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Ask Dr. Sears: Frequent Ear Infections

Q. Can a baby really get an ear infection from having a bottle in bed or by being in a house where people smoke? What about house pets?

A. Yes, yes, yes! All three can trigger an ear infection. Here's how:

Nighttime Bottles

When a baby lies flat, the eustachian tube—the tube that connects the back of the throat with the middle ear—is more horizontal. This allows fluid and germs to travel more easily from the back of the throat to the middle ear. Fluid, formula or milk in the middle ear can act as a culture medium, basically growing the germs that cause ear infections. Also, during sleep the natural rinsing action of saliva diminishes, allowing baby's teeth to be bathed in the sugary milk or formula, leading to decay. For this reason, juice—because it is so sugary—should never be given in a nighttime bottle. Best is water.

If your baby is prone to ear infections, always feed him upright (at no less than 30 degrees). Keep him upright for at least thirty minutes after a feeding. This will allow the stomach contents to empty. Many babies are prone to reflux—a regurgitation of stomach contents up into the throat, which can also enter the eustachian tube.

To wean your baby off a nighttime bottle, try the trick we call "watering down." Gradually dilute the formula or milk with increasing amounts of water until the contents is only water. Also, tank your baby up with more frequent feedings during the day. Babies under a year often need at least one nighttime bottle. If so, prop your baby upright during the feeding and brush his teeth well in the morning. Again, reserve juice bottles for during the daytime. Ditto these feeding precautions during naps.

Cigarette Smoke

Smoking and babies don't mix. Nearly every organ of baby's delicate and growing body is harmed by exposure to cigarette smoke. Babies who are around smokers have at least twice the number of doctor's visits for respiratory infections, especially ear infections. Here's why: Lining the breathing passages are millions of tiny hair-like filaments, called cilia. The cilia wave back and forth like sea plants, moving secretions and germs out of the breathing passages. Smoke paralyzes these cilia, allowing germs and secretions to be trapped throughout all the breathing passages, including the Eustachian tube leading to the middle ear. The allergens in cigarette smoke trigger secretions to plug the breathing passages and the Eustachian tube, setting up fluid in the middle ear and consequent infection.

Pets and Ear Infections

In fact, any allergen in the air can trigger secretions that build up in the middle ear and lead to infection. In general, any way that you can help minimize the amount of fluid and secretions that enter the middle ear will lessen the frequency and severity of your baby's ear infections. Animal dander is a common allergen. So, keep pets out of baby's bedroom. And, certainly, don't let baby and pet share a sleeping room. If you live in close quarters, an air purifier may help.

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