Should children fly with ear infections and colds?
1. No studies exist to help you make the decision. While saying “no” is prudent, doing so ruins long planned family trips, often unnecessarily. Worse, sometimes it strands families on vacation. The scenario: An infant is cranky and has a fever or an older child complains of an earache. They are seen at a medical facility, a diagnosis of ear infection is made, medication is prescribed, and a delay in air travel is recommended. The delay recommended may be until the pain/temperature subsides, or until a course of antibiotics is completed, which may last five to ten days.
2. Ear infections are greatly over diagnosed. Especially in emergency care clinics, the kind often found in resorts. Infants/children are often seen by personnel with limited experience in examining screaming, struggling young children, in removing wax from the ear canals to visualize the ear, and in deciding if there is an infection. In order not to miss infections, inexperienced personnel tend to treat.
3. Air travel-related ear pain is quite common. The source: the Eustachian tube, which connects an air space in the middle ear with the back of the nose. Normally, air passes freely from the air space through the tube and nose to the outside. Problems arise when the tube is blocked by mucus from colds (common in kids) and you fly. As airplanes ascend and descend, air pressure changes. During ascent air, including the air in the middle air expands. The increased volume of air has no place to go. This exerts pressure (pain) on surrounding tissue. During descent, the air contracts, creating a vacuum in the middle ear. The vacuum sucks in surrounding tissue causing pain. The vacuum is more forceful than expansion, hence pain occurs more frequently and is more severe during descent than ascent.
4. Ear infections decrease the risk of ear pain during flight. Infection tends to fill the middle ear with pus/fluid, leaving no air to expand/contract, hence no pain. Children with aerating tubes in their ears (to prevent infections) can also fly safely. These tubes connect the middle ear with the outside through the ear canal, bypassing the Eustachian tubes and neutralizing pressure changes.
5. Ear pain during air travel does not appear to cause permanent ear damage in children. It may do so in adults who have other medical issues. Tens of millions of children fly annually. Yet surveys of hundreds of pediatric ear specialists, airline physicians, and pediatricians found no one who was aware of a child whose ears were permanently damaged by ear travel. However, this does not prove it never happens. But if it does, it is an extremely rare event.
6. When infants cry during flight, is it because their ears hurt? Older children complain of earaches during air travel, so presumably infants also experience pain. Their Eustachian tubes are narrow making blockage by mucus more likely. But, in fact, surprisingly few infants cry, considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and often uncomfortable positions and, if they are on a parent’s lap, are disturbed every time the parent moves. They do seem to cry more frequently during descent when ears are more likely to hurt, but that is also the time they are most likely to be disturbed.
7. Conventional wisdom says to feed infants during ascent and descent, and often during flight. Such “wisdom” is both true and false. Sucking does help to keep Eustachian tubes open. However, at cruising altitudes the air in the stomach and intestine is already expanded by 20%, the result of air pressure changes. (This is what gives many adults a bloated feeling.) For infants, sucking adds more and unnecessary air and food to the stomach, which may cause fussiness and crying. Feed infants no more often in flight than at home.
8. Many commonly used remedies given to children are of questionable usefulness. Oral antihistamines to reduce nasal secretions/congestion are no longer recommended for children under any circumstances. Nose drops/sprays and drinking lots of fluids to loosen secretions and unplug Eustachian tubes are ineffective in children.
9. Preventing ear pain. Pain most commonly occurs during descent. Note that descent may commence before the captain announces it. Ask flight attendants to inform you when descent begins. Keep infants awake during landings. Sleep reduces the frequency of swallowing. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) reduces pain. Give about 30 minutes before descent if your child has a history of ear pain while flying.
10. Treating ear pain. Administer acetaminophen or ibuprofen. Teach children the Valsalva maneuver: blow firmly, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times. Encourage children to swallow. Older children can chew gum, suck on hard candies, yawn, and move their jaws from side to side, maneuvers that may help open the Eustachian tubes.
