Speech Development and Ear Fluid

     It is common for infants and toddlers to have ear infections.  It is also common for them to have an excess amount of fluid in their ears that never becomes infected.  Otitis Media is the medical term for inflamation of the middle ear (the part of the ear right behind the eardrum) that is accompanied by a build-up of fluid. (The Otitis Media link above has a great deal of information and is a great supplement to this basic information I am providing). The fluid can be an infection, but this is not always the case. It is more difficult to recognize when a child has only fluid build-up because there is no accompanying pain or other symptoms.  When they have an ear infection, they may cry, pull on their ears or have a fever to tip you off.  You will likely take them to the doctor and they may be put on an antibiotic to clear up the infection.  Once the infection is cleared up, there is still the chance that they have excess fluid. If the child has excess fluid behind the eardrum, but no pain, you may never know this situation is happening. Other children may have excess fluid in their ears for many months or constantly and it may go undetected because there is no infection.
    Think of walking around with your ears plugged or being under water.  The muffled sounds that you hear is how the infant or toddler with an infection or excess fluid will hear their world. This is why many children who have had recurring ear infections or chronic fluid build-up do not develop speech and language skills at a typical rate.  For all of the time they have this fluid or infection, they are missing the models of speech.  In an infant and toddler, a total of six months of not hearing adequately can make a big difference in development.
     At times, a pediatrician will refer children to an Otolaryngologist (ENT) for tubes. These tubes have been called PE tubes meaning pressure-equalizing. They are also known as tympanostomy tubes. These tubes help keep fluid draining and work to prevent infections from recurring.  One possible side effect from tubes is a small amount of scarring on the ear drum that may slightly affect hearing due to making the ear drum a bit more rigid. This is not generally significant enough to worry about, it is just a small result from a procedure that is helpful in the long run.
     Children with known chronic ear infections are usually more closely followed  by their pediatricians for a possible delay in speech and language development skills. This is not always the case.  It is also important for parents to educate themselves in the developmental milestones their children should reach so that if there is ever a concern, they can notify the pediatrician early. The time that it may be realized that a child has non-infected chronic fluid build-up may not be until a scheduled well-baby doctor visit or at a time when the child has been brought to the doctor for an unrelated issue.  Delays in sound production and language skills should be a clue that something with the child's ears may be a concern.
     It is recommended that any child with recurring ear infections or delay in speech and language skills receive a complete hearing assessment.  It is at this time that the reason for the delay may be discovered and addressed. A very common reason for speech delay is chronic ear infections.  Once this issue is cleared up, a child will generally begin to catch up skills.  Speech therapy may be recommended to help the parents and children gain missing skills more quickly. Even if a child has not had known ear infections or fluid, they should get a hearing assessment as soon as it is determined that there is any speech delay.  There are other reasons for hearing loss in children and for speech delays.  It is always important to have hearing tested so the correct treatment can occur.
     I have been asked many times if it is possible to prevent ear infections in babies and toddlers.  Although some children will get them regardless of the steps you take to prevent them (the same way they get the common cold), there are things you should know and do.  A baby's eustachian tube (the tube from the ear to the throat) is smaller and positioned horizontally. Until a persons eustachian tube grows and changes angle to a more downward position, they will be more suseptible to infection and fluid build-up. 
      A baby should never be lying flat to drink a bottle.  If they are held at an angle of  at least 45 degrees, you lessen the chance of any liquid backing up and sitting in the eustachian tube, possibly causing infections. My professional opinion on this tip is also that babies should never be left propped up someplace to drink a bottle. Feeding a baby is one of the best times to bond with them emotionally and provides a perfect time to talk and interact with him.  You can sing to him, look at him, encourage feedback and just bond.  Speech and language skills can be learned in this time by making funny noises, showing various nice emotions in your face, saying strings of consonants-vowel combinations (ba-ba-ba or ma-ma-ma).  The baby has your undivided attention and eye contact during this time. Breastfeeding is also a way to prevent ear infections for two reasons.  Babies generally are not lying flat to breastfeed and they are gaining the benefits to their immune systems that breastfeeding provides. I also like the benefit of having to be with your baby while feeding, increasing the speech time!
     There are several other tips for trying to prevent ear infections. Children should not be exposed to cigarrette smoke. Children who have weakened immune systems or have allergies are more susceptible, so trying to avoid having them get colds will also help. Children in large day care settings may be exposed to more colds and other germs that may increase infection risk. If a child does have a cold with nasal congestion, try to keep his nose clear of fluid to decrease back-up into eustachian tube. Provide your child with a well balanced and healthy diet rich in fruits and vegetables that boost the immune system. 
feel free to ask questions here or to my direct email at beajvw@hotmail.com