads inward. More commonly this is caused by an ethmoid sinus infection. That type occurs without any pus in the eye. Symptoms of Bacterial Eye Infection Yellow or green discharge or pus in the eye Dried pus on the eyelids and eyelashes The eyelashes are more likely to be stuck together after sleep The whites of the eye may or may not be red or pink The eyelids are often puffy When To Call Call Doctor or Seek Care Now Eyelid is very red or very swollen Vision is blurred Eye pain or discomfort is more than mild Fever over 104° F (40° C) Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Pus in the eye, but none of the symptoms above. Reason: you may need antibiotic eyedrops to treat it. Using antibiotic eye drops more than 3 days and pus is still there Care Advice What You Should Know About Bacterial Eye Infections: Bacterial eye infections are common with colds. They respond to home treatment with antibiotic eye drops which need a prescription. They are not harmful to vision. Until you get some antibiotic eye drops, here is some advice that should help. Remove Pus: Remove all the dried and liquid pus from the eyelids. Use warm water and wet cotton balls to do this. Do this whenever pus is seen on the eyelids. Also, remove the pus before the antibiotic eye drops are put in. Reason: They will not work if you don't. The pus can spread infection to others. So, dispose of it carefully. Wash your hands well after any contact with the pus. Antibiotic Eye Drops: How to Use For a cooperative child, gently pull down on the lower lid. Put 1 drop inside the lower lid. Then ask your child to close the eye for 2 minutes. Reason: So the medicine will get into the tissues. For a child who won't open his eye, have him lie down. Put 1 drop over the inner corner of the eye. If your child opens the eye or blinks, the eye drop will flow in. If he doesn't open the eye, the drop will slowly seep into the eye. Contact Lenses: Children who wear contact lenses need to switch to glasses until the infection is gone. Reason: To prevent damage to the cornea. Disinfect the contacts before wearing them again. Discard them if they are disposable. Return to School: Your child can return to school when the pus is a small amount. Antibiotic eye drops should be used for 24 hours before going back. The antibiotic eye drops can be used for other family members. Use only if they develop the same symptoms. What to Expect: With treatment, the yellow discharge should clear up in 3 days. The red eyes may last up to a week. Call Your Doctor If: Eyelid gets red or swollen You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Red Without Pus

Definition Red or pink color of the white of the eye without any pus The eye looks irritated May have increased tears (a watery eye) Eyelid may be puffy (mildly swollen) No pus or yellow discharge Not caused by an eye injury Causes of Pinkeye (Red Eye) Pinkeye Defined. When the white of the eye becomes pink or red, it's called pinkeye. Conjunctivitis is the medical name for pinkeye. The conjunctiva is the membrane that covers the white of the eye. It becomes pink or red when it is infected or irritated. Pinkeye (conjunctivitis) has many causes. Viral Conjunctivitis is the main cause of pink or red eyes without pus. Most often, it is part of a cold. Bacterial Conjunctivitis. Pinkeye plus the eyelids are stuck together with pus. Most likely, this is a secondary infection of a viral conjunctivitis. Allergic Conjunctivitis from pollens. Most children with eye allergies also have nasal allergies (hay fever). Symptoms include sneezing and clear nasal discharge. Irritant Conjunctivitis from sunscreen, soap, chlorine in pool water, smoke, or smog. Irritants can also be transferred by touching the eye with dirty fingers. Irritants can be food or plant resins. Contact Lens Conjunctivitis is caused by poor use of disinfectant solution or lenses kept in overnight. Rebound Conjunctivitis from Vasoconstrictor Eye Drop Abuse. Usually occurs in teens who use daily OTC eye drops to remove mild redness. After the medicine wears off, the blood vessels become larger than they were to begin with. Similar to the rebound nasal congestion seen in chronic nose drop abuse. Foreign Object. If only one side has pinkeye, an object in the eye must be considered. Palpebral Cellulitis (Serious). A bacterial infection of the eyelids and skin around them. Causes the lids to be very red and swollen. When To Call Call Doctor or Seek Care Now Eyelid is very red or very swollen Nonstop tears or blinking Vision is blurred Eye pain or discomfort is more than mild Turns away from any light Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Only 1 eye is red and lasts more than 24 hours Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Age less than 1 month old Redness lasts more than 7 days You have other questions or concerns Self Care at Home Red eye is part of a cold Red eye is caused by mild irritant (such as soap, sunscreen, food, smoke, chlorine) Care Advice Treatment for Viral Eye Infections What You Should Know About Viral Eye Infections: Some viruses cause watery eyes (viral conjunctivitis). It may be the first symptom of a cold. It isn't serious. You can treat this at home. Colds can cause a small amount of mucus in the corner of the eye. Here is some care advice that should help. Eyelid Rinse: Cleanse eyelids with warm water and a clean cotton ball. Try to do this 3 times a day. This usually will keep a bacterial infection from occurring. Artificial Tears: Artificial tears often make red eyes feel better. No prescription is needed. They can be used at any age. Use 1 drop per eye 3 times a day as needed. Use them after cleansing the eyelids. Antibiotic and vasoconstrictor eye drops do not help viral eye infections. Eye Drops: How to Use For a cooperative child, gently pull down on the lower lid. Put 1 drop inside the lower lid. Then ask your child to close the eye for 2 minutes. Reason: So the medicine will get into the tissues. For a child who won't open his eye, have him lie down. Put 1 drop over the inner corner of the eye. If your child opens the eye or blinks, the eye drop will flow in. If he doesn't open the eye, the drop will slowly seep into the eye. Contact Lenses: Children who wear contact lenses need to switch to glasses until the infection is gone. Reason: To prevent damage to the cornea. Return To School: Pinkeye with watery discharge is harmless. There is a slight risk it could be passed to others. Children with pink eyes from a cold do not need to miss any school. Pinkeye is not a public health risk. Keeping these children home is over-reacting. If asked, tell the school your child is on eye drops (artificial tears). What to Expect: Pinkeye with a cold usually lasts about 7 days. Sometimes, it turns into a bacterial eye infection. You can tell because the eyelids will become
stuck together with pus. Pinkeye from an irritant usually goes away within 2 hours after it's removed. Call Your Doctor If: Your child gets pus in the eye Redness lasts more than 1 week You think your child needs to be seen Your child becomes worse Treatment for Mild Eye Irritants What You Should Know About Pinkeye from Irritants: Most eye irritants cause redness of the eyes. It that will go away on its own. You can treat that at home. Face Wash: Wash the face with mild soap and water. This will remove any irritants still on the face. Eyelid Rinse: Rinse the eyelids with warm water for 5 minutes. Eye Drops: Red eyes from irritants usually feel much better after being washed out. At any age, if eyes remain bloodshot, you can use some artificial tears. Dose: 1 drop, 3 times per day, as needed. If more than 6 years old, switch to a vasoconstrictor eye drop (such as Visine). No prescription is needed. Dose: Use 1 drop. May repeat once in 8 to 12 hours. Never use for more than 3 days. What to Expect: After the irritant is removed, the eyes usually return to normal color. This may take 1 to 2 hours. Prevention: Try to avoid future contact with the irritant. Call Your Doctor If: Pus in the eye occurs Redness lasts more than 7 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Eye Injury

Definition Injuries to the eye, eyelid, and area around the eye Types of Eye Injuries Cut or Scratch of Eyelid. Small cuts heal on their own. Deep cuts or ones that go through the edge of the eyelid need sutures. Bruise of the Eyelids. Also called a "black eye". The swelling and bruise get worse for a few days. Then it will go away on its own over 2 -3 weeks. It's normal for the bruise to change colors as it heals. Subconjunctival Hemorrhage. This is a flame-shaped bruise of the white part (sclera) of the eyeball. It's bright red. It's caused by a scratch to the sclera. It's a mild injury that will go away on its own over 2 weeks. Corneal Abrasion. A scratch of the clear part (cornea) of the eye. The cornea is the window in front of the iris. The main symptoms are severe eye pain, tearing and constant blinking. Some children will just hold their eye closed. Caused by a scratch from a branch of a tree or bush. Can also be caused by a foreign object stuck under the upper eyelid. Most are minor and heal in 2 days. This is the most common eye injury that needs to see a doctor. Acute Hyphema (Serious). It means bleeding in the space between the cornea and the iris. The blood often layers out at the bottom of the cornea. It's caused by blunt trauma. Punctured Eyeball (Serious). It means a sharp object has completely torn the cornea or sclera. Can happen with tiny objects thrown by a lawnmower. Vision The main concern is whether the vision is damaged. Older children can tell us if their vision is blurred or out of focus. You can test this at home. Cover each eye in turn and having them look at a distant object. Children less than 5 years old usually need to be examined. This is also true even if the injury seems minor. Having an exam is the only way to know the child's vision is okay. When To Call Go to ER Now Vision is blurred or lost in either eye Seeing double or can't look up Bloody or cloudy fluid behind the clear part of the eye (cornea) Object hit the eye at high speed (such as from a lawn mower) Nonstop tears or blinking Child keeps the eye covered or will not open it Severe eye pain Large deep cut that will need many stitches Call Doctor or Seek Care Now Pupils not equal in size Sharp object hit the eye (such as a metal chip or flying glass) Skin is split open or gaping and may need stitches Any cut on the eyelid or eyeball Age less than 1 year old You think your child has a serious injury You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Bruises near the eye You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Dirty cut and no tetanus shot in more than 5 years Clean cut and no tetanus shot in more than 10 years You have other questions or concerns Self Care at Home Minor eye injury Care Advice Small Cuts, Scratches or Scrapes Treatment: For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped. Wash the wound with soap and water for 5 minutes. Protect the eye with a clean cloth. For cuts or scrapes, use an antibiotic ointment (such as Polysporin). No prescription is needed.
Put it on the cut 3 times a day. Do this for 3 days. Cover large scrapes with a bandage (such as Band-Aid). Change daily. Swelling or Bruises with Intact Skin (including a Black Eye) Treatment: Put a cold pack or ice wrapped in a wet cloth on the eye. Do this for 20 minutes. This will help stop the bleeding and swelling. Repeat as needed. A black eye usually takes 1 to 2 days to occur. A flame-shaped bruise of the white of the eyeball is also common. After 48 hours, use a warm wet cloth for 10 minutes. Do this 3 times per day. Reason: To help reabsorb the blood. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. What to Expect: Minor cuts and scratches, as well as bruises, are harmless. They last about 2 weeks. They do not need any medicine to help them go away. Call Your Doctor If: Pain becomes severe Changes in vision You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Eye Swelling

Definition Swelling of eyelids or area around the eye No redness of white part of the eye (sclera) No yellow or green discharge (pus) Swelling is not caused by an eye injury. If so, see that guide. Eye Swelling Scale Mild: eyelid is puffy, but can open eyes like normal Moderate: more than puffy, but eyes still open some Severe: eyelids swollen shut or almost shut Causes of Eye Swelling on One Side Rubbing the Eye. Rubbing from any cause will make the eyelids puffy. Often, it starts from getting an irritant in the eye. Young children often touch their eyes with dirty hands. They also may get food in the eye. Insect Bite near the eye. A reaction to the insect's spit causes swelling. The loose eye tissues swell easily. The most common bite is from a mosquito. Contact Dermatitis near the eye. An example is poison ivy. Injury near the eye. Can cause a bruise and swelling. Sty. A minor infection of an eyelash. Dacryocystitis. An infection of the tear sac in the corner of the eye. Ethmoid Sinus Infection (serious). This causes swelling and redness of the eyelid. The ethmoid sinus is behind the eye. Periorbital Cellulitis (serious). A bacterial infection of the eyelid. Caused by spread from nearby infected wound or insect bite. The eyelid is very red and usually painful to touch. Causes of Eye Swelling on Both Sides Allergic Conjunctivitis. Itchy pink eyes from pollen or pet dander. Viral Conjunctivitis. The main symptom is red eyes with a cold. Bacterial Conjunctivitis. The main symptom is yellow pus in the eye or eyes. Eyelids may be matted shut. Edema (serious). Edema is retained fluid within body tissues. Edema fluid first appears as swelling of the feet due to gravity. Edema fluid also occurs around both eyes after lying down. It's caused by kidney, heart or liver failure. Anaphylaxis (very serious). A severe life-threatening allergic reaction. Triggered by foods, drugs and bee stings. Serious symptoms such as trouble breathing or swallowing occur. Hives are almost always present. Swelling of Eye: Clues to the Cause Swelling of 1 eye is often due to an insect bite. Mosquito bites are a common cause. It can also be from an irritant (e.g. food) transferred to the eye by the hands. Suspect mosquito bites if there are bites on other parts of the body. Insect bites of the upper face can cause the eyelid to swell. This can last for a few days. With insect bites, the swelling can be pink as well as large. Large swelling is common for ages 1-5 years. Swelling of both eyes is usually due to pollen that's airborne. This includes tree, grass or weed pollen. These pollens float in the air and can travel hundreds of miles. Itching also makes the swelling worse. Swelling of the face is usually due to allergic reactions to swallowed substances. Examples are foods or medicines. May be part of a severe allergic reaction. Allergic reactions to antibiotic eyedrops can cause severe swelling of both eyes. Swollen eyelids from insect bites, pollens or other allergies are itchy. Swollen eyelids from eyelid infections are painful and tender to the touch. When To Call Call 911 Now You think your child has a life-threatening emergency Call Doctor or Seek Care Now Severe swelling (shut or almost) of both eyes Severe swelling (shut or almost) of one eye with fever Eyelid (outer) is very red and swollen with fever Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Fever Severe swelling (shut or almost) of one eye without fever Eyelid (outer) is very red and swollen without fever Eyelid is painful or very tender Swollen ankles or feet Sinus pain or pressure Moderate swelling with the eye open some. Exception: due to a mosquito bite. You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Mild swelling (puffy eye or eyes) lasts more than 3 days Eyelid swelling is a chronic problem and not explained You have other questions or concerns Self Care at Home Eyelid swelling from suspected bug bite Eyelid swelling without a cause Care Advice Treatment for Eyelid Swelling from Suspected Bug Bite What You Should Know About Eye Swelling from Bug Bites: Mosquito bites are very common. Bites to the face can cause severe swelling around the eye. Reason: The tissues around the eye are loose. Size is larger in young children. The swelling is harmless. Here is some care advice that should help. Cold Pack for Swelling: Apply ice wrapped in a wet washcloth to the eye for 20 minutes. Allergy Medicine for Swelling and Itching: Give an allergy medicine by mouth. This will help to lessen the swelling and itching. Benadryl every 6 hours is best. Teen dose is 50 mg. Give it 2 or 3 times. If you only have another allergy med at home (but not Benadryl), use that. Follow the package directions. Eye Drops: The eyelid swelling often will improve after a cold pack or Benadryl is given. Age 6 years and older. For eyelid swelling that interferes with vision after cold pack, use some eye drops. Use a long-acting vasoconstrictor eye drop (such as Visine). No prescription is needed. Dose: 1 drop every 8 to 12 hours as needed for 1 or 2 days. Do not use for over 5 days. Reason: Will cause red eyes from rebound effect. What to Expect: Itching may last for 2 days. Pinkness or redness lasts about 3 days. The eye may be puffy for up to 7 days. Call Your Doctor If: Swelling lasts over 7 days Redness lasts over 3 days Becomes painful to touch You think your child needs to be seen Your child becomes worse Treatment for Eyelid Swelling Without a Cause What You Should Know about Eyelid Swelling Without a Cause: Most eye swelling without a cause is from rubbing the eyes. The eye tissues are loose and easily swell. The rubbing is often from getting an irritant in the eye. It's often seen in young children who touch their eyes with dirty hands. While eating, some children even get food in their eyes. This type of swelling to an irritant can be treated at home. Here is some care advice that should help. Cold Pack for Swelling: Apply ice wrapped in a wet washcloth to the eye for 20 minutes. Allergy Medicine for Swelling and Itching: Give an allergy medicine by mouth. This will help to lessen the swelling and itching. Benadryl every 6 hours is best. Teen dose is 50 mg. Give it 2 or 3 times. If you only have another allergy med at home (but not Benadryl), use that. Follow the package directions. Eye Drops: The eyelid swelling often will improve after a cold pack or Benadryl is given. Age 6 years and older. For eyelid swelling that interferes with vision after cold pack, use some eye drops. Use a long-acting vasoconstrictor eye drop (such as Visine). No prescription is needed. Dose: 1 drop every 8 to 12 hours as needed for 1 or 2 days. Do not use for over 5 days. Reason: Will cause red eyes from rebound effect. What to Expect: The itching should stop after the irritant is washed out of the eye. This may take up to a few hours. The swelling will clear 24 hours after the child stops rubbing the eye. Call Your Doctor If: Swelling lasts over 3 days Eyelid becomes red and painful to the touch You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Sty

Definition A red lump or pimple on the edge of an eyelid It starts at the bottom of an eyelash Symptoms of a Sty A tender, red lump on the eyelid at the base of an eyelash Turns into a small pimple on the eyelid A sty is tender to touch A sty causes mild swelling of the eyelid A sty can cause a watery eye Causes A bacterial infection of the hair follicle of an eyelash. The most common germ that causes this is Staph. Risk factors. Rubbing the eyes (especially after picking the nose.) The nose is the most frequent home of Staph. Also, more common when using eye makeup. When To Call Call Doctor or Seek Care Now Eyelid is very red or very swollen Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Sty gets larger than ¼ inch (6 mm) You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours 2 or more styes are present now Styes have occurred in the past 3 or more times Sty has come to a head (pimple), but has not drained after 3 days Sty lasts for more than 10 days You have other questions or concerns Self Care at Home One sty Care Advice What You Should Know About a Sty: A sty is a minor infection of an eyelash. A sty usually comes to a head and forms a pimple in 3 to 5 days. Most often, it drains and heals in a few more days. Most styes can be treated at home. Here is some care advice that should help. Apply Heat to Bring to a Head: Put a warm, wet washcloth to the eye. Do this for 10 minutes 3 times a day. Reason: This helps the sty come to a head. Continue the warm wet cloth even after the sty begins to drain. Reason: To help remove the discharge and heal the sty. Caution: Do not rub the eye. Reason: Rubbing can cause more styes. Open the Pimple: Age limit: Your child is over 5 years old and cooperative. When the center of the sty becomes yellow, you can open it. Do this by using tweezers. Pull out the eyelash that goes through the pimple. This will start drainage and healing. Another option is to wait for drainage to start on its own. Most often, this occurs in another 1-2 days. Caution: Do not squeeze the red lump. Reason: This can cause an eyelid infection. Antibiotic Eye Medicine: Most single styes respond to the treatment with heat. They don't need prescription antibiotic eyedrops. If there is more than one sty, your child may need antibiotic eyedrops. Also, antibiotics may be needed if styes keep coming back. This usually happens to children who rub their eyes often. Contact Lenses: Children who wear contact lenses need to switch to glasses until the sty heals. Reason: To prevent damage to the cornea. Disinfect the contacts before wearing them again. Discard them if they are disposable. What to Expect: A sty usually comes to a head and forms a pimple in 3 to 5 days. Most often, it drains and heals in a few more days. Return To School: Children with a sty usually do not need to miss any school. Call Your Doctor If: Eyelid gets red or swollen Sty comes to a head, but does not drain by 3 days More styes occur Sty is not gone by 10 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Tear Duct - Blocked

Definition Blocked tube that normally carries tears from the eye to the nose It's blocked in 10% of newborns Use this guide only if a doctor has told you it's a blocked tear duct Symptoms of a Blocked Tear Duct A constant watery eye Tears fill the eye and run down the face. This happens even when not crying. The eye is not red and the eyelid is not swollen. Both sides are blocked in 30% of these children. Cause of a Blocked Tear Duct Caused by blockage of the lacrimal duct. This duct carries tears from the corner of the eye to the nose. A watery eye may not be noticed until 1 or 2 months old. Reason: that's when the eye starts making more tears. When To Call Call Doctor or Seek Care Now Eyelid is very red or very swollen Clear part in the middle of the eye (cornea) is cloudy Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Red lump at inner corner of eyelid Eyelid is red or swollen Pus in the eye You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Diagnosis has never been made by a doctor Age more than 12 months old You have other questions or concerns Self Care at Home Blocked tear duct Care Advice What You Should Know About Blocked Tear Ducts: A blocked tear duct is common. It happens in 10% of newborns. Both sides are blocked 30% of the time. A blocked tear duct does not need treatment unless it becomes infected. Here is some care advice that should help. Antibiotic Eyedrops for Pus in the Eye: Pus in the eye or eyelids stuck together means the eye is infected. This is common with blocked tear ducts. It should clear up in a few days with antibiotic eyedrops. For pus in the eye, call your child's doctor for a prescription. In the meantime, here is some advice that should help. Remove Pus: Remove the dried and liquid pus from the eyelids with warm water and wet cotton balls. Do this each time you see pus. Also, clean the eyes before you use the prescription eyedrops. The eyedrops will not work unless the pus is removed first. Massage of Lacrimal Sac - Do it Carefully: Some doctors suggest massage of the lacrimal sac (where tears collect). Other doctors do not. Massage is not required. The tear duct will open without any massage. If massage is advised, do it this way: The lacrimal sac is in the inner corner of the lower eyelid. This sac can be massaged to empty it of old fluids. A cotton swab works much better than a finger. Reason: The swab is smaller. Start at the inner corner of the eye and press upward. Be very gentle. Do this twice a day. Fluid and mucus should come out of the lacrimal sac. What to Expect: Over 90% of tear ducts open up on their own. This should happen by the time the child is 12 months of age. If your child is over 12 months old, talk to your child's doctor. Your child may need to see an eye doctor. Call Your Doctor If: Eye looks infected Eyelid becomes red or swollen You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Ears

Congestion

Definition Stuffy or plugged up feeling in the ear Crackling or popping noise in the ear Hearing is often muffled No ear pain, except with air-travel type Rare complaint before age 4 or 5 years Causes of Ear Congestion Common Cold. A viral infection of the nose is the most common cause. The nasal congestion also blocks the ear tube (eustachian tube). The ear tube normally keeps air in the middle ear. Ear Infection. Middle ear pus can also cause muffled hearing on that side. This commonly happens with an ear infection. Middle Ear Fluid. Fluid may remain in the middle ear after the infection is cleared up. It can last for months. The main symptoms are popping and crackling noises in the ear. Blowing the Nose. Blowing too hard can force secretions into the ear tube. Allergic Rhinitis. Hay fever is an allergic reaction to pollens. It causes nasal congestion, clear drainage and sneezing. It also can block the ear tube and back up secretions in the ear. Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is ear pain. Sometimes, it just causes congestion. It usually starts when coming down for a landing. It can also occur during mountain driving. When To Call Call Doctor Within 24 Hours You think your child needs to be seen Earache Could be a foreign object in the ear canal Ear congestion lasts more than 48 hours Call Doctor During Office Hours Could be blocked with ear wax You have other questions or concerns Self Care at Home Ear congestion most likely from blocked ear tube Care Advice What You Should Know About Ear Congestion: Most often, this is from a blocked ear tube (eustachian tube). This tube normally drains the space behind the eardrum. It is usually not caused by an ear infection. Here is some care advice that should help. Swallow and Chew More: Swallow water or other fluid while the nose is pinched closed. Reason: Makes a vacuum in the nose that helps the ear tube open up. After age 6, can also use chewing gum. Decongestant Nose Spray (Age 12 years or Older): If chewing doesn't help after 1 or 2 hours, use a long-acting decongestant nose spray. An example is Afrin. Dose: 1 spay per side, 2 times per day as needed. Don't use for more than 3 days. Reason: Can cause rebound swelling in the nose. Decongestants given by mouth (such as Sudafed) are another choice. They can also open a stuffy nose and ears. Side effects: They may make a person feel nervous or dizzy. Follow the package directions. Allergy Medicines: Nose allergies can cause ear stuffiness. If your child has hay fever or other allergies, give an allergy medicine. An example is Benadryl. See the Nose Allergy care guide for other advice. What to Expect: The symptoms most often clear within 2 days (48 hours) with treatment. It's safe for your child to swim or fly. Prevention During Air or Mountain Travel: It's safe to fly when your child has a cold. Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing. Keep your child awake during takeoff and descent. Swallow during descent using fluids or a pacifier. Age over 6: Can chew gum during descent. Yawning during descent also can open the middle ear. Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out. Call Your Doctor If: Ear pain occurs Ear congestion lasts more than 48 hours You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Discharge

Definition Drainage of substance or liquid from the ear canal Drainage through an ear tube is included Types of Ear Discharge Pus or Cloudy Fluid. This is the most common type of ear discharge. The main cause is an ear infection. The drainage is from a torn eardrum. The eardrum ruptures in about 10% of bacterial ear infections. Ear Tube Fluid Release. Children with frequent ear infections may get ventilation tubes put in. These help the middle ear drain its fluids and become dry. Sometimes, the ear tube gets plugged up. Normal fluids build up in the middle ear until the ear tube opens up again. This can cause some clear fluid drainage from the ear canal for a day. Earwax. Earwax is light brown, dark brown, or orange brown in color. If it gets wet, it can look like a discharge. Blood. This follows an injury to the ear. Usually, it's just a minor scratch of the lining of the ear canal. Water. Bath water or tears can get in the ear canal. Seeing a clear "discharge" that happens once is likely this. Ear Drops. The person who sees the discharge may not know someone else put in drops. Swimmer's Ear Discharge. Early symptoms are an itchy ear canal. Later symptoms include a whitish, watery discharge. Mainly occurs in swimmers and in the summer time. Ear Canal Foreign Object. Young children may put small objects in their ear canal. It can cause a low grade infection and pus colored discharge. If the object was sharp, the discharge may have streaks of blood. When To Call Call Doctor or Seek Care Now Pink or red swelling behind the ear Clear or bloody fluid after a head injury Bleeding from the ear canal. Exception: few drops and after an ear exam. Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Age less than 6 months old Ear pain or crying like in pain Discharge is yellow or green, cloudy white or smells bad Clear drainage (not from a head injury) lasts more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours You have other questions or concerns Self Care at Home Normal earwax or other harmless discharge Care Advice Earwax: Ear wax protects the lining of the ear canal and has germ-killing properties. If the earwax is removed, the ear canals become itchy. Do not use cotton swabs (Q-tips) in your child's ear. Call Your Doctor If: Begins to look like pus (yellow or green discharge). Clear Discharge (without head injury): Most likely, this is from tears or water that entered the ear canal. This can happen during a bath, shower, swimming or water fight. Don't overlook eardrops your child or someone else used without telling you. In children with ventilation tubes, some clear or slightly cloudy fluid can occur. This happens when a tube blockage opens up and drains. Call Your Doctor If: Clear drainage lasts for more than 24 hours. Blood After Ear Exam: Sometimes, ear wax needs to be removed by your doctor to see the eardrum. If ear wax was removed, it can cause a small scratch inside the ear canal. This happens about 10% of the time. The scratch oozes 1 or 2 drops of blood and then clots. This should heal up in a few days. It shouldn't affect the hearing. Don't put anything in the ear canal. This may start the bleeding again. Call Your Doctor If: Bleeding starts again. Cloudy Discharge - Ear Infection: Cloudy fluid or pus draining from the ear canal usually means there's an ear infection. The pus drains because there's a small tear in the eardrum. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. See Earache care guide for more advice. Call Your Doctor If: Your child becomes worse. And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Pulling At or Rubbing

Definition A child who pulls, tugs, pokes, rubs or itches the ear No crying or report of ear pain Causes of Ear Pulling Habit. Main cause in infants. Normal touching and pulling with discovery of ears. This is usually not seen before 4 months of age. Usually not seen after 12 months old. By then, they have more interesting things to do. Earwax. The main cause in older children is a piece of earwax. This earwax buildup is usually caused by putting cotton swabs in the ear canal. Until the teen years, cotton swabs are wider than the ear canal. Therefore, they just push the earwax back in. Soap. Another cause of an itchy ear canal is soap or other irritants. Soap or shampoo can get trapped in the ear canal after showers. Ear Infection. Children with ear infections act sick. They present with an earache or unexplained crying. Rubbing the ear is common in younger children (under age 2 or 3). Simple ear pulling without other symptoms such as fever or crying is harmless. These children rarely have an ear infection. When To Call Call Doctor or Seek Care Now Fever over 104° F (40° C) Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Seems to be in pain (or is crying) Starts to wake up from sleep Fever or symptoms of a cold are present Drainage from the ear canal Frequent digging inside 1 ear canal You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Pulling at or rubbing the ear lasts more than 3 days Itching lasts more than 1 week You have other questions or concerns Self Care at Home Normal ear touching or pulling Itchy ear canal Care Advice What You Should Know About Ear Rubbing: Most infants have discovered their ears and are playing with them. Some have an itchy ear canal. Earwax buildup is the most common cause. Most wax problems are caused by putting cotton swabs in the ear canal. Ear pulling can start when your child has a cold. It can be caused by fluid in the middle ear. Less often, it's caused by an ear infection. If this is the case, your child will develop other symptoms. Look for fever or increased crying. Ear pulling without other symptoms is not a sign of an ear infection. Here is some care advice that should help. Habit Type of Ear Rubbing: If touching the ear is a new habit, ignore it. This helps prevent your child from doing it for attention. Cotton Swabs - Do Not Use: Cotton swabs can push earwax back and cause a plug. Earwax has a purpose. It protects the lining of the ear canal. Earwax also comes out on its own. Q-tips should never be used before the teen years. Reason: They are wider than the ear canal. Keep Soap Out of the Ears: Keep soap and shampoo out of the ear canal. Reason: Makes the ears itchy. White Vinegar Eardrops: For an itchy ear canal, you can use half-strength white vinegar. Make this by mixing the vinegar with equal parts warm water. Place 2 drops in each ear canal once daily. Do this for three days. Reason: Restores the normal acid pH. Caution: Do not use eardrops if your child has ear drainage or ear tubes. Also, do not use if your child has a hole in eardrum. What to Expect: With this treatment, most itching is gone in 2 or 3 days. Call Your Doctor If: Rubbing the ear lasts more than 3 days Itching of ear lasts more than 1 week You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Swimmer's

Definition An infection or irritation of the ear canal from lots of swimming The ear canal is itchy or painful Also caused by using cotton swabs Symptoms of Swimmer's Ear Starts with an itchy ear canal Ear canal can become painful Pain gets worse when you press on the tragus. (The tragus is the tab of tissue in front of the ear.) The ear feels plugged or full Ear discharge may start as the swimmer's ear gets worse No cold symptoms or fever Cause of Swimmer's Ear Water gets trapped in the ear canal. Then, the lining becomes wet and swollen. This makes it prone to an infection with germs (swimmer's ear). Wax buildup also traps water behind it. Most often, this is caused by cotton swabs. Ear canals were meant to be dry. When To Call Call Doctor or Seek Care Now Severe ear pain and not improved after using care advice Redness and swelling of outer ear Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Yellow discharge or pus from ear canal Fever Blocked ear canal Swollen lymph node near ear You are not sure that ear pain is caused by swimmer's ear Ear symptoms last more than 7 days on treatment You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours You have other questions or concerns Self Care at Home Swimmer's ear with no other problems Care Advice What You Should Know About Swimmer's Ear: Swimmer's ear is a mild infection of the ear canal. It's caused by water getting trapped in the ear canal. Ear canals were meant to be dry. Here is some care advice that should help. White Vinegar Rinses: Rinse the ear canals with half-strength white vinegar. Mix vinegar with equal parts warm water. Exception: ear tubes or hole in eardrum. Start by having your child lie down with the painful ear upward. Fill the ear canal. Wait 5 minutes. Then, turn your child's head to the side and move the ear. This will remove the vinegar rinse. Do the other side. Continue twice a day until the ear canal returns to normal. Reason: Restores the normal acid pH of the ear canal and lessens swelling. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Heat For Pain: If pain is moderate to severe, use a heating pad (set on low). You can also use a warm wet cloth to outer ear. Do this for 20 minutes. (Caution: Avoid burns). Repeat as needed. This will also increase drainage. Reduce Swimming Times: Try not to swim until symptoms are gone. If on a swim team, it's usually okay to continue. Swimming may slow your child's recovery, but causes no serious harm. Return to School: Swimmer's ear cannot be spread to others. What to Expect: With treatment, symptoms should be better in 3 days. They should be gone in 7 days. Prevention of Swimmer's Ear: Try to keep the ear canals dry. After showers, hair washing, or swimming, help the water run out of ears. Do this by turning the head. Do not use cotton swabs. Reason: Packs in the earwax. The wax buildup then traps water behind it. If swimmer's ear is a frequent problem, rinse the ear canals after swimming. Use a few drops of a white vinegar-rubbing alcohol rinse. Use equal parts of each to make the rinse. Lake water has the greatest risk. Rinse the ear canals with tap water after any lake swimming. Do this until you can get vinegar ear drops. Call Your Doctor If: Ear pain becomes severe Ear symptoms last over 7 days on treatment You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Infection Questions

Definition Your child was diagnosed with an ear infection Your child's ears were recently looked at by a doctor You are worried that the fever or ear pain is not getting better fast enough Your child is still taking an antibiotic for the ear infection Symptoms of Ear Infections The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever. Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days. Cause of Ear Infections A bacterial infection of the middle ear (the space behind the eardrum) Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat. Blockage results in middle ear fluid (called viral otitis). If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold. How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children. When To Call Call 911 Now Not moving or too weak to stand You think your child has a life-threatening emergency Call Doctor or Seek Care Now Stiff neck (can't touch chin to the chest) Walking is not steady Fever over 104° F (40° C) Ear pain is severe and not better 2 hours after taking ibuprofen Crying is bad and not better 2 hours after taking ibuprofen Pink or red swelling behind the ear Crooked smile (weakness of 1 side of the face) New vomiting Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Taking antibiotic more than 48 hours and fever still there or comes back Taking antibiotic more than 3 days and ear pain not better Taking antibiotic more than 3 days and ear discharge still there or comes back You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours You have other questions or concerns Self Care at Home Ear infection on antibiotic with no other problems Normal hearing loss with an ear infection Prevention of ear infections Ear tube (ventilation tube) surgery questions Care Advice Treatment for an Ear Infection What You Should Know About Ear Infections: Ear infections are very common in young children. Most ear infections are not cured after the first dose of antibiotic. Often, children don't get better the first day. Most children get better slowly over 2 to 3 days. Note: For mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral. Here is some care advice that should help. Keep Giving the Antibiotic: The antibiotic will kill the bacteria that are causing the ear infection. Try not to forget any of the doses. Give the antibiotic until it is gone. Reason: To stop the ear infection from flaring up again. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Cold Pack for Pain: Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work. Note: Some children prefer heat for 20 minutes. Caution: Heat or cold kept on too long could cause a burn or frostbite. Limits on Activity: Your child can go outside and does not need to cover the ears. Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum. Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse. Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier may help as well. Children over age 6 can chew gum. Return to School: Your child can go back to school when any fever is gone. Your child should feel well enough to join in normal activities. Ear infections cannot be spread to others. What to Expect: Once on antibiotics, your child will get better in 2 or 3 days. Make sure you give your child the antibiotic as directed. The fever should be gone by 2 days (48 hours). The ear pain should be better by 2 days. It should be gone by 3 days (72 hours). Ear Infection Discharge: If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes. The pus may be blood-tinged. Most often, this heals well after the ear infection is treated. Wipe the discharge away as you see it. Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal) Call Your Doctor If: Fever lasts more than 2 days on antibiotics Ear pain becomes severe or crying becomes nonstop Ear pain lasts more than 3 days on antibiotics Ear discharge is not better after 3 days on antibiotics You think your child needs to be seen Your child becomes worse Treatment for Hearing Loss with an Ear Infection Brief Hearing Loss: During an ear infection, fluid builds up in the middle ear space. The fluid can cause a mild hearing loss for a short time. It will slowly get better and go away with the antibiotic. The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months. Permanent harm to the hearing is very rare. Talking With Your Child: Get close to your child and get eye contact. Speak in a louder voice than you usually use. Decrease any background noise from radio or TV while talking with your child. Call Your Doctor If: Hearing loss not better after the antibiotic is done. Prevention of Recurrent Ear Infections What You Should Know: Some children have ear infections that keep coming back. If this is your child's case, here are some ways to prevent future ones. Avoid Tobacco Smoke: Contact with tobacco smoke can lead to ear infections. It also makes them harder to treat. No one should smoke around your child. This includes in your home, your car or at child care. Avoid Colds: Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children. Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care. Breastfeed: Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk lower the rate of ear infections. If you breastfeed, continue it. If you do not, think about it with your next child. Do Not Prop the Bottle: During feedings, hold your baby with the head higher than the stomach. Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear. Having babies hold their own bottle also causes milk to drain into the middle ear. Get All Suggested Vaccines: Vaccines protect your child from serious infections. The pneumococcal and flu shots also help to prevent some ear infections. Control Allergies: Allergies may lead to some ear infections. If your baby has a constant runny or blocked nose, suspect an allergy. If your child has other allergies like eczema, ask your child's doctor about this. The doctor can check for a milk protein or soy protein allergy. Check Any Snoring: Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth. Large adenoids can contribute to ear infections. Talk to your child's doctor about this. Ear Tube Surgery Questions Ear Tubes: Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor. The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter the space. This lowers the risk of repeated ear infections and returns the hearing to normal. Ear Tubes - When Are They Needed? Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid. Also, the fluid has caused a hearing loss greater than 20 decibels. Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed. Ear infections that do not clear up after trying many antibiotics may need tubes. Prevention should be tried before turning to surgery. Talk to your child's doctor about when ear tubes are needed. What to Expect: In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax. If the tubes stay in over 2 years, talk with your child's doctor. The surgeon may need to take them out. Risks of Ear Tubes: After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn't heal. Both of these problems can cause a small hearing loss. Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when giving anesthesia to young children. Therefore, doctors suggest ear tubes only for children who really need them. And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.