Top Ten Sleep Tips for Children

Top Tip 1 - Work With Your Family Doctor

Sleeping problems can cause serious health issues or can be a symptom of another underlying health problem. Children who don't get enough sleep simply don't thrive as they should. They are less happy, get ill more frequently, find learning more difficult and don't even grow as well as they should.
So it is important that you seek accurate and appropriate medical advice from your health care professional before embarking on any treatment to help improve your child's sleep.

Top Tip 2 - Get the Bedroom Environment Right

During the day the bedroom needs to be light but at night it needs to be dark so the window blinds or drapes need to block out street lights and any LED displays on clocks should not be too bright. If your child is a clock watcher it might be wise to remove any clocks from the bedroom altogether. Other than being dark the bedroom also needs to be quiet, calm, and a comfortable temperature.

Top Tip 3 - Set a Regular Bedtime

Your child needs to develop a regular sleep routine where they go to bed and get up at the same time each day and every day including weekends and holidays. To do this you need to work out what time they will be getting up and then roughly work out how much sleep they need and work backwards to calculate the time they need to get to bed allowing a short period of time in bed to fall asleep. In my hub A Guide to Solving Your Child's Insomnia you will find a table which give approximate sleep needs based on your child's age.


Top Tip 4 - Wind Down Hour

Establish a routine for your child that does not include stimulating activities within an hour of bedtime such as watching TV, playing computer games or carrying out homework. Suitable activities for this period would be reading or listening to relaxing music. If your child is young enough it could include you reading them a bedtime story.

Top Tip 5 - Keep Bed for Sleeping

Keep bed for sleeping only and don't allow your child to read, watch TV or play video or computer games whilst in bed so that their body associates being in bed just with sleeping.


Top Tip 6 - Don't Toss and Turn

If your child can’t sleep after 20 minutes, it is better for them to get up and read or listen to music for 15-20 minutes, rather than to stay in bed and tossing and turning. After staying out of bed for 15-20 minutes they should return to bed and try to get to sleep again. If they still are unable to fall asleep the cycle can be repeated.

Top Tip 7 - Avoid Sugar and Caffeine

Avoiding coffee just before going to bed is an obvious tip but coffee isn't the only caffeinated drink. Tea but not herbal teas), colas, some non-cola pops and energy drinks also contain caffeine and they should be avoided for 4 to 6 hours before bedtime. The same should apply to sugar products if they make your child hyped up.


Top Tip 8 - Warm Milk and a Cookie

A glass of warm milk is considered to be one of the most effective sleep remedies for children. Milk contains melatonin which does have a track record for the successful treatment of insomnia but the melatonin in milk is 100% natural. Lactose-free, soy, almond and goat milk will also provide the same melatonin benefits. You can flavor the milk with cinnamon and honey if preferred. If your child doesn't like milk you can give them a weak chamomile herbal tea instead. The cookie helps to stave off any hunger pangs and helps making going to bed a more pleasurable experience.


Top Tip 9 - Exercise

Encourage your child to exercise during the day as exercise has been shown to help improve sleep but they shouldn't exercise just before bedtime as this has the opposite effect. Exercising in the sunshine is the best of all as it helps their body produce the valuable sleep hormone melatonin.

Top Tip 10 - Teach Your Child Relaxation Techniques

Relaxation techniques can work with children from a fairly young age. Teaching them to concentrate on their breathing whilst imagining lying on a warm, sunny beach.

Living with a Recurrent Fever

Just a Virus?

I can’t tell you exactly when this started, because it took awhile for us to figure out what was going on, but it was sometime around age 2. For a long time, we just kept thinking Hayley had a bad string of viruses. Our other children never caught any of them, however, and after awhile, we began to realize that all of her viruses were very similar. She never had a stomachache, never threw up, never had diarrhea, never had a cough or a runny nose—most of the common virus symptoms were always absent whenever Hayley got sick. Instead, her fever was always accompanied by a sore throat and a severe headache. It acted a lot like influenza or strep, and as a result, she was given countless flu and strep tests, which almost always came back negative.

I didn’t always take her to the doctor, even though she would run a high fever of 103 or better, because, after awhile, I got tired of being told, “It’s just a virus.” All of those co-pays added up, not to mention her ever growing fear of yet another finger prick or throat swab. We began to believe that the fever was perhaps her way of coping when she didn’t get enough sleep or just got worn down. It seemed that after she had a few days to essentially sleep it off, she was fine.

However, niggling in the backs our minds was the terrifying fear that something more was going on with our child. As a parent, when you start to be able to predict that your child will come down with a fever, you know something isn’t right.

I questioned the doctor several times. Is my child all right? Is her immune system compromised? If these are just viruses, why the regularity? Why don’t my other children ever catch any of them? The doctor continued to insist that Hayley was fine, that some children just have lower immune systems than others, and that she was just one of those children who got sick a lot. She was growing normally, her body was always able to bounce back after being sick, and she never developed any “serious” illnesses, so there was no reason to worry.

We tried to buy those explanations. We really did. Every time Hayley got well after having a fever, she would look and act so healthy, and we would breathe an inner sigh of relief. She’s better. It’s over. Perhaps the doctor is right. Then, a heavy feeling of dread would settle in when, a few weeks later, the fever would start all over again


Missing Out On Life

By this time, I was quite confident that Hayley wasn’t contagious, but I still couldn’t bring her places when she had the fever. For one thing, she didn’t feel well enough to go out, but on top of that, other people would get offended. After all, they didn’t want their kids catching something, which was understandable. Hayley missed dance recitals, birthday parties, church activities, community events, and more. It was so disappointing for her every time she came down with the fever and had to miss yet another event that she had really been looking forward to. It was also terribly inconvenient for the family, because we would all have to stay home as well, if the event was happening while her daddy was at work. If the event happened outside working hours, one parent would bring the other children while the other parent stayed home with her. Thankfully, we homeschool, so we didn’t have to deal with the additional issue of missed school days.


Finally, a Diagnosis

This past summer, everything changed when we met with Dr. Ben Sweeney, a chiropractor, to implement the wellness plan, Maximized Living. When I described Hayley’s symptoms, he said, “This isn’t normal. No healthy child should be coming down with a fever every month.” Finally, we had been heard! Through his encouragement, we began to implement a rigorously healthy diet, as well as exercise and chiropractic adjustments. He also recommended a new doctor to us, who would be willing to treat Hayley in order to prevent illness from happening, rather than simply “fix” her when she got sick.

This new doctor was familiar with symptoms such as we described, but wanted to do more research before examining Hayley. When we did meet with her, she first did extensive bloodwork to rule out any other serious illnesses. When Hayley’s lab work all came back normal, she diagnosed Hayley with PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis Syndrome). It was the longest name of a condition I had ever heard! I had to ask her to repeat it several times, then I finally gave up on being able to pronounce the majority of the words and simply clung to the initials.


What Is PFAPA?

PFAPA is a syndrome that mostly affects children, starting at age 2-4, and going away by the time they turn 10. It is characterized by a regularly occurring fever, which lasts approximately 3-7 days, and can be accompanied by mouth sores, headache, swollen lymph nodes in the neck, and a sore throat. The fevers occur every few weeks, often with such regularity that they can actually be predicted.


What Causes PFAPA?

No one knows. Researchers do know that PFAPA isn’t contagious, it isn’t genetic, and it isn’t an infection. Inflammation is somehow involved, but researchers aren’t sure why. For more information on PFAPA, click here.

A lot of children out there suffer with this, and a lot of parents are frustrated because they can’t get any answers. There is no cure for this condition, but there is a good chance that Hayley will outgrow it. Most children with PFAPA do. Around age 10, the space between fevers will usually lengthen until they completely stop occurring. As far as researchers can tell, there aren’t any long term effects from PFAPA, and it has no effect on growth or overall health. It is very inconvenient and uncomfortable, but it will hopefully go away in the next three years or so.


Our Solutions

In the meantime, although we can’t take PFAPA away from Hayley, we’ve learned through our chiropractor and new doctor some things we can do for her. We can work to lessen the length, as well as the severity, of her symptoms. She takes several dietary supplements, and she is on a very strict, anti-inflammatory diet (Maximized Living). We make sure she gets plenty of sleep, and she sees the chiropractor regularly. Doing these things has resulted in a dramatic reduction of her symptoms. Before we started doing these things, she would run a fever of 103 or better for 3-7 days, which is actually the normal severity and length for children who suffer from this disorder. Since implementing changes like Maximized Living to Hayley’s life, however, we’ve seen a reduction in both the length and the severity of her fevers. They now last between 1-2 days, and her fever hovers right at 100, usually having one short spike up to 102 just before it ends. Managing her PFAPA is possible, but it isn’t always easy. It takes discipline and effort to manage the supplements, chiropractor visits, and strict dietary needs. It is worth it, though, for her to spend less time in bed, and to get to enjoy more of her childhood.

If you have a child whom you suspect might have PFAPA, I recommend finding a doctor, preferably a pediatric rheumatologist, who will listen to you and help you make this condition more manageable for your child and your family. I also recommend checking out Maximized Living. Implementing this wellness program has made a world of difference, for Hayley, and for our entire family.

Heart Murmurs and Your Child

Many parents fear the worst when their child is diagnosed with a heart murmur, but this diagnosis is actually extremely common. In fact, many kids are found to have a heart murmur at some point during their lives. Most murmurs are not a cause for concern and do not affect the child's health at all.

What exactly is a heart murmur? By itself, the term heart murmur isn't a diagnosis of an illness or disorder. To better understand what it does mean, it's important to know how the heart works.

How the Heart Works
The normal heart has four chambers and four valves (which function like one-way doors). The two lower pumping chambers of the heart are called the ventricles, and the two upper filling chambers are the atria (singular is atrium).
Here's how blood moves in normal circulation:
Blood that returns from the body to the filling chamber on the right side (the right atrium) is low in oxygen.
This blood passes across a valve (the tricuspid valve) to the pumping chamber on the right side (the right ventricle) and then travels across the pulmonary valve to the lungs to receive oxygen.
The oxygen-enriched blood returns to the filling chamber on the left side (the left atrium), then across a valve (the mitral valve) to the pumping chamber on the left side (the left ventricle).
The blood is then pumped across the aortic valve out to the body through the aorta, a large blood vessel that carries blood to the smaller blood vessels in the body to deliver oxygen.
Using a stethoscope, a doctor examines the heart by listening to the sounds it makes. The familiar "lub-dub" sound of a normal heartbeat is caused by the closing sound of the valves as the heart squeezes to push blood through the body.

A heart murmur describes an extra sound in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem.

Cholesterol and Your Child

Most parents probably don't think about what cholesterol means for their kids. But high levels of cholesterol are a major factor contributing to heart disease and stroke, and medical research shows that cardiovascular disease has its roots in childhood. And with the dramatic increase in childhood obesity, more and more kids are at risk.

Problems associated with high cholesterol generally don't show up for years, so making the connection between kids' health and cholesterol can be difficult. But it's important to know your child's cholesterol levels, especially if there's a family history of high cholesterol or premature heart disease.

Identifying high cholesterol now will let you and your doctor work together to make changes that will lower your child's risk of developing heart disease later.

About Cholesterol
Cholesterol is a waxy substance produced by the liver. It's one of the lipids, or fats, the body makes and is used to form cell membranes and some hormones.

If you never ate another bowl of ice cream or another cheeseburger, your body would have enough cholesterol to run smoothly. That's because the liver makes enough for healthy body function. In fact, the liver produces about 1,000 milligrams of cholesterol a day. The rest comes from the foods we eat.

Although vegetables, fruits, and grains don't have any cholesterol, these foods from animals do:

egg yolks
meat
poultry
seafood
dairy products (including milk, cheese, and ice cream)

Arrhythmias

An arrhythmia is an abnormal heart rhythm usually caused by an electrical "short circuit" in the heart.

The heart normally beats in a consistent pattern, but an arrhythmia can make it beat too slowly, too quickly, or irregularly. This can cause the heart muscle's pumping function to work erratically, which can lead to a variety of symptoms, including fatigue, dizziness, and chest pain.

What Causes Arrhythmias?
The heart has its own conduction system, or electrical system, that sends electrical signals around the heart, telling it when to contract and pump blood throughout the body. The electrical signals originate from a group of cells in the right atrium, called the sinus node. The sinus node functions as the heart's pacemaker and makes sure the heart is beating at a normal and consistent rate. The sinus node normally increases the heart rate in response to factors like exercise, emotions, and stress, and slows the heart rate during sleep.

However, sometimes the electrical signals flowing through the heart don't "communicate" properly with the heart muscle, and the heart can start beating in an abnormal pattern — an arrhythmia (also called dysrhythmia).

Arrhythmias can be temporary or permanent. They can be caused by several things, but also can occur for no apparent reason. Arrhythmias can be congenital (meaning kids are born with it), sometimes due to a birth defect of the heart but sometimes even when the heart has formed normally.

Other causes of arrhythmias in kids include chemical imbalances in the blood, infections, or other diseases that cause irritation or inflammation of the heart, medications (prescription or over-the-counter), and injuries to the heart from chest trauma or heart surgery. Other factors (such as illegal drugs, alcohol, tobacco, caffeine, stress, and some herbal remedies) also can cause arrhythmias.

Anemia

About Anemia
Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health problems because RBCs contain hemoglobin, which carries oxygen to the body's tissues. Anemia can cause a variety of complications, including fatigue and stress on bodily organs.

Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:

excessive destruction of RBCs
blood loss
inadequate production of RBCs
Among many other causes, anemia can result from inherited disorders, nutritional problems (such as an iron or vitamin deficiency), infections, some kinds of cancer, or exposure to a drug or toxin.

Anemia Caused by Destruction of RBCs
Hemolytic anemia occurs when red blood cells are being destroyed prematurely. (The normal lifespan of RBCs is 120 days; in hemolytic anemia, it's much shorter.) And the bone marrow (the soft, spongy tissue inside bones that makes new blood cells) simply can't keep up with the body's demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications — such as antibiotics or anti-seizure medicines — are to blame.

In autoimmune hemolytic anemia, the immune system mistakes RBCs for foreign invaders and begins destroying them. Other kids inherit defects in the red blood cells that lead to anemia; common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and hereditary spherocytosis.

Sickle cell anemia is a severe form of anemia found most commonly in people of African heritage, although it can affect those of Middle Eastern and Mediterranean descent, as well as others. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This leads to premature destruction of RBCs, resulting in chronically low levels of hemoglobin.

These abnormal red cells can clog small blood vessels, leading to recurring episodes of pain, as well as problems that can affect virtually every other organ system in the body. About 1 out of every 500 African-American children is born with this form of anemia.
Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived RBCs. Thalassemia major, also called Cooley's anemia, is a severe form of anemia in which RBCs are rapidly destroyed and iron is deposited in the vital organs. Thalassemia minor results in less severe anemia.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects males of African heritage, although it has been found in many other groups of people. With this condition the RBCs either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and doesn't work well. When someone born with this deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body's RBCs suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.
Hereditary spherocytosis is a genetic disorder of the RBC's membrane that can cause anemia, jaundice (yellow-tinged skin), and enlargement of the spleen. The RBCs have a smaller surface area than normal red blood cells, which can cause them to break open easily. A family history increases the risk for this disorder, which is most common in people of northern European descent but can affect all races.

Alpha Thalassemia

Thalassemias
Thalassemias are a group of blood disorders that affect the way the body makes hemoglobin, a protein found in red blood cells that is responsible for carrying oxygen throughout the body.

The body contains more red blood cells than any other type of cell, and each has a life span of about 4 months. Each day, the body produces new red blood cells to replace those that die or are lost from the body.

With a thalassemia, the red blood cells are destroyed at a faster rate, leading to anemia, a condition that can cause fatigue and other complications.

Thalassemias are inherited conditions — they're carried in the genes and passed on from parents to children. People who are carriers of a thalassemia gene show no thalassemia symptoms and might not know they're carriers. If both parents are carriers, they can pass the disease to their kids. Thalassemias are not contagious.

While there are many different types of thalassemias, the main two are:

Alpha thalassemia: when the body has a problem producing alpha globin
Beta thalassemia: when the body has a problem producing beta globin
When the gene that controls the production of either of these proteins is missing or mutated, it results in that type of thalassemia.

About Alpha Thalassemia

Alpha thalassemia occurs when the gene that controls the making of alpha globins is absent or defective. It can be mild to severe and is most commonly found in people of African, Middle Eastern, Chinese, Southeast Asian, and, occasionally, Mediterranean descent.

Some children with alpha thalassemia have no symptoms and may require no treatment. Others with more severe cases need regular blood transfusions to treat anemia and other symptoms.

A child can only get alpha thalassemia by inheriting it from his or her parents. Genes are "building blocks" that play an important role in determining physical traits and many other things about us.

Humans are made up of trillions of cells that form the structure of our bodies and carry out specialized jobs like taking nutrients from food and turning them into energy. Red blood cells, which contain hemoglobin, deliver oxygen to all parts of the body.

All cells have a nucleus at their center, which is kind of like the brain or "command post" of the cell. The nucleus directs the cell, telling it to grow, mature, divide, or die. The nucleus contains DNA (deoxyribonucleic acid), a long, spiral-shaped molecule that stores the genes that determine hair color, eye color, whether or not a person is right- or left-handed, and many more traits. DNA, along with genes and the information they contain, is passed down from parents to their children during reproduction.

Each cell has many DNA molecules, but because cells are very small and DNA molecules are long, the DNA is packaged very tightly in each cell. These packages of DNA are called chromosomes, and each cell has 46 of them. Each package is arranged into 23 pairs — with one of each pair coming from the mother and one from the father. When a child has alpha thalassemia, there is a mutation in chromosome 16.

Alpha globin is made on chromosome 16. So, if any gene that tells chromosome 16 to produce alpha globin is missing or mutated, less alpha globin is made. This affects hemoglobin and decreases the ability of red blood cells to transport oxygen around the body.

Speech-Language Therapy

In a recent parent-teacher conference, the teacher expressed concern that your child may have a problem with certain speech or language skills. Or perhaps while talking to your child, you noticed an occasional stutter.

Could your child have a problem? And if so, what should you do?

It's wise to intervene quickly. An evaluation by a certified speech-language pathologist can help determine if your child is having difficulties. Speech-language therapy is the treatment for most kids with speech and/or language disorders.


Speech Disorders and Language Disorders
A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty understanding or putting words together to communicate ideas.
Speech disorders include:
Articulation disorders: difficulties producing sounds in syllables or saying words incorrectly to the point that listeners can't understand what's being said.
Fluency disorders: problems such as stuttering, in which the flow of speech is interrupted by abnormal stoppages, repetitions (st-st-stuttering), or prolonging sounds and syllables (ssssstuttering).
Resonance or voice disorders: problems with the pitch, volume, or quality of the voice that distract listeners from what's being said. These types of disorders may also cause pain or discomfort for a child when speaking.
Dysphagia/oral feeding disorders: these include difficulties with drooling, eating, and swallowing.
Language disorders can be either receptive or expressive:

Receptive disorders: difficulties understanding or processing language.
Expressive disorders: difficulty putting words together, limited vocabulary, or inability to use language in a socially appropriate way.

Peritonsillar Abscess

The Basics
Lots of kids get tonsillitis (an infection of the tonsils), especially younger kids. As kids get older, however, this throat infection can be accompanied by an unpleasant condition called a peritonsillar abscess.

A peritonsillar abscess is an area of pus-filled tissue at the back of the mouth, next to one of the tonsils. The abscess can be very painful and make it difficult to open the mouth. It can also cause swelling that can displace the tonsil and push it toward the uvula (the dangling fleshy object at the back of the mouth). This can block the throat, making it difficult to swallow, speak, and sometimes even breathe.

An untreated peritonsillar abscess can lead to a spread of the infection into the neck and chest, as well as other serious complications.

Causes
Peritonsillar abscesses are most often caused by group A beta-hemolytic streptococci bacteria, which also cause strep throat. Sometimes other types of bacteria are also involved.

Peritonsillar abscesses usually happen as a complication of tonsillitis, when the infection spreads from a tonsil into the space surrounding it. Fortunately, these kinds of abscesses are uncommon because doctors use antibiotics to treat tonsillitis.

Tooth and gum disease and smoking can increase the chances of a peritonsillar abscess.

Symptoms
Often the first sign of a peritonsillar abscess is a sore throat. As the abscess develops, other symptoms will appear. Some of the most common are:

red, swollen tonsils
a tonsil that's pushing against the uvula
tender, swollen glands (lymph nodes) on one side of the neck
severe pain on one side of the throat
difficulty and pain when swallowing or opening the mouth
fever and chills
headache
earache
drooling
a muffled or hoarse voice
A peritonsillar abscess that goes untreated for a long time can lead to serious complications — for example, the infection may extend into the jaw, neck, and chest, or lead to pneumonia.

Ototoxicity (Ear Poisoning)

Sometimes kids who take high doses of drugs for cancer, infection, or other illnesses develop hearing or balance problems (or both) as a result of taking the drugs. When a medication damages the inner ear — the part of the ear responsible for receiving/sending sounds and controlling balance — it's called ototoxicity or "ear poisoning."

The degree of damage to the ear depends on what type of drug a child is taking, how much, and for how long. And the severity can vary from child to child. Some kids may have no or very minimal hearing loss and "ringing in the ears" (tinnitus), while others may experience major problems with balance and/or profound hearing loss (deafness).

Fortunately, when ototoxicity is caught early, doctors can try to prevent problems from becoming worse and get kids the rehabilitation they need to address the damage that's been done.


Signs and Symptoms
Some kids may notice obvious hearing problems, usually in both ears (called bilateral hearing loss). They may have trouble hearing certain things, from high-pitched sounds to talking if there's background noise. Or they may have tinnitus, which can cause not just that annoying ringing in the ears but other strange sounds like hissing, buzzing, humming, and roaring.
Sometimes, though, there's only limited damage, and kids might not even notice a problem. Or they might just have a hard time hearing high-frequency sounds while everything else sounds perfectly clear. As a parent, it can be hard to tell at any given moment whether your child can't hear you or (like most kids) just isn't listening or paying attention.

Most kids with hearing problems:
have limited, poor, or no speech
are frequently inattentive
have problems in school or difficulty learning
need to constantly turn up the volume on the TV or stereo
fail to respond to conversation-level speech or answer appropriately (babies and pre-verbal children fail to "startle" or turn their heads when they hear a loud sound)
When balance is affected, kids may fall frequently and have symptoms of disequilibrium — an unsteady "woozy" feeling that makes it hard to stand up, walk, or climb the stairs without falling. They may walk with their legs too far apart or be unable to walk without staggering. And walking in the dark can also be tricky.

In the most severe cases, vision also can be affected and kids may see images that bounce, jump erratically, or look blurry whenever they move their heads (called oscillopsia). As a result of balance and vision problems, kids may get headaches often, or feel lightheaded, dizzy, or disoriented. Nausea, vomiting, and diarrhea also might occur, as can changes in heart rate and blood pressure.

The symptoms of ototoxicity can come on suddenly after a course of medication or show up gradually over time.

Middle Ear Infections and Ear Tube Surgery

Why Surgery?
Many kids get middle ear infections (otitis media, or OM), usually between the ages of 6 months and 2 years.
Some kids are particularly susceptible because of environmental and lifestyle factors (like attendance at a group childcare, secondhand tobacco smoke exposure, and taking a bottle to bed).

Although these infections are relatively easy to treat, a child who has multiple ear infections that do not get better easily or has evidence of hearing loss or speech delay may be a candidate for ear tube surgery.

During this surgery, small tubes are placed in the eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear.

About Otitis Media
The middle ear is an air-filled cavity located behind the eardrum. When sound enters the ear, it makes the eardrum vibrate, which in turn makes tiny bones in the middle ear vibrate. This transmits sound signals to the inner ear, where nerves relay the signals to the brain.

A small passage leading from the middle ear to the back of the nose — called the eustachian tube — equalizes the air pressure between the middle ear and the outside world. (When your ears pop while yawning or swallowing, the eustachian tubes are adjusting the air pressure in the middle ears.)

Infection

Bacteria or viruses can enter the middle ear through the eustachian tube and cause an infection — this often occurs when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial.

Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may experience a temporary decrease in hearing.

With treatment, a bacterial infection can be quickly cleared up. In most kids the fluid will resolve over time and hearing will be restored. Some research suggests that long periods of hearing loss in young children can lead to delays in speech development and learning.

Enlarged Adenoids

Enlarged Adenoids
Often, tonsils and adenoids are surgically removed at the same time. Although you can see the tonsils at the back of the throat, adenoids aren't directly visible. A doctor has to use a telescope to get a peek at them. As an alternative, an X-ray of the head can give the doctor an idea of the size of someone's adenoids.

So, what are adenoids anyway? They're a mass of tissue in the passage that connects the back of the nasal cavity to the throat. By producing antibodies to help the body fight infections, adenoids help to control bacteria and viruses that enter through the nose.
In kids, adenoids usually shrink after about 5 years of age and often practically disappear by the teen years.


Symptoms of Enlarged Adenoids
Because adenoids trap germs that enter the body, adenoid tissue can temporarily swell as it tries to fight off an infection. These symptoms are often associated with enlarged adenoids:
difficulty breathing through the nose
breathing through the mouth
talking as if the nostrils are pinched
noisy breathing
snoring
stopped breathing for a few seconds during sleep (sleep apnea)
frequent "sinus" symptoms
ongoing ear middle ear infections or middle ear fluid in a school-aged child
If enlarged adenoids are suspected, the doctor may ask about and then check your child's ears, nose, and throat, and feel the neck along the jaw. To get a really close look, the doctor might order one or more X-rays. For a suspected infection, the doctor may prescribe oral antibiotics.

Ears

Listen. Whatever you're hearing — the hum of a computer, your kids playing, a car going by — is thanks to your ears.

Hearing is their main job, but it's not all our ears do. These delicate organs also need care and protection, so let's take a look at how they work and what conditions and problems can affect them.

All About Ears
There's a lot more to an ear than what you see on the side of your head. The ear is made up of three different sections that work together to collect sounds and relay them to the brain: the outer ear, the middle ear, and the inner ear.

The outer ear, the part that is visible on the side of your head, is called the pinna or auricle. It's made of tough cartilage covered by skin. The pinna's main job is to gather sounds and funnel them to the ear canal, which leads to the middle ear. The pinna, which includes the earlobe, is the part that people pierce to wear earrings.

The ear canal, the hollow passage that leads to the eardrum, is also part of the outer ear. Glands in the skin lining the ear canal produce earwax, which protects the canal by cleaning out dirt and helping to prevent infections.

The middle ear is an air-filled cavity about the size of a pea. It turns sound waves into vibrations and delivers them to the inner ear. The middle ear is separated from the outer ear by the eardrum, or tympanic membrane, a thin, cone-shaped piece of tissue stretched tight across the ear canal.

To hear properly, the pressure on both sides of your eardrum needs to be equal. When you go up or down in elevation, the air pressure changes and you may feel a popping sensation as your ears adjust. Ears are able to adjust thanks to the narrow Eustachian tube that connects the middle ear to the back of the nose and acts as a sort of pressure valve, opening to keep the pressure equalized on both sides of the eardrum.

The middle ear also includes the three smallest bones in the body, located just past the eardrum and collectively known as the ossicles. The ossicles consist of:

the malleus (Latin for "hammer"), which is attached to the eardrum

the incus ("anvil"), which is attached to the malleus

the stapes ("stirrup"), which is attached to the incus and is the smallest bone in the body

The inner ear consists of two tiny organs called the cochlea and the semicircular canals. The snail-shaped cochlea act as a sort of microphone, converting the vibrations from the middle ear into nerve impulses that travel to the brain along the cochlear nerve, also known as the auditory nerve.

The semicircular canals look like three tiny, interconnected tubes sticking out in loops from the top of the cochlea. It's their job to help you balance. The canals are filled with fluid and lined with tiny hairs. When your head moves, the fluid in the canals sloshes around, moving the hairs. The hairs send this position information as impulses through the vestibular nerve to your brain. The brain interprets these impulses and sends messages to the muscles that help keep you balanced.

When you spin around and stop, the reason you feel dizzy is because the fluid in your semicircular canals continues to slosh around for awhile, giving your brain the idea that you're still spinning even when you aren't. When the fluid stops moving, the dizziness goes away.

The cochlear nerve, which is attached to the cochlea and relays sound information to the brain, and the vestibular nerve, which carries balance information from the semicircular canals to the brain, are collectively known as the vestibulocochlear nerve, or 8th cranial nerve.

Eardrum Injuries

A ruptured or perforated eardrum is exactly what you might imagine: a tear or hole in the eardrum — the part of the ear that vibrates in response to sound waves. Eardrum injuries can be extremely painful and, in the worst cases, might lead to infections and hearing loss.

Fortunately, though, most eardrum injuries heal within a few weeks with no problems arising. When an eardrum won't heal on its own, surgery may be required to repair it and restore normal hearing.

How the Ear Works
The eardrum, also called the tympanic membrane, is the thin, cone-shaped piece of tissue that separates the outer ear from the middle ear. It's found at the end of the ear canal (the part that gets waxy).

The hearing process begins when the pinna (the part of the ear that's visible) funnels sound waves into the ear canal, where they hit the eardrum and make it vibrate. In the inner ear, these vibrations are converted into nerve impulses by the snail-shaped cochlea. These impulses then travel to the brain along the cochlear nerve, also known as the auditory nerve. The brain's auditory cortex receives these signals and interprets them as different sounds.

If the eardrum is perforated, it can hinder the eardrum's ability to vibrate correctly, leading to muffled or diminished hearing. Hearing loss is usually temporary and can vary in intensity based on the size and location of the injury.
Sometimes bacteria and other materials enter the middle ear through this opening and can cause an infection. Fortunately, this rarely leads to permanent hearing damage.

Ear Injuries

Falls, blows to the head, sports injuries, and even listening to loud music can cause ear damage, which can affect hearing and balance. That's because the ear not only helps us hear, but also keeps us steady on our feet.

Kids need to hear well to develop and use their speech, social, and listening skills. Even mild or partial hearing loss can affect their ability to speak and understand language, while problems with balance can influence how they're able to move and how well they feel.

How the Ear Works
To understand ear injuries, it's helpful to review the ins and outs of the ears. Basically, the ear is made up of three parts — the outer ear, middle ear, and inner ear.

Hearing begins when sound waves that travel through the air reach the outer ear, or pinna (the visible part of the ear). The outer ear captures the sound vibration and sends it through the ear canal to the middle ear, which contains the eardrum (a thin layer of tissue) and three tiny bones (called ossicles). The sound causes the eardrum to vibrate. The ossicles amplify these vibrations and carry them to the inner ear.

The inner ear is made up of a snail-shaped chamber (the cochlea), which is filled with fluid and lined with four rows of tiny hair cells. When the vibrations move through this fluid, the outer hair cells contract back and forth and amplify the sound.

When the vibrations are big enough, the inner hair cells translate them into electrical nerve impulses in the vestibulocochlear nerve (also called the auditory nerve, acoustic nerve, or eighth cranial nerve), which sends signals to the brain to be interpreted as sound. The vestibulocochlear nerve also helps with balance.

Cochlear Implants

Sometimes called a "bionic ear," the cochlear implant offers the hope of regaining or restoring the ability to sense sound for some people who have experienced significant hearing loss.

Although they're not miracle devices, cochlear implants help some children and adults, whether they're born deaf or whether hearing loss occurs later in life, experience talking on the phone, listening to music, and hearing the voices of their friends and loved ones.

What Is a Cochlear Implant?
A cochlear implant is a surgically implanted device that helps overcome problems in the inner ear, or cochlea. The cochlea is a snail-shaped, curled tube located in the area of the ear where nerves are contained. Its function is to gather electrical signals from sound vibrations and transmit them to your auditory nerve (or hearing nerve). The hearing nerve then sends these signals to the brain, where they're translated into recognizable sounds.

If important parts of the cochlea aren't working properly and the hearing nerve isn't being stimulated, there's no way for the electrical signals to get to the brain. Therefore, hearing doesn't occur. (Sometimes referred to as nerve deafness, this is called sensorineural hearing loss.) By completely bypassing the damaged part of the cochlea, the cochlear implant uses its own electrical signals to stimulate the auditory nerve, allowing the person to hear.

Chronic Hoarseness

All kids strain their voices every now and then: cheering for the home team at a ballgame; belting out a favorite song in the shower; calling out to friends on the playground.

Most of the time, such actions don't do any real harm to the vocal cords, the delicate bands of tissue in the larynx, or voice box. But chronic misuse of the vocal cords — caused by such things as repetitive screaming, yelling, or using the voice in an unnatural way — can lead to hoarseness. When this happens, the voice crackles and sounds rough, raspy, or breathy.

Sounding hoarse for a few hours or the day after a big game is probably nothing to worry about, and usually resolves on its own. However, chronic hoarseness that lasts for days, weeks, or even months needs to be checked out by a doctor. Speech therapy may be required to get the vocal cords back into perfect pitch.

How Vocal Cords Work
When we inhale, oxygen travels through the nose or mouth and down the throat (pharynx), passing through the voice box and windpipe (trachea), to get to the airway passages in the lungs. This route is reversed when exhaling carbon dioxide from the lungs, or talking.

To speak, air is pushed out of the lungs. In the larynx, the vocal cords — a "V"-shaped band of muscle — prepare for making sound by tightening up and moving closer together. As air passes through the vocal cords, they vibrate. This vibration, combined with the movement of the tongue, lips, and teeth, is what makes the sound of the voice.

Chronic misuse of the voice can cause excess wear and tear on the vocal cords. They may stretch too far or rub together, causing small irritations that, if not allowed to heal, turn into small calluses, or vocal cord nodules.

Balance Disorders

When you think about balance, the role that ears play might not come to mind. But ears are crucial to maintaining balance thanks to their vestibulocochlear nerve. This nerve sends signals to the brain that control hearing (auditory function) and help with balance (vestibular function).

But the ears aren't the only organs that help us balance. Ears, eyes, joints, and muscles work together to keep us steady and upright. When one or more of these systems is out of whack, it can be hard to get around and just function, day to day. The simplest things — like walking, riding a bike, succeeding in school, even playing — can become difficult and frustrating.

Balance disorders are considered uncommon in kids but might be underestimated — kids' symptoms could be misdiagnosed as something else or missed altogether. But resolving kids' balance problems can make a big improvement in their overall quality of life — their ability to play, learn, and feel as happy and healthy as possible.

How Balance Works
To understand balance problems, it's important to understand how balance works normally. Basically, the body relies on three separate systems, each sending nerve impulses to the brain:

In the neck, torso, leg joints, and feet are pressure sensors that send information to the brain about where the body is in relation to the world (known as proprioception). Messages are sent when we do things like turn our heads, move, and walk on different surfaces.
In the front of the inner ear, or labyrinth, are the cochlea, involved in hearing; in the rear are semicircular canals, which affect balance. Connecting them is the vestibule (with sensory organs known as the utricle and saccule), which affects balance and equilibrium. When we turn our heads rapidly, the liquid in the semicircular canals moves the tiny hairs lining the cochlea, sending a message (through the vestibulocochlear nerve) to the brain about the movement. In less than a second, the brain sends messages to the muscles needed to maintain balance and help the eyes stay focused.
In the eyes, the nerve endings in the retina (at the back of the eye) have light-sensitive cells called rods and cones. When we look at something, light hits the retina, and the rods and cones send electrical signals to the brain through the optic nerve. The brain uses these signals to interpret what we're seeing and create visual images. Each eye gets slightly different images of (and information about) the same object, which aids depth perception (how far away an object is) and is vital to maintaining balance.
If any of these systems isn't working right, it can affect balance.

Auditory Processing Disorder

About Auditory Processing Disorder
Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is a complex problem affecting about 5% of school-aged children. These kids can't process the information they hear in the same way as others because their ears and brain don't fully coordinate. Something adversely affects the way the brain recognizes and interprets sounds, most notably the sounds composing speech.

Kids with APD often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. These kinds of problems usually occur in background noise, which is a natural listening environment. So kids with APD have the basic difficulty of understanding any speech signal presented under less than optimal conditions.

Detecting APD
Kids with APD are thought to hear normally because they can usually detect pure tones that are delivered one by one in a very quiet environment (such as a sound-treated room). Those who can normally detect sounds and recognize speech in ideal listening conditions are not considered to have hearing difficulties.

However, the ability to detect the presence of sounds is only one part of the processing that occurs in the auditory system. So, most kids with APD do not have a loss of hearing sensitivity, but have a hearing problem in the sense that they do not process auditory information normally.

If the auditory deficits aren't identified and managed early, many of these kids will have speech and language delays and academic problems.

Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, consider these questions:

Is your child easily distracted or unusually bothered by loud or sudden noises?
Are noisy environments upsetting to your child?
Does your child's behavior and performance improve in quieter settings?
Does your child have difficulty following directions, whether simple or complicated?
Does your child have reading, spelling, writing, or other speech-language difficulties?
Is abstract information difficult for your child to comprehend?
Are verbal (word) math problems difficult for your child?
Is your child disorganized and forgetful?
Are conversations hard for your child to follow?
APD is an often misunderstood problem because many of the behaviors noted above also can appear in other conditions like learning disabilities, attention deficit hyperactivity disorder (ADHD), and even depression. Although APD is often confused with ADHD, it is possible to have both. It is also possible to have APD and specific language impairment or learning disabilities.