Ear, nose and throat

Your Child and Ear Infections

Middle-ear infections, which doctors call otitis media, are less common during mid­dle childhood than at younger ages.

When the Ear is Infected…

When an ear is infected, the eustachian tube—the narrow passage connecting the middle ear (the small chamber behind the eardrum) to the back of the throat—becomes blocked. During healthy periods this tube is filled with air and keeps the space behind the eardrum free of fluid; dur­ing a cold or other respiratory infection, or in children with allergies, this tube can become blocked, fluid begins to accumulate in the middle ear, and bacteria start to grow there. As this occurs, pressure on the eardrum increases and it can no longer vi­brate properly. Hearing is temporarily reduced, and at the same time the pressure on the eardrum can cause pain.

Your pediatrician should examine your youngster’s ears with an instrument called an otoscope, with which inflammation and fluid behind the eardrums can be detected. If an infection is present, your physician may prescribe antibiotics to destroy the bacteria and diminish the buildup of fluids. Antibiotics are not always necessary. Acetaminophen or ibuprofen can help ease the pain.

About Ear Tubes

Occasionally, when a child has repeated ear infections, and when fluid in the ears tends to persist despite medication, the doctor may suggest inserting small drainage tubes through the eardrum to help remove the trapped fluid. To date, however, the research examining the poten­tial benefits of these tubes is inconclusive, and there are clearly some drawbacks to them—namely, anesthesia is required for insertion, and the tubes can sometimes come out by themselves.

Treatment for Recurrent Ear Infections

If your child has recurrent ear infections (4 or more ear infections in the past 12 months with at least 1 in the past 6 months), your doctor may decide to place your child on low doses of antibiotics on a long-term basis to prevent infections. This therapy has been shown to decrease the frequency of ear infections. However, this therapy can increase the risk of resistant infections. Some doctors may also suggest surgical removal of the adenoids (adenoidectomy) if they are blocking the child’s eustachian tube.

When to Return to Child Care or School

Ear infections are not contagious. Your child can safely return to child care or school after the pain and fever subside. However, he should continue taking the antibiotics as pre­scribed until the pills or liquid are used up.

Ear, nose and throat

When is a Sore Throat a More Serious Infection?

Sore throats are common in kids. However, it can be difficult to sort out when your child has a sore throat that will get better on its own, or one caused by a more serious infection.

Here’s some information on common infections that may include a sore throat.

The Common Cold

Sore throats are most often caused by a viral infection like the common cold. These illnesses show up more commonly during winter but can happen year-round. In addition to a sore, scratchy throat, a cold virus can cause your child to have a fever, runny nose and cough. Antibiotics will not help a sore throat caused by a virus. These infections usually get better without medication in 7 to 10 days. The best way to care for a cold and sore throat is to help keep your child comfortable and make sure he or she gets plenty of fluids and rest.

Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is caused by a family of viruses called enteroviruses. This infection most often spreads among young children during summer and fall, although cases may occur year-round. Early symptoms may include fever and sore throat or mouth pain, followed by a rash that appears as a mix of small red bumps and blisters, particularly on the hands, feet, buttocks, and around the mouth. Blisters and sores may form in the mouth and throat, making it painful to swallow. As with other viruses, antibiotics will not help this type of sore throat. Your pediatrician may recommend acetaminophen or ibuprofen for the fever and pain, along with fluids and rest at home until the blisters heal.

Strep Throat

Strep throat is an infection caused by the bacterium Streptococcus pyogenes. It’s most commonly seen among children 5 to 15 years old, usually during winter and early spring. Only 20% to 30% of throat infections in school age children are caused by strep throat. Symptoms include sore throat, pus on the tonsils, difficulty swallowing, fever, and swollen glands. Children may also complain of headaches, stomachaches, and may develop a red, sandpaper-like rash on their bodies. Cough and runny nose are NOT typical symptoms of strep throat among older children. Strep throat is extremely uncommon in infants and toddlers. When they do get strep, though, their symptoms may be different. Your pediatrician will prescribe antibiotic medicine for strep throat.  

Why is it important to know the difference?

The cause of sore throats in children usually is viral infections, which do not benefit from antibiotics and go away on their own. Children with strep throat also may also recover without antibiotics. However, antibiotics can speed up recovery time, reduce contagiousness, and lower the risk of developing certain complications from strep throat. The most important complications to avoid include acute rheumatic fever, a disease that can damage the heart and joints. Antibiotics are important for treating bacterial infections like strep throat but have their own risks, including diarrhea, yeast infections, allergic reactions, and the development of antibiotic resistance. That’s why it is important to know when antibiotics are necessary for sore throat and when they are not.

Sore Throat: Diagnosis & Treatment

Your pediatrician can diagnose a sore throat caused by a virus after examining your child and ruling out a bacterial infection. The best way to care for a sore throat caused by a virus is to keep your child comfortable  and making sure they get plenty of fluids and rest. Your pediatrician may recommend acetaminophen or ibuprofen to relieve the fever and pain. For hand, foot and mouth disease, which is highly contagious, your child should stay home until the blisters begin to heal.

If your pediatrician is concerned about a possible strep throat infection, he or she may swab the back of your child’s throat to collect a test sample. Most pediatric clinics can do a rapid strep test, which gives results within about 10-15 minutes and can detect most cases of strep throat. If this test is negative, the pediatrician may send the sample to a lab where they will try to grow the bacteria. If either test is positive, your child may be diagnosed with strep throat. If both tests are negative, your child does not have strep throat.

Preventing Illnesses that Cause Sore Throat

The viruses and bacteria that cause a sore throat are passed from person to person through droplets of moisture in the air (from a sneeze or cough) or on the hands of someone who is infected. The illnesses may spread through schools and child care centers. One challenge for prevention is that people are often most contagious before they even begin to have symptoms. Washing hands, covering coughs and sneezes with a tissue or upper arm (rather than hand), cleaning toys, and not sharing drinking cups is the best way to try to prevent the spread of illness.

When to Call the Pediatrician  

If your child complains of a sore throat that does not improve over the course of the day―especially after drinking water―you should call your pediatrician. This is especially true if there there’s a fever, headache, stomachache, drooling (because it hurts to swallow), or signs of dehydration. Your child’s pediatrician may want him or her to come in for to determine if a strep test is needed.

If your child tests negative for strep throat or if your pediatrician does not think your child needs a throat swab, that is great news. Your child most likely has a virus that will get better with time. However, if his or her symptoms don’t get better after 3 to 5 days, or if they develop other symptoms such as an earache or a new fever, he or she should see the pediatrician again to determine if more tests are needed.

Ear, nose and throat

What to Do If You Discover a Lump on Your Child’s Neck

Finding a lump on your child’s neck can be alarming but neck masses are very common in children and usually harmless. 

A swollen spot on the neck is often an enlarged lymph node, for example, a sign your child’s immune system is fighting off an infection. 

Always have any lumps, bumps or swelling on your child’s neck checked. 

Your child’s pediatrician will check to see the lump’s size, location, firmness, and ask you about:

  • the legnth of time it has been there
  • whether your child has been sick or has other symptoms of infection
  • whether your child has been near pets or other animals, or has been outside the country

Most lumps found in a child’s neck are enlarged lymph nodes caused by an infection. 

Lymph nodes are part of the immune system and help rid the body of harmful bacteria, viruses, and other causes of irritation or infection. There are 200 to 300 lymph nodes in the back of the nose, throat, and neck. They may swell when you child’s body is fighting a common cold or strep throat, for example. 

​Lumps on the neck may also be an infection of the lymph node itself, or in other nearby spots.

Diagnosis and treatment of infections of the neck:

The most common infections of the neck are viral or bacterial and some can be treated with antibiotics. In certain types of “atypical” or unusual neck infections, a child may not seem that sick but the infected lumps seem to worsen. They may also be changes in the color and consistency of the overlying skin. 

The most common type of atypical lymph node infection is non-tuberculosis mycobacterium and may need surgery, or take months to improve. 

If your child does not respond to antibiotics or seems especially sick, has a high or prolonged fever and redness of the skin over the lump, your pediatrician may recommend:

  • IV antibiotics, which treat infections more quickly because they go directly into the bloodstream. A visit to the emergency department or stay in the hospital will also make it easier to monitor your child.
  • Lab or imaging tests, often either ultrasound or computer tomography (CT scan), to determine how severe the infection is. In rare cases, a needle biopsy might also be done to help identify the cause of the infection.
  • Surgical draining. If antibiotics alone do not clear up the infection, sometimes it may need to be drained using a needle or surgical instruments such as a scalpel or lancet.

Not all neck lumps are related to an infection. 

The lump could be from different types of cysts, abnormal growths of blood vessels, scar tissue or–rarely–tumors or cancer. Location, consistency, and color of the lump or skin around it can give clues as to what it might be.

Congenital cysts

It is common for young children to have small neck cysts—benign (non-cancerous) pockets of tissue that formed before birth and can grow larger over time. These are called congenital cysts. They can cause repeated infections and may need to be removed surgically. 

Common types of congenital cysts:

  • Thyroglossal duct cysts are the most common type of congenital neck cyst. They are usually located in the front of the neck, formed from cells leftover after the thyroid gland develops in the womb.
  • Branchial cleft cysts form when sections of the head and neck don’t come together exactly right before birth. They often are located below one or both ears or in the sides of the neck. These cysts may not be noticeable until later in childhood or adolescence.
  • Dermoid cysts can happen when layers of skin do not form properly during fetal development. These slow growing cysts may contain trapped sweat glands, hair follicles and other types of cells normally found in skin.

Deep hemangiomas

Sometimes neck lumps are a type of birthmark called hemangiomas, growth of blood vessels under a child’s skin. They may be noticeable when a baby is born and enlarge quickly by the first birthday. Deep hemangiomas can feel squishy than cysts, and the skin over them may look reddish. Although they often go away by the time a child reaches school age, your pediatrician may recommend treatment if it starts to cause grow rapidly or cause other symptoms.

Torticollis “pseudotumor”

Some babies with torticollis, a tightness on one side of the neck, develop a pseudotumor on the large muscle that connects the head, neck, and breastbone. The bump is often made up of scar tissue where the muscle was injured in the womb or during birth. It usually becomes noticeable between birth and 8 weeks of age. Your pediatrician may provide a referral for physical therapy that includes gentle heat, massage and passive stretching.

Malignant masses

Rarely, a neck lump may be a sign of childhood cancer. The most common types of childhood cancers of the neck include lymphoma, neuroblastoma, sarcoma, or thyroid tumors. A needle biopsy can help with the diagnosis, or the lump may need to be surgically removed to exam the cells under a microscope.

Ear, nose and throat

Treating Middle Ear Fluid

My child has middle ear fluid. How is that treated?

Treatment options include observation and tube surgery or adenoid surgery. Because a treatment that works for one child may not work for another, your child’s doctor can help you decide which treatment is best for your child and when you should see an ear, nose, and throat (ENT) specialist. If one treatment doesn’t work, another treatment can be tried. Ask your child’s doctor or ENT specialist about the costs, advantages, and disadvantages of each treatment.

When should middle ear fluid be treated?

Your child is more likely to need treatment for middle ear fluid if she has any of the following:

  • Conditions placing her at risk for developmental delays
  • Fluid in both ears, especially if present more than 3 months
  • Hearing loss or other significant symptoms

What treatments are not recommended?

A number of treatments are not recommended for young children with middle ear fluid.

Medicines not recommended include antibiotics, decongestants, antihistamines, and steroids (by mouth or in nasal sprays). All of these have side effects and do not cure middle ear fluid.

Surgical treatments not recommended include myringotomy (draining of fluid without placing a tube) and tonsillectomy (removal of the tonsils). If your child’s doctor or ENT specialist suggests one of these surgeries, it may be for another medical reason. Ask your doctor why your child needs the surgery.

Other treatment options

There is no evidence that complementary and alternative medicine treatments or that treatment for allergies works to decrease middle ear fluid. Some of these treatments may be harmful and many are expensive.

Ear, nose and throat

Tonsillitis: Symptoms and Treatment

The tonsils produce antibodies when the body is fighting infection. Like the tonsils, the adenoid is part of your child’s defense against infections. Read on to learn tonsillitis, signs of an enlarged adenoid and tonsils, and when surgery is recommended.

What are the tonsils and adenoid?

If you look into your child’s throat, you may see a pink, oval-shaped mass on each side. These are the tonsils. The tonsils are small in infants and increase in size over the early years of childhood. They produce antibodies during periods when the body is fighting infection.

Like the tonsils, the adenoid is part of your child’s defense against infections. The adenoid is located in the very upper part of the throat, above the uvula and behind the nose. The adenoid can be seen only with special instruments passed through the nose or mouth, or indirectly by X-ray.

What is tonsillitis?

A common illness associated with the tonsils is tonsillitis. This is an inflammation of the tonsils usually due to an infection. Sometimes, tonsils can be enlarged and not be infected. However, most of the time there is an infection that has caused them to be larger than normal.

Symptoms of tonsillitis

There are several signs and syptoms of tonsillitis, including:

  • Red and swollen tonsils
  • White or yellow coating over the tonsils
  • A “throaty” voice
  • Sore throat
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (“glands”) in the neck
  • Fever

Symptoms of an enlarged adenoid

It is not always easy to tell when your child’s adenoid is enlarged. Some children are born with a larger adenoid. Others may have temporary enlargement of their adenoid due to colds or other infections; this is especially common among young children. Also, chronic rhinitis (a persistent runny nose) is more frequently the cause of these symptoms, and can be treated with corticosteroid nasal sprays. But the constant swelling or enlargement of the adenoid can cause other health problems, such as ear and sinus infections.

Some signs of an enlarged adenoid include:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the child talks
  • Noisy breathing during the day
  • Snoring at night

When both the tonsils and adenoid enlarged

Both the tonsils and the adenoid may be enlarged if your child has the above symptoms along with any of the following:

  • Breathing stops for a short at night during snoring or loud breathing (this condition is called sleep apnea)
  • Choking or gasping during sleep
  • Difficulty swallowing, especially solid foods
  • A constant “throaty voice,” even when there is no tonsillitis

In severe cases, your child may have such difficulty breathing. It can interfere with the normal exchange of oxygen and carbon dioxide in his lungs. This is important to recognize since it may interrupt your child’s normal sleep pattern.

If your child has severe breathing difficulties, seems drowsy during waking hours, and lacks energy despite what should have been adequate amounts of sleep, consult your pediatrician; when breathing problems are severe, call 911.

If your child shows the signs and symptoms of enlarged tonsils or adenoid, and doesn’t seem to be getting better over a period of weeks, mention it to your pediatrician.

Does my child need their tonsils or adenoid taken out?

There are two types of operations: tonsillectomy (surgery to remove the tonsils) and adenoidectomy (surgery to remove the adenoid).

Although these two operations (often combined and called T & A) were done almost routinely in the past and remain one of the most common major operations performed on children, not until recently has their long-term effectiveness been adequately tested. In light of current studies, today’s physicians are much more conservative in recommending these procedures, even though some children still need to have their tonsils and/or adenoid taken out.

Your pediatrician may recommend surgery if:

  • Tonsil or adenoid swelling makes normal breathing difficult (causing problems such as behavioral issues, bed-wetting, sleep apnea, school performance problems, etc.).
  • Tonsils are so swollen that your child has a problem swallowing.
  • An enlarged adenoid makes breathing uncomfortable, severely alters speech, and possibly affects normal growth of the face. In this case, surgery to remove only the adenoid may be recommended.
  • The child has an excessive number of severe sore throats each year.

What if my child needs surgery?

If your child needs surgery, make sure they knows what will happen before, during, and after surgery. Don’t keep the surgery a secret from your child. An operation can be scary, but it’s better to be honest than to leave your child with fears and unanswered questions.

The hospital m​ay have a special program to help you and your child get familiar with the hospital and the surgery. If the hospital allows, try to stay with your child during the entire hospital visit. Let your child know that you’ll be nearby during the entire operation. Your pediatrician also can help you and your child understand the operation and make it less frightening.

Ear, nose and throat

Tips to Preserve Your Child’s Hearing during the Holidays

Hearing loss that results from exposure to loud noise, called noise-induced hearing loss, is of particular concern for today’s children. One of the main reasons is the widespread use of personal audio technology and other smart devices. 

Data from World Health Organization (WHO) states  1.1 billion teenagers and young adults  worldwide are at risk for hearing loss due to exposure to loud noise—and they point to noisy technology as a primary source. 

When not used safely, ear buds or headphones, present a significant danger to a child’s hearing. Of course, these devices and accessories also happen to top many holiday wish lists. Beyond tech gifts, other holiday hearing hazards include noisy toys for the youngest of children and noisy gatherings such as parties and concerts.

​In this article, the American Academy of Pediatrics and the American Speech-Language-Hearing Association list tips for protecting your kids’ hearing while enjoying the best of the holidays.

Noisy Technology

Smart devices, state-of-the-art headphones, and other tech gifts are among the most coveted items for kids of almost all ages. The products aren’t bad, but it’s critical to use them safely:

  • Teach safe listening. Help kids protect their ears by teaching them to turn the volume down (keep it to half level) and take listening breaks (ears benefit greatly from the rest).
  • Model good listening habits. As a parent​, it is critical that you practice what you preach when it comes to safe listening. Little ears are listening.
  • Choose wisely. Certain features or products may help with volume control. Noise-cancelling headphones are often a good idea, as kids won’t need to turn the volume up to drown out outside noise. Look for ear buds or headphones that fit the child well, which will prevent sound leakage and again reduce the need to turn the volume up to hear. Need a practical tip? If a you are an arm’s length away, your child wearing headphones should still be able to hear you when asked a question. 
​What Parents Need to Know About “Kid Safe” Headphones and Other Products:According recommendations from the WHO and International Telecommunication Union, to prevent hearing damage, children should listen to devices at volumes no higher than 75 decibels (a decibel is unit of measurement for sound), for no longer than 40 hours a week.

Many headphones and other products marketed as “kid safe” limit the volume at 85, 90 or even higher decibels. And upon testing, many are even louder than what they claim. So, while these products may be a good start, parents should still give it a listen themselves and teach kids to dial the volume down. Remember, headphone manufacturers aren’t interested in your child’s hearing; they are interested in selling products. There is no mandatory standard that restricts the maximum sound output for listening devices or headphones sold in the United States.

Noisy Toys

Toys designed for infants and toddlers may be noisy enough to cause hearing damage—especially since young children hold objects close to their face/ears.

  • Check your list. Before heading to the toy store or shopping online, check the annual Sight & Hearing Association’s Noisy Toys study to see if any of the products listed there are on your child’s wish list.
  • Listen up before purchasing. Pay attention to how loud a toy sounds, and consider a different option, if necessary.
  • Make a minor do-it-yourself modification. An easy way to reduce the noise is to put a piece of tape over the speaker. Alternatively, you can remove the batteries. Instantly, you’ve made the toy a much safer product.

Noisy Environments

Holiday parties and concerts, sporting events, and other gatherings are part of the season. Make sure to be mindful of the noise level.

  • Use hearing protection. Bring earplugs or ear muffs with you when there is potential for loud noise. This is a cheap, easy, and effective way to preserve kids’ (and adults’) hearing.
  • Keep a distance from noise sources. Don’t let kids stand near speakers or other noise emitters.
  • Leave if noise is enough to cause discomfort. Ringing and pain are signs that ears need a break. If your child is complaining, covering his or her ears, or seems uncomfortable, consider an early exit.

Concerned About Your Child’s Hearing?

Even minor hearing loss can significantly impact a child’s development, academic success, and social interactions, among other things. It’s important that you act early if you have concern.

  • Learn the early signs of hearing loss and schedule a hearing evaluation.
Ear, nose and throat

The Difference Between Sinusitis and a Cold

Sinusitis is an inflammation of the lining of the nose and sinuses. It is a very common infection in children.

  • Viral sinusitis usually accompanies a cold. Allergic sinusitis may accompany allergies such as hay fever.
  • Bacterial sinusitis is a secondary infection caused by the trapping of bacteria in the sinuses during the course of a cold or allergy.

General Characteristics of Viral Colds

It is often difficult to tell if an illness is just a viral cold or if it is complicated by a bacterial infection of the sinuses. 

  • Colds usually last only 5 to 10 days.
  • Colds typically start with clear, watery nasal discharge. After a day or 2, it is normal for the nasal discharge to become thicker and white, yellow, or green. After several days, the discharge becomes clear again and dries.
  • Colds include a daytime cough that often gets worse at night.
  • If a fever is present, it is usually at the beginning of the cold and is generally low grade, lasting for 1 or 2 days.
  • Cold symptoms usually peak in severity at 3 or 5 days, then improve and disappear over the next 7 to 10 days.

Signs and Symptoms of Bacterial Sinusitis:

  • Cold symptoms (nasal discharge, daytime cough, or both) lasting more than 10 days without improving
  • Thick yellow nasal discharge and a fever for at least 3 or 4 days in a row
  • A severe headache behind or around the eyes that gets worse when bending over
  • Swelling and dark circles around the eyes, especially in the morning
  • Persistent bad breath along with cold symptoms (However, this also could be from a sore throat or a sign that your child is not brushing his teeth!)
  • In very rare cases, a bacterial sinus infection may spread to the eye or the central nervous system (the brain). If your child has the following symptoms, call your pediatrician immediately:
    • Swelling and/or redness around the eyes, not just in the morning but all day
    • Severe headache and/or pain in the back of the neck
    • Persistent vomiting
    • Sensitivity to light
    • Increasing irritability
    • Diagnosing bacterial sinusitis

It may be difficult to tell a sinus infection from an uncomplicated cold, especially in the first few days of the illness. Your pediatrician will most likely be able to tell if your child has bacterial sinusitis after examining your child and hearing about the progression of symptoms. In older children, when the diagnosis is uncertain, your pediatrician may order computed tomographic (CT) scans to confirm the diagnosis. 

Treating Bacterial Sinusitis

  • If your child has bacterial sinusitis, your pediatrician may prescribe an antibiotic for at least 10 days. Once your child is on the medication, symptoms should start to go away over the next 2 to 3 days—the nasal discharge will clear and the cough will improve. Even though your child may seem better, continue to give the antibiotics for the prescribed length of time. Ending the medications too early could cause the infection to return.
  • When a diagnosis of sinusitis is made in children with cold symptoms lasting more than 10 days without improving, some doctors may choose to continue observation for another few days. If your child’s symptoms worsen during this time or do not improve after 3 days, antibiotics should be started.
  • If your child’s symptoms show no improvement 2 to 3 days after starting the antibiotics, talk with your pediatrician. Your child might need a different medication or need to be re-examined.

Treating Related Symptoms of Bacterial Sinusitis

  • Headache or sinus pain. To treat headache or sinus pain, try placing a warm washcloth on your child’s face for a few minutes at a time. Pain medications such as acetaminophen or ibuprofen may also help. (However, do not give your child aspirin. It has been associated with a rare but potentially fatal disease called Reye syndrome.)
  • Nasal congestion. If the secretions in your child’s nose are especially thick, your pediatrician may recommend that you help drain them with saline nose drops. These are available without a prescription or can be made at home by adding 1/4 teaspoon of table salt to an 8-ounce cup of water. Unless advised by your pediatrician, do not use nose drops that contain medications because they can be absorbed in amounts that can cause side effects.
    • Placing a cool-mist humidifier in your child’s room may help keep your child more comfortable. Clean and dry the humidifier daily to prevent bacteria or mold from growing in it (follow the instructions that came with the humidifier). Hot water vaporizers are not recommended because they can cause scalds or burns.


If your child has symptoms of a bacterial sinus infection, see your pediatrician. Your pediatrician can properly diagnose and treat the infection and recommend ways to help alleviate the discomfort from some of the symptoms. 

Ear, nose and throat

Swollen Glands

Lymph glands (or lymph nodes) are an important part of the body’s defense system against infection and illness. These glands normally contain groups of cells, called lymphocytes, which act as barriers to infection. The lymphocytes produce substances called antibodies that destroy or immobilize infecting cells or poisons. When lymph glands become enlarged or swollen, it usually means that the lymphocytes have increased in number due to an infection or other illness and that they are being called into action to produce extra antibodies. Rarely, swollen glands, particularly if long-lasting and without other signs of inflammation, such as redness or tenderness, may indicate a tumor.

If your child has swollen glands, you’ll be able to feel them or actually see the swelling. They also may be tender to the touch. Often, if you look near the gland, you can find the infection or injury that has caused it to swell. For example, a sore throat often will cause glands in the neck to swell, or an infection on the arm will produce swollen glands under the arm. Sometimes the illness may be a generalized one, such as those caused by a virus, in which case many glands might be slightly swollen. In general, because children have more viral infections than adults, lymph nodes, particularly in the neck, are more likely to be enlarged. Swollen glands at the base of the neck and just above the collarbone may be an infection or even a tumor within the chest, and should be examined by a physician as soon as possible.


In the vast majority of cases, swollen glands are not serious. Lymph node swelling usually disappears after the illness that caused it is gone. The glands gradually return to normal over a period of weeks. You should call the pediatrician if your child shows any of the following:

  • Lymph glands swollen and tender for more than five days
  • Fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius)
  • Glands that appear to be swollen throughout the body
  • Tiredness, lethargy, or loss of appetite
  • Glands that enlarge rapidly, or the skin overlying them turning red or purple

As with any infection, if your child has a fever or is in pain, you can give her acetaminophen in the appropriate dosage for her weight and age until you can see the pediatrician. When you call, your doctor probably will ask you some questions to try to determine the cause of the swelling, so it will help if you do a little investigating beforehand. For instance, if the swollen glands are in the jaw or neck area, check if your child’s teeth are tender or her gums are inflamed, and ask her if there is any soreness in her mouth or throat. Mention to your doctor any exposure your child has had to animals (especially cats) or wooded areas. Also check for any recent animal scratches, tick bites, or insect bites or stings that may have become infected.

The treatment for swollen glands will depend on the cause. If there’s a specific bacterial infection in nearby skin or tissue, antibiotics will clear it, allowing the glands gradually to return to their normal size. If the gland itself has an infection, it may require not only antibiotics but also warm compresses to localize the infection, followed by surgical drainage. If this is done, the material obtained from the wound will be cultured to determine the exact cause of the infection.

Doing this will help the doctor choose the most appropriate antibiotic. If your pediatrician cannot find the cause of the swelling, or if the swollen glands don’t improve after antibiotic treatment, further tests will be needed. For example, infectious mononucleosis might be the problem if your child has a fever and a bad sore throat (but not strep), is very weak, and has swollen (but not red, hot, or tender) glands, although mononucleosis occurs more often in older children. Special tests can confirm this diagnosis. In cases where the cause of a swollen gland is unclear, the pediatrician also may want to do a tuberculosis skin test.

If the cause of prolonged swelling of lymph nodes cannot be found in any other way, it may be necessary to perform a biopsy (remove a piece of tissue from the gland) and examine it under a microscope. In rare cases this may reveal a tumor or fungus infection, which would require special treatment.


The only swollen glands that are preventable are those that are caused by bacterial infections in the surrounding tissue. In cases of suspected infection, you can avoid involving the lymph nodes by properly cleaning all wounds and receiving early antibiotic treatment.

Ear, nose and throat

Swimmer’s Ear in Children

Swimmer’s ear, which doctors call otitis externa, is an infection of the skin inside the ear canal or outer ear. This type of infection occurs most often after swimming or other activities that allow water into the ears.

What causes swimmer’s ear?

Swimmer’s ear develops because moisture in the ear canal encourages the growth of certain bacteria. The moisture also causes the skin that lines the ear canal to soften (like the white, swollen area that forms under a wet bandage). The bacteria then invade the softened skin and multiply there, causing this often painful infection.

For reasons that are not clear, some children are more prone to swimmer’s ear than others. Injury to the ear canal (sometimes from the improper use of cotton swabs) or conditions such as eczema and seborrheic dermatitis can make a child more likely to get swimmer’s ear.

What are symptoms of swimmer’s ear?

With the mildest form of swimmer’s ear, your child will com­plain only of itchiness or a plugged feeling in the ear. If your child is too young to tell you what’s bothering them, you might notice them sticking their finger in their ear or rubbing it with their hand. Within hours to days the opening of their ear canal may become swollen and slightly red, causing a dull pain. If you push on the opening or pull up on their ear, it may be painful.

In more severe cases of swimmer’s ear, the pain will be constant and intense. Your child may cry and hold their hand over their ear. The slightest motion, even chewing, will hurt a lot. The ear canal opening may be swollen shut, with a few drops of pus or cheesy material oozing out. Your child may also have a low-grade fever (rarely more than one or two degrees above normal). In the most serious infections, the redness and swelling may spread beyond the ear canal to the entire outer ear.

How is swimmer’s ear treated?

If your child has pain in his ear, or if you suspect swimmer’s ear, call your pediatrician. Although the condition usually isn’t serious, it still needs to be examined and treated by a doctor.

Until you see your pediatrician, you can help relieve your child’s pain with acetaminophen or ibuprofen. Keep your child out of the water for several days, and see if the pain subsides. Do not insert a cotton swab or anything else into the ear in an attempt to relieve itching or promote drainage; this will only cause further skin damage and provide more places for bacteria to grow.

What medicine is prescribed for swimmer’s ear?

At the pediatrician’s office, the doctor first will examine the affected ear. Then, they may carefully clean out pus and debris from the canal. Most doctors also prescribe ear drops for five to seven days. The eardrops fight infection. By doing this, they also decrease swelling, which helps to relieve the pain.In order to be effective, however, eardrops have to be used properly.

If the ear canal is too swollen for drops to enter, your pediatrician may insert an ear wick—a small piece of cotton or spongy material that soaks up the medicine and holds it in the canal. In this case, you’ll need to resaturate the wick with the drops three or four times per day. Rarely, oral antibiotics also are prescribed.

Can you go swimming with swimmer’s ear?

When your child is being treated for swimmer’s ear, your doctor may recommend they stay out of the water for a few days. However, they can take brief showers or baths daily and have his hair washed, as long as you dry the ear canal afterward with the corner of a towel or a blow-dryer (on a very low setting, held away from the ear). Once that’s done, put in more eardrops.

How do you prevent swimmer’s ear?

There’s no need to try to prevent swimmer’s ear unless your child has had this infection frequently or very recently. Under these circumstances, limit his stays in the water, usually to less than an hour. Then, when they come out, remove the excess water from their ear with the corner of a towel, or have them shake their head.

Swimmer’s ear home remedy: vinegar rinse

A mixture of half white vinegar and half rubbing alcohol can be a practical and effective home remedy to help prevent swimmer’s ear. A few drops in each ear can be used after swimming. To avoid injury, resist the temptation to clean out your child’s ear with cotton swabs, your finger or any other object.

Many pediatricians recommend acetic acid eardrops to help prevent swimmer’s ear. They are available in various preparations, some of which need a prescription. They usually are used in the morning, at the end of each swim, and at bedtime.

Ear, nose and throat

Strep Throat, Sore Throat or Tonsillitis: What’s the Difference?

The terms sore throat, strep throat, and tonsillitis often are used interchangeably, but they don’t mean the same thing.

  • Strep throat is an infection caused by a specific type of bacteria, Streptococcus. When your child has a strep throat, the tonsils are usually very inflamed, and the inflammation may affect the surrounding part of the throat as well.
  • Tonsillitis is inflammation (swelling) of the tonsils.
  • Other causes of sore throats include viruses, which may cause inflammation only of the throat around the tonsils and not of the tonsils themselves.

Strep throat

Strep throat is caused by a bacterium called Streptococcus pyogenes or group A streptococcus. Strep throat is most common among school-age children and adolescents, peaking at 7 or 8 years of age. Children To some extent, the symptoms of strep throat depend on the child’s age.

Children over three years of age with strep may have an may have an extremely painful throat, fever over 102 degrees Fahrenheit (38.9 degrees Celsius), swollen glands in the neck and pus on the tonsils.
Cough, runny nose, hoarseness (changes in your voices that make sound raspy) and conjunctivitis (also called pinkeye) are not symptoms of strep throat. If your child has these symptoms, a virus may be the cause of illness instead. It’s important to be able to distinguish a strep throat from a viral sore throat, because strep infections are treated with antibiotics.

Other infections that can cause a sore throat

In infants, toddlers and preschoolers, the most frequent cause of sore throats is a viral infection. No specific medicine is required when a virus is responsible, and your child should get better over a 7- to 10-day period. Often children who have sore throats due to viruses also have a cold at the same time. They may develop a mild fever, too, but they generally aren’t very sick.

One particular virus (called Coxsackievirus), seen most often during the summer and fall, may cause your child to have a somewhat higher fever and more difficulty swallowing. This virus can also cause asicker overall feeling. If your child has a Coxsackie infection, they may have one or more blisters in their throat and on their hands and feet (often called Hand, Foot, and Mouth disease).

Infectious mononucleosis (often called “Mono”) can produce a sore throat, often along with tonsillitis. . However, most young children who are infected with the mononucleosis virus have few or no symptoms.

Diagnosing & treating a sore throat

Call your pediatrician if your child has a sore throat that persists (not one that goes away after their first drink in the morning)–whether or not it is accompanied by fever, headache, stomachache or extreme fatigue. That call should be made even more urgently if your child seems extremely ill, or if they have difficulty breathing or extreme trouble swallowing (causing them to drool). This may indicate they have a more serious infection, such as epiglottitis.

Rapid strep test

Most pediatric offices perform rapid strep tests that provide findings within minutes. If the rapid strep test is negative, your doctor may confirm the result with a throat culture (see below). A negative test means that the infection is presumed to be due to a virus. In that case, antibiotics (which work against bacteria, not viruses) will not help and need not be prescribed.

Throat culture

The doctor will may perform a throat culture to determine the nature of the infection. This involves touching the back of the throat and tonsils with a cotton-tipped applicator. The tip is then sent to a lab, where it is smeared onto a special culture dish that allows strep bacteria to grow if they are present. The culture dish usually is examined 24 hours later for the presence of the bacteria.


If the test shows that your child does have strep throat, your pediatrician will prescribe an antibiotic to be taken by mouth or by injection (a shot).If your child is given the oral antibiotics, it’s very important that they take it for the full course, as prescribed—even if the symptoms get better or go away.

If a child’s strep throat is not treated with antibiotics, or if they don’t complete the treatment, the infection may worsen or spread to other parts of their body. This can lead to conditions such as abscesses of the tonsils or kidney problems. Untreated strep infections also can lead to rheumatic fever, a disease that affects the heart. However, rheumatic fever is rare in the United States and in children under 5 years old.

Is strep throat and other types of throat infection contagious?

Most types of throat infections are contagious. They are passed primarily through the air on droplets of moisture or on the hands of someone infected. For that reason, it makes sense to keep your child away from people who have symptoms of of strep throat and other throat infections. However, most people are contagious before their first symptoms appear. So, there’s often no practical way to prevent your child from contracting the disease.

If my child gets strep throat a lot, should they have their tonsils out?

In the past when a child had several sore throats, their tonsils might have been removed in an attempt to prevent further infections. But this operation, called a tonsillectomy, is recommended today only for the most severely affected children. Even in difficult cases, where there is repeated strep throat, antibiotic treatment is usually the best solution.