How important is a Postnatal Care Plan?

As a new mum you have responsibility for the welfare of your new baby but who looks after you? You have made plans and talked about your pregnancy and the birth, but what about when you get home with baby?

Making a few preparations and having a few conversations before baby is born will mean you have arrangements in place when you will need a little help or assistance.

Looking after your health and wellbeing during pregnancy will mean you are better placed to cope with labour and delivery and the immediate postnatal period. Remember self-care is not “me first”, it’s “me too”. By looking after your own physical and mental wellbeing, you are ensuring you can give your best to your baby. As the saying goes, you cannot pour from an empty cup.

If you intend to make a postnatal care plan for your over-all post birth wellness, here are a few tips that may help.

  • What products will you need after baby is born? Have a good stock of everything you may need for you (and baby). Put your postnatal care kits in the bathrooms you use. Ask for recommendations from other mums for the products they felt worked best for them.
  • Make a list of all the professionals you may need help from after baby is born. Have your research done and get your recommendations early.
  • Have your support set up. Know who your go-to people are. Most people will offer advice if asked but who do you trust most? Who will you listen to?
  • What about practical help? Talk about who will do the everyday things – the cooking, washing, cleaning, and shopping. Who can you ask to help you in the early weeks?

Conversations to have before baby is born.

You have probably discussed everything from breastfeeding pumps to car seats to how to announce baby’s arrival, but there are other conversations that are probably best to have before baby arrives. These can be difficult conversations to have when you are tired or stressed, so having them when you both are calm will allow you make decisions with calm logical heads.

  • Visitors in the first few days – who is allowed visit and for how long? How to manage this? What will be the role of grandparents?
  • How do you deal with tiredness and sleep deprivation? How can your partner support you?
  • How will the workload be divided? This should cover everything from baby to housework to free time. You are a team and setting the ground rules early is best for everyone.
  • Night-time feedings and waking – who does what?
  • Self-care – what will you need and how to recognise when you need time for yourself?

You should go back and review these conversations regularly after baby is born as you see what is required. It’s hard to imagine exactly how tired you will be or how busy you will be before baby is born. You might find that you want to do more as you are feeling great, or that you need much more support than you expected as you had a caesarean section. Whatever the situation, you can both adjust the plan as needed. As with your Birth Plan, the key with your Postnatal Plan is flexibility, as babies are unpredictable.

If you would like to know more about the postnatal period, our online course may be helpful. While it’s primarily about Baby Reflux, it is packed with very useful information for any new parent. From the effects of delivery, gut health, allergy, why babies cry, how to sooth them and so much more. You can get the full list of what is covered here – http://thehappybabyacademy.teachable.com/p/baby-reflux-a-new-approach

The Premature Baby

Having a baby a little earlier than expected can be stressful, particularly if they need a care in an Neonatal Unit. We recently spoke to Mary Cullinane, a NNU Nurse in Cork University Maternity Hospital about what parents can expect when their baby is admitted to NNU. You can listen to that episode of our podcast later in this article.

We also see babies at our clinic who were born prematurely.

One the main issues we see in premature babies is that their nervous system is often in a state of fight or flight. The earlier a baby is born and longer they spend in NICU, the more likely this is. Premature babies can cry more often, a sign of their immature nervous system. Other signs that they are under stress are:

  • they can be very alert
  • they are often in constant motion
  • and they like to be held a lot.

Parents often bring their baby to see us for a digestive issue they may be having and again, this is not unusual as their digestive systems are a little immature and in need of support.

Premature babies are often windy and their bowels can be sluggish. One of the reasons for this is that research has shown that premature babies have has fewer good bacteria compared to bad bacteria in their bowel. Breast feeding will help promote good bacteria in the gut, as will skin to skin. A breastfeeding mum can supplement the good bacteria by taking a probiotic herself too. If a premature baby is bottle fed, it is worth giving baby a good infant probiotic for at least 6 weeks. I have seen the beneficial effects of doing this in the babies attending my clinic.

Here are our Top 9 things to bring with you to the NNU if your baby is born preterm.

  1. Notebook and pen – you will be given new information about your baby almost every day and the best way to remember it is to write it down. You may also want to make some notes about what happened that day, what time baby was fed at or questions you may have for the staff.
  2. Diary or a journal – it can help to keep a diary of each day as it can give you a sense of control. The days can melt together, and it can be difficult to remember what happened even yesterday. Keeping a record will help.
  3. A muslin cloth that has been worn by you – Having your scent near baby will help to keep them calm. Even though you cannot be with them all the time, they know their Mum. It also helps to leave them there when you know they have a little bit of you next to them.
  4. A blanket – Use a soft cotton blanket when baby is in your arms to keep them warm and cosy. Preterm babies can lose heat easily, particularly when removed from their warm incubator.
  5. Wear loose clothing – If you are doing skin to skin with baby, or if you are breastfeeding your baby, loose clothing will help.
  6. A mirror – a small mirror will help you see baby’s face when you are doing skin to skin. Never miss a moment or an expression or a little yawn.
  7. Photographs – if you have other children at home, it’s important to include them in baby’s care. While they cannot come in to see baby, a photograph of them attached to the incubator or crib will show them that they are a very important part of this new baby’s care.
  8. Cooler bag – If you are breast feeding, having a cooler bag for expressed breast milk will save time.
  9. Food and drinks – Having some nutritious snacks and drinks for yourself is very important too. You may get time to leave the NNU to get lunch, but you may not. And as a new Mum, recovering from birth and possibly breastfeeding, your nutrition is vital.

We spoke to Mary Cullinane, a NNU Nurse in Cork University Maternity Hospital about the babies she cares for every day. Mary has been working in NNU for many years and is a wonderfully caring and dedicated nurse and midwife. Listen to this episode of our podcast below.

The Colic Chronicles!

Colic is a diagnosis that very often comes with the assumption that nothing can be done to help baby. But this is incorrect. We believe that there is always something that you can do for an upset baby.

First of all, is it really colic? Babies with other digestive issues can have very similar symptoms to the typical colic symptoms. When we see a baby at the clinic presenting with colic type symptoms Frank will always rule out other digestive issues. Very often it’s not colic, it’s something else.

When there’s no other digestive condition identified we then look at why a baby may have colic symptoms. The first thing we look at is gut immaturity or imbalance.

Many of the bacteria in a newborn baby’s gut comes from Mum. The type of delivery is important. As it when they were born. Having a well populated gut is essential to good digestive health. How a baby is fed also affects gut health.

Our latest podcast episode is all about colic. We chat about what colic is and some of the other issues it can be confused with. We discuss the causes of colic symptoms and we look at the treatment options available to help ease baby’s digestive upset.

If your baby is very distressed our Online Course may help.

Our course, Baby Reflux – A New Approach, will give you the benefit of all our years of experience treating babies with this condition and many of the associated conditions. We want to find a solution for every baby we see at our clinic and over the years we have studied this condition in detail, looking for causes, optimum treatment options, new research, and practical solutions. We have combined all this information in this course so that we can help as many babies (and parents!) as possible.

If you want answers, if you want a happy baby who is not continually crying and distressed, then this course is for you.

Let us help you become the best possible advocate for your baby.

Tummy Time for your Reflux Baby

We all know how important Tummy Time is for newborns. However, it can take a while for newborn babies to settle into tummy time. It’s a bit like the first day you go to the gym. Muscles are being used that had a very quiet existence up to that point. It’s tough. And tummy time can feel a little like that for a small baby.

If you have a reflux baby, you have another hurdle to jump. Reflux babies do not like lying flat and they very often do not like tummy time at all. But tummy time is as important for these babies as it is for all babies. So how do you manage it?

Here are a few tips for effective tummy time for your reflux baby.

  1. Timing is everything. Before a feed is due but before they realise they are hungry is the best time. That can be a very short window but remember you only need to do a few minutes of tummy time to start off with.
  2. You don’t have to lie baby on the floor for tummy time. Lie baby on their tummy on your chest as you recline back and make eye contact with your baby. Encourage them to look up at you by engaging with them. This too is tummy time.
  3. Another great idea is to use a gym ball. Most pregnant mums have one and now that baby is born it may be taking up space. Let’s repurpose it for a while by using it for tummy time. Place a soft blanket on your gym ball and lie baby tummy down on it. Hold baby securely all the time by their arms. Gently and slowly roll the gym ball back and forth, while engaging with baby and making eye contact. As you roll the gym ball forward baby will lift their head to keep eye contact. This is tummy time too.

So, as you can see you have a few options for tummy time. As your baby’s reflux improves (especially if you have bought our course and found the cause of your baby’s reflux), tummy time will get a little easier. And remember too that if your baby is having a bad day, don’t feel like you must do tummy time. Tomorrow is another day.

Baby Reflux – A New Approach

Hello, we are Frank & Rose Kelleher. We have been working with babies and children for over 30 years, Frank as a Paediatric Osteopath and a Director of Nursing Services for Disability and Rose as a Nurse and Midwife and the Manager of our Paediatric Clinic. We are also parents to 4 children.

We have a busy paediatric clinic with parents travelling from all over Ireland to see Frank. We see as many babies as we possibly can every week at our clinic, but we know there are so many other babies who need our help.

You see we look at reflux in a different way. Having seen reflux babies every day for many years at our clinic, we began to see a pattern, we began to identify causes, and we quickly understood that reflux is a symptom that is caused by several very common issues. It also has many contributory causes that can aggravate symptoms. In our opinion and experience, identifying and treating the cause MUST be the first step in the process.

During our time working with babies, we have seen many changes. Back when we started there really was no information available for parents other than from their Public Health Nurse or Doctor. The terms “all babies cry” and “he will grow out of it” are throwbacks from this era and demonstrate clearly how poorly babies and their parents were treated.

Of course, you may still be told this today but thankfully you have the power in your hands, and you can seek out a solution for your baby’s distress yourself.

We will show you how to understand and solve your baby’s reflux in our step-by-step course. No big words or complicated theories we promise. Just no-nonsense professional advice and information from people who love babies.

Baby Reflux can feel like an extremely complicated condition with many causes, treatments, and solutions. We will break it down for you piece by piece so that you will see why your baby has reflux and how you can help your baby feel more comfortable and happier.

Reflux can also require many frequent adjustments. It can feel like 1 step forward, 2 steps back some days. Again, we will help you navigate these adjustments with clarity, understanding why they are necessary and how they will help. We believe information is essential for parents dealing with baby reflux. It shows you light at the end of the tunnel. It points you in the direction of that light. And it keeps you sane!

How do you know if this course is the right one for you? Well, ask yourself these questions.

Has your baby been diagnosed with reflux?

Is your baby still in discomfort and pain?

Is treatment not making any real difference to your baby?

Is he still screaming in pain?

Do you have to hold your baby all the time?

Do you feel helpless, not knowing what is wrong and how you can help?

Then yes, our course is exactly what you are looking for.

Our course, Baby Reflux – A New Approach, will give you the benefit of all our years of experience treating babies with this condition and many of the associated conditions. We want to find a solution for every baby we see at our clinic and over the years we have studied this condition in detail, looking for causes, optimum treatment options, new research, and practical solutions. We have combined all this information in this course so that we can help as many babies (and parents!) as possible.

If you want answers, if you want a happy baby who is not continually crying and distressed, then this course is for you.

Let us help you become the best possible advocate for your baby.

Paced Feeding – What it is and why it’s so important for bottle fed reflux babies.

If you have a bottle-fed baby with reflux symptoms, you may have noticed that they can drink their bottle very quickly. They may gag and splutter as they drink it. And if they do, they are without doubt taking in too much air.

And why is that a problem?

This air takes up valuable space in your baby’s tiny tummy. If you can hear the milk sloshing around in your baby’s stomach, then there’s too much air there too. When you burp baby, they will often bring up a portion of their feed with the air and this can aggravate the reflux symptoms.

The remainder of the air must also be dealt with. This air travels down through their digestive system and baby will groan, grunt and strain as they try to get it through and out the other end. This straining adds extra pressure to an already struggling digestive system.

So how can you reduce the amount of air your baby takes in while feeding.

Paced feeding is a way of bottle feeding that allow your baby to control the flow of milk better.

1. The best position for controlled feeding is to hold baby in a semi-upright position, as opposed to lying down. This helps baby to control the flow of milk better. He only needs to be slightly reclined so that the bottle isn’t pouring down into baby’s mouth.

2. Lay the bottle teat across baby’s lips (pointed up) when baby starts rooting and opening his mouth. Let baby pull the teat into his mouth and close his lips on the base of the teat.

3. Once latched on, keep the bottle just above horizontal. This allows baby to control the flow of milk better without taking in air. This also helps the bottle to last the entire length of a normal feeding, usually 10–20 minutes, rather than baby gulping a bottle down in 5 minutes.

Baby learns to recognize when he’s full because he is not filling his belly before the signals of fullness can reach his brain.

To prevent over-feeding look for cues that baby may be getting full, such as:

• Slower sucking

• Eyes wandering or getting distracted

• Not interested in feeding

• Falling asleep

• Hands are open and relaxed

When you think baby’s getting close to being full, remove the teat from his mouth by gently twisting.

Offer it again, and if he accepts, give him about 10 sucks, and repeat until he refuses. This will help him to recognise the feelings of satiety and reduce over-feeding.

Likewise, don’t make baby take the last few drops of milk in the bottle. If he falls asleep, he is finished (an exception being new-borns, who may need to be woken up in the first few days to feed)

Tongue Tie in Babies – What you need to know.

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. But Tongue-tie is the non-medical term for a relatively common but often over-looked physical condition, that limits the use of the tongue. The medical name for tongue-tie is ankyloglossia.

Tongue-tie affects 5-10% of new-born babies and is more common in boys than girls. Normally, the tongue is loosely attached to the base of the mouth with a piece of skin called the lingual frenulum. In babies with tongue-tie, this piece of skin is unusually short and tight, restricting the tongue’s movement. Tongue-tie can run in families, with some only mildly affected, and others function is severely affected.

The biggest effect of a tongue-tie in a newborn baby, is on the breast-feeding baby. To breastfeed successfully, the baby needs to latch on to both breast tissue and nipple, and the baby’s tongue needs to cover the lower gum, so the nipple is protected from damage. Babies with tongue-tie are not able to open their mouths wide enough to latch on to their mother’s breast properly. They tend to slide off the breast and grind on the nipple with their gums. This is very painful, and the mother’s nipples can become sore. Some babies feed poorly and get tired, but they soon become hungry and want to feed again.

Many Mums who experience this type of difficulty with breast-feeding will look for advice from a Lactation Consultant. Tongue-tie should always be out ruled or diagnosed by a Health Professional in breast-feeding mums who are having feeding difficulties.

Of course, bottle-fed babies can also have a tongue tie. While feeding is less dependent on the good movement of the tongue, very often these babies can take in a lot of air when feeding. They can gulp their feed and will be on and off the teat often during the feed. We frequently see babies who have symptoms very similar to Reflux as a result of Tongue Tie. For this reason, it is always worthwhile checking for the possibility of tongue or lip tie in babies with reflux symptoms.

Symptoms of Tongue-Tie

Baby Symptoms may include;

•        Falls asleep while feeding

•        Poor latch

•        Slides off nipple/teat during feeds

•        Audible clicking noise while feeding

•        Reflux Symptoms

•        Poor weight gain

•        Gumming/Chewing of mum’s nipples while feeding

•        Short sleep episodes requiring feeds every 2-3 hours

•        When baby cries the tongue can be seen to be suspended in the mouth with the sides curled upwards at the edges.

“If milk is leaking out, then that’s the same space where air is getting in.”

Kate Roche of The National Tongue Tie Centre

Mum’s signs and symptoms may include;

•        Cracked, bruised and blistered nipples

•        Creased, flattened, or blanched nipples after breastfeeding

•        Bleeding nipples

•        Severe pain when baby attempts to latch

•        Poor or incomplete breast drainage

•        Mastitis or nipple thrush

•        Plugged ducts

Although it is often overlooked, tongue-tie can be an underlying cause of feeding problems that not only affect a child’s weight gain but lead many mothers to abandon breast feeding altogether.

Lip Tie

A lip tie is very similar to a tongue tie. With a lip tie, the piece of tissue connecting the upper lip to the gum is too tight. This prevents the upper lip from flaring out and creating a good seal on the breast. In some cases, a baby may even have difficulty feeding from a bottle. Treatment for a lip tie is to release it by cutting the frenulum connecting the upper lip to the gum. Many children who have a lip tie can also have a tongue tie. Both can be released at the same time.

How to correct Tongue-Tie.

Once a Tongue Tie has been diagnosed by your Lactation Consultant, Osteopath or GP, it’s then time to get treatment. We have listed the people we refer to at the end of this article, but your Lactation Consultant or GP will be able to give you contact details for someone in your area who treats Tongue Tie.

A Frenotomy is a surgical incision of the lingual Frenulum, a band of tissue that connects the base of the tongue to the floor of the mouth. It is done with a sterile scissors or by laser. In older children, a mild general anaesthetic or sedative may be given, while a local anaesthetic gel is applied to the area under the tongue in babies. Most babies will cry a little during the procedure due to the lifting up of the tongue to access the area. The procedure takes as little as 1 minute. Once the frenotomy is done, baby can breast feed immediately.

Very often, a Lactation Consultant will see you after the procedure to advise you about feeding positions and to ensure that baby is now feeding better than before the procedure. You will be advised about pain relief for your baby as it is very important to keep baby comfortable while the wound is healing so that they can tolerate the mouth work required and that they will continue to feed and move their tongue.

You will be given very specific exercises to do with baby to prevent the tongue tie re-attaching. When doing these exercises, it’s very important to pick a time of day when baby is most settled and has had pain relief. For a small baby, mid feed is a good time.

How Paediatric Osteopathy can help Tongue-Tie.

Frank will often see babies when they have had a frenotomy (tongue tie) correction done. The key to treatment is the re-balancing of muscular tension in the front and the back of the neck. Prior to having the frenotomy, the baby’s tongue has been anchored to the floor of the mouth and unable to form a good latch. The neck and jaw muscles have been used to create the latch and that becomes exhausting for the baby when feeding.

Once the tongue tie is released the baby will learn to orientate the movement of the tongue to deepen the latch. Frank uses very gentle techniques to ease tension in the muscles of the neck and the jaw to allow the baby’s latch to improve. Re-balancing of the neck muscles will allow the baby to rotate to both sides more easily and have the head in a neutral position for feeding. Improving ribcage movement, allows an improved suck-breath-swallow mechanism to occur when baby is feeding.

We recently spoke to Dr Justin Roche and his wife Kate Roche from The National Tongue Tie Centre on our podcast about tongue tie in babies and older children. If you think your child may have a tongue tie, we would really recommend that you listen to Episode 8, links below.

For more information about Tongue Tie contact:

Dr Justin Roche at https://www.drjustinroche.com/

Deirdre O Leary at https://tonguetiecork.ie/

Glue Ear and why Hearing Tests are so important.

Glue ear is essentially fluid behind the eardrum. This fluid builds up as a result of recurring ear infections . The tube that should drain the fluid from the middle ear, the Eustachian tube, can become inflamed and blocked. Over time, this fluid may become thick (hence the name – glue) and cause discomfort, and can also affect the child’s hearing. Imagine hearing everything with water in your ears! That is what it sounds like for a child with glue ear.

While ear infections are easy to diagnose, glue ear can be more difficult. Sound waves travel through the ear by vibrating the eardrum and then these vibrations are transferred to three tiny bones in the middle ear and then to the inner ear where the vibrations are interpreted as sound. If the middle ear contains fluid rather than air, the movement of the sound waves through this area to the inner ear is affected.

Very often, if glue ear is a persistent problem, the child’s speech and hearing may be affected and this in turn can lead to behavioural issues as they become frustrated. Audiology tests are important as they will both confirm the presence of fluid behind the ear drum and test the child’s hearing.

Audiology testing will include a tympanometry test, which measures how well the eardrum can move. If there is fluid in the middle ear the eardrum will not work properly. A hearing test will also be done to check if the glue ear is affecting your child’s hearing and if so, by how much.

Look out for the following if you think your child may have glue ear:

No reply when called

TV turned up loud

Complains of ear pain or discomfort

Speech is delayed

Lack of concentration

Balance issues or clumsiness

In school going children they may begin to fall behind at school

Treatment

Paediatric osteopathy can help drain this fluid from the ears. It is a wonderful first option treatment as it is so gentle. As winter approaches, we always begin to see more children with ear infections as a result of the usual coughs and colds picked up at that time of year. Many parents also bring their children back for check-ups to keep them healthy over the winter.

Another helpful idea is an Otovent auto-inflation device. This is suitable for children who are old enough to blow their nose. The aim of the device is to inflate the balloon with the nose. The balloons are included in the kit and are specially pressurised. This action helps to open the Eustachian tubes allowing the fluid associated with glue ear to safely drain away.

Sometimes grommets may need to be inserted by an ENT doctor to assist the drainage. This is a very minor surgical procedure done under a general anaesthetic where a small incision is made in the ear drum and little plastic tubes are inserted to allow fluid to drain. Children who have grommets inserted should avoid getting water in their ears. Precautions should be taken when swimming and at bath-time.

A great product for swimming is the Ear Band-It Ultra headband which was invented by an Ear Nose and Throat (ENT) physician. This headband will hold earplugs in place while the child is swimming. Occasionally the grommets can fall out. If this happens, the eardrum heals naturally itself.

How paediatric osteopathy can help ear infections and glue ear

As a paediatric osteopath, I treat children with recurrent ear infections and glue ear frequently. Firstly, I examine the available movement in their temporal bones; these are the bones at the side of the skull in which the ear is located. I observe the position of the temporal bones compared to each other and compared to the occipital bone at the back of the skull.

A flat head in baby may affect the movement of the ear bones and the adjacent bones of the skull. Babies who have had a forceps delivery are more likely to have increased tension in the temporal bones due to the pressure applied during delivery.

By reducing the tension in the temporal bones, the function of the Eustachian tube is improved and this in turn helps fluid to drain from the middle ear. I also examine upper rib cage movement and the tension in the muscles that connect the ribs to the ear bone surfaces, as many ear infections originate in the upper respiratory tract as a result of coughs and colds.

Successful treatment must also include the doctor, as ear infections may continue to occur occasionally. The fluid in the middle ear is thick and mucousy and can take time to drain. However, over time, the ear infections become less frequent and the glue ear begins to resolve.

If you would like more information about ear infections, glue ear and hearing tests listen to Episode 4 of The Happy Baby Podcast

Sadie’s story

Sadie was a great baby. She had a little reflux but that seemed to settle down after a few months. A week after her first birthday she got an ear infection and needed antibiotics. She recovered quickly but after three weeks she got another one. This was the start of her getting ear infections every six weeks or so. Her sleep got worse too and she had been a great sleeper.

After her sixth antibiotic I brought her to see Frank. He told me that she had some fluid behind her eardrum and that this was very likely causing the repeated infections. He treated her three times over a six week period and after the second treatment, she started sleeping through the night again. She was so much happier and thankfully has not had another ear infection since.

Mark’s story

Mum brought Mark to see me when he was three years old. She said that Mark had got his first ear infection at eighteen months old and to date, was just finishing his ninth antibiotic. She was down to visit the doctor every three to four weeks.

I asked Mum to tell me Mark’s story. He had reflux from six weeks to six months but when he went on solids it eased. He was a very poor sleeper and only started sleeping through the night at two years. He had persistent congestion, waxy ears, runny nose and a night-time cough. He had a tough teething process, lots of dribbling, chewing, red cheeks and wakeful nights and would fall a lot when learning to walk. He had up to ten to twelve ear infections at this stage, some of them viral, others bacterial with a discharge from his ear.

The key here was the recurrent nature of the ear infections. I asked Mum about any family history of ear infections. Dad had grommets as a child and a first cousin also had to have grommets inserted. In my experience there is often a previous family history in children with recurring ear infections and glue ear. It’s worth asking the question at case history.

I treated Mark at the clinic over a period of six weeks, three treatments in total. I focused treatment on the respiratory system, activation of ribcage, lengthening of musculature of the neck, deepening the breathing and improve the ear surface motion to help Eustachian tube drainage.

I advised Mum to undertake a decongestion home plan. This involved giving Mark probiotics to strengthen his immune system response, using a Salin salt pump at night to decongest and dry up mucous, and decreasing diary intake and substitute with other fortified diary sources. I suggested a visit to the doctor to check ear integrity.

I reviewed Mark after six weeks. He was ear infection-free, less congested and healthy. If the plan hadn’t worked and Mark’s response was poor, I would have asked his Mum to contact his doctor to get a referral to an Ear Nose and Throat consultant because in my opinion a family history of ear infections can be significant as some children may inherit smaller Eustachian tubes than others.

Ear Infections in Children

The ear is made up of three distinct parts: the outer ear, the middle ear (behind the ear drum) and the inner ear (deep within the temporal bone). Ear infections are the most common illness to affect pre-school children with up to 90% of children experiencing one before their third birthday.

When an ear infection occurs, it is the middle ear which is affected. Some children just get the occasional ear infection, others get recurring ear infections and it’s generally these children we see at the clinic. They may also go on to develop glue ear as a result of fluid building up in the middle ear.

The middle ear is normally filled with air and is connected to the back of the nasal passages by a small tube called the Eustachian tube. This tube is short and narrow and horizontal in babies and therefore not so effective. As a child grows the tube becomes more oblique and this allows fluid to drain from the middle ear much more effectively. This explains why some parents are often told that their child will “grow out” of ear infections.

The Eustachian tube allows us to equalise the pressure on either side of the ear drum – like when your ears go pop in a plane. Babies do this by crying, swallowing and yawning. However, when a child is susceptible to coughs, colds and ear infections this tube often becomes inflamed and can be blocked with mucus.

Children are frequently brought to see us because they don’t sleep. On closer examination, we sometimes find that the child has had a few ear infections. In many cases like this, the child wakes at night because of the fluid in the middle ear. It may be uncomfortable, and the ears may need to pop. A little drink of water may help when they wake up, but the main aim of treatment is to move the fluid and mucus away from the middle ear, relieving the pressure behind the eardrum.

There are certain conditions that increase the risk of ear infections and glue ear.

Being under three years of age or being a boy.

Going to nursery. Children in day-care have more contact with other children and as a result are more likely to catch infections.

Bottle-fed babies. Breastmilk increases the baby’s immune system.

Being near second-hand smoke. Children with a parent who smokes are 50% more likely to get ear infections and 40% more likely to get glue ear.

Being in a large family or having a family history of glue ear.

Using a soother. Children diagnosed with an ear infection have almost double the risk of recurrent infections if they use a soother. Sucking on a soother increases the negative pressure in the Eustachian tube and this draws mucus into the tube.

Having recurrent coughs and colds and babies who are constantly chesty.

Research done in the Czech Republic and published in the International Journal of Pediatric Otorhinolaryngology in 2015 suggests that there may be a link between infant reflux and glue ear. In the study, they tested the fluid in the middle ear for the presence of pepsinogen (an enzyme only found in the stomach) during grommet insertion. They discovered that samples from 31.8% of children were positive for pepsinogen.

In babies the Eustachian tube is not fully developed; it’s shorter and more horizontal than in adults. As a result, refluxed acidic stomach contents may enter the Eustachian tube and reach the middle ear. This increases the risk of ear infections and glue ear in babies with severe reflux.

Signs and symptoms of an ear infection

Ear infections can be caused by a viral or bacterial infection and very often follow on from a sore throat, cough or cold. Signs and symptoms of an ear infection include high temperature, pain and irritability, nausea and vomiting, difficulty sleeping and the child will often pull at their ears.

In some cases, the ear infection does not clear up completely and this may lead to fluid developing in the middle ear. This in turn will progress on to another ear infection, which exacerbates the problem by increasing the inflammation in the Eustachian tube.

Small children may not be able to tell you they have pain or discomfort and may be seen tugging at their ears. Children with symptoms of an ear infection should always be seen by their doctor.

Types of ear infection

Acute Otitis Media – This is the most common type of ear infection. Fluid builds up behind the eardrum and causes pain. When a very severe infection is present, the eardrum may perforate due to the pressure of the fluid in the middle ear. If this happens, you should see your doctor.

Otitis Media with Effusion – This is more commonly known as glue ear. In this case, fluid remains behind the eardrum after the infection has cleared. This can affect the child’s hearing and poses a risk to another infection developing.

If you would like more information about ear infections, glue ear or hearing tests, listen to episode 4 of The Happy Baby Podcast below.

Treatment for Ear Infections

For many infections the main treatment is to manage the symptoms. Give your child an analgesic like paracetamol to relieve the pain and bring down their temperature. Always follow the manufacturer’s dosage guidelines and only give the medication when needed.

If the symptoms persist for longer than 48 hours, or if you are concerned about your child, see your doctor. An antibiotic may be needed to treat the infection. You should however always see you doctor if your child’s temperature is above 38 degrees Celsius, if they are very distressed or if you have any other concerns.

A cold compress on the affected ear will help reduce the pain.

Encourage your child to drink plenty of fluids, particularly if they have a high temperature.

For children who have a recurring ear infection, it may be worth asking your doctor about antibiotic drops instead of oral antibiotics.

Why does your newborn baby cry?

All babies cry, that’s a well documented fact. But as a new parent you can sometimes feel like your baby cries more than you expected. Sometimes having a few reasons why a baby may be crying can help you solve their upset.

Your newborn baby is fully dependent on you. You provide her with the food, warmth, security, and comfort that she requires. When she cries, it’s her way of communicating those needs and asking you for attention and care. When you respond quickly to comfort your crying baby, she will cry less often overall. It’s perfectly fine to pick up your baby when she cries. It tells her that she’s safe because you’re a caring, responsive parent who loves her.

You can’t spoil a newborn.

If your newborn is crying, it’s because he needs your help. If you respond calmly and consistently, it helps your baby learn that the world is a safe and predictable place.

As a parent, we are also programmed to respond to a baby’s cry. It’s a sound that can spur you into action, even when you’re asleep. If you’re a breastfeeding mum, it can trigger your let-down reflex. However, it’s sometimes hard to work out what exactly your baby wants you to take care of. Is it food, a change of nappy, a cuddle? As your baby grows, she’ll learn other ways of communicating with you and you will be better at identifying her different cries.

In the meantime, here are some reasons why your baby may cry, and what you can try to soothe her.

Is baby hungry?

The most common reason babies cry is because they are hungry. In fact, the younger baby is, the more likely that hunger is the reason why she is crying. Once you start feeding, they will stop crying and will be much more settled by the end of the feed. Some babies take a little while to build up to crying when they are hungry, and you will observe the other hunger cues that occur before crying. Other babies realise they are hungry very quickly and can skip the hunger cues and go straight to crying!

Is baby tired?

The second most common reason babies cry is that they need sleep. Your baby may find it hard to get to sleep, particularly if she’s over-tired. The younger your baby is, the more subtle her sleep cues are, so it may take a few weeks for you to recognise the signs.

Has baby had too much to eat?

Some babies cry because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.

Have you had too much coffee?

Caffeine is a stimulant that can cause increased crying and trouble falling asleep. You’d never have a coffee yourself before bed-time would you? Breastfeeding mothers need to limit their caffeine intake so that their baby isn’t overstimulated by it. After all, you’ll be the one paying the price if baby won’t sleep.

Are they uncomfortable?  

Being too hot or too cold can make a baby cry. You can check whether your baby is too hot or too cold by feeling her tummy or the back of her neck. Don’t be guided by the temperature of your baby’s hands or feet. It’s normal for them to feel colder than the rest of her body. Keep the temperature of the room your baby sleeps in between 16 degrees C and 20 degrees C. Use a room thermometer to keep track of the temperature. Place baby to sleep on her back with her feet at the foot of her cot. That way she can’t wriggle down under the blankets and become too hot. Use cotton sheets and cellular blankets as bedding in your baby’s cot or Moses basket. If her tummy feels too hot, remove a blanket or layer, and if it feels cold, simply add one.

Do they need a change of their nappy?

A wet or dirty nappy can be very irritating to the skin. Some babies don’t seem to mind it, others find it extremely uncomfortable. You’ll soon develop a parent’s ability to sniff a wet or dirty nappy from a distance.

Have they got tummy pains?

“Colic” is said to be the main cause of recurrent crying during the early months. All babies have some normal fussy crying every day, we all remember the witching hour. When this occurs over 3 hours per day, it’s often called colic. But colic is an umbrella term to describe all manner of digestive issues a baby may have. See COLIC Fact Vs Fiction for more information. It’s important to get medical advice so that you can get to the cause of the problem.

Have they pain?

A baby in pain or discomfort will cry to let you know they need your help. Wind, gas, nappy rash or reflux are all reasons a baby may be in pain. If however you have looked for all the usual reasons a baby will cry and you cannot find a solution, it may be worth a visit to your Doctor to have baby checked over. Trust your instinct on this.

Is baby over-stimulated?

Lots of attention and handling from doting visitors may over-stimulate your baby and make it hard for her to sleep, as can too much rocking and singing. Try taking her to a quiet room after a feed and before bed to help her calm down. Use white noise to sooth baby and avoid any eye contact as even this may be sufficient stimulation to keep baby awake.

Does baby need a cuddle?

Your baby needs lots of cuddles, physical contact and reassurance so her crying may mean that she just wants to be held. Swaying and singing to her while you hold her close, will help to distract and comfort her. That familiar voice and smell will give then the feeling of security they may need.

Nobody knows your baby as well as you do. If you feel that something’s not right, trust your instincts and call your GP.

Very often babies just naturally cry a lot in the early weeks. Crying tends to peak at around two months, and usually starts to ease off after that. But in the meantime, it’s likely to make you and your partner feel very anxious at times. Whatever the cause, living with a baby who regularly cries inconsolably can be incredibly stressful. It’s important to look after yourself too, so that you have the patience and energy to soothe your little one. And remember, it ok not to be ok. Ask for help if you need it. Your baby needs you to be well.