She gives tips to parents about the importance of checking the volume of their child’s headphones and earbuds. The question for the column: My child wears headphones for school and on long car rides. Can this hurt their hearing? The answer, yes.

We live in a world where children love to watch movies or play games on their electronic devices, but Vaughan warns that prolonged headphone use can be risky.

“What is ‘too loud’ can vary based on a child’s ear size, type of headphones, and length of listening time,” Vaughan said.

With children having control of how loud or soft the volume is in their ear, she says listening at too high a volume can cause permanent hearing damage.

Vaughan explains if you can hear what your child is listening to, the volume is too loud and urges parents to use headphones with volume limits.

In the column, she also teaches parents that headphones are always a better route to go than earbuds, and often the volume has to be louder in earbuds to compensate for the way they fit in a child’s ear.

Lastly, she gives guidance that best practice may be for your child to go without headphones, but to also remember that external speakers can also be a hazard if your child is too close or the volume is too loud.

Dr. Olvera and Dr. Hanson have been piercing ears as part of their clinical practice within the Cook Children’s Network since 2016. They both use a medical ear piercing system only available to pediatricians and medical providers.

When should I get my baby’s ear pierced?

This is truly an individual decision. If you decide to pierce your baby’s ears, we only ask that they have received their first set of immunizations at age 2 months. Dr. Olvera and Dr. Hanson prefer to pierce ears from 2 to 9 months and then after age 4 years. Piercing a child’s ears between the ages of 1 to 4 is the most difficult age in terms of cooperation. It is important to understand that most children will cry when getting their ears pierced.

As far as age, some parents prefer to wait until a child can make the decision for themselves. Again, no judgment here. For some, the decision is a cultural one. In some countries, such as Spain, infants' ears are pierced right after birth. Dr. Olvera had her ears pierced at age 8, so she offered the same for her own daughters. Many families have the tradition of waiting until age 10 or 13 to have ears pierced. We respect all decisions!

Where should I get my baby’s ear pierced?

Again, this is a personal choice. More and more pediatricians do offer this service to their patients. First, ask your pediatrician if they offer the service. Some families will choose to go to a local tattoo parlor or the local mall. We recommend that you do your research on the place you choose and determine the age groups they serve. Make sure that you know families have had a good experience at the place you decide to go to.

Dr. Olvera and Dr. Hanson provide medical ear piercing to everyone in the Cook Children’s Network, even if your pediatrician does not offer the service.

What earrings should I use?

With the system that we use, the earrings are provided. You will have a choice of either medical-grade titanium or medical-grade plastic earrings. The earrings used for piercing are only designed to stay in for 6 weeks. You are asked to remove the earrings after 6 weeks and replace them with earrings of your choice. This step is important as the earrings used for piercing have thicker posts. We caution patients to stay away from costume jewelry for the first year. It can take up to a full year for the holes to be completely healed. If a patient has very sensitive skin, we recommend buying replacement hypoallergenic earrings to use for the first year. The medical-grade plastic earrings are excellent for patients with sensitive skin.

How do I take care of my ears after piercing?

The medical ear piercing system we use requires no special cleaning agents. The company recommends cleaning the piercing site (around the earring) with soap and water twice a day. Older children should be reminded to not touch their ears with dirty hands.

What sites do you pierce?

We do traditional ear piercing, usually single lobe piercing on each side. However, we are also comfortable offering second piercings on the lobes to preteens and up. We do not offer cartilage, nose, or belly button piercings.

Do you pierce boy’s ears?

Absolutely!

Since we have access to medical-grade equipment, are trained in sterilization techniques, and are equipped to handle any potential side effects, we can offer piercings as an option. As with any procedure, there are some risks involved, but we have found that when having this done in a medical setting, and more importantly, with proper technique, the risks are rather minimal. For that reason, parents are often relieved to hear that we offer this service in our office because they feel more comfortable having us perform it.

Now there is no medical reason to pierce a child’s ears, and as such, there is no official “best” time to have it done. Ultimately, the timing and age at which you have this done are up to you and your family. My mother made that decision for me and had my ears pierced at infancy, and I'm not mad. Sometimes families want to have their baby’s ears pierced during infancy so that babies won’t remember how it felt. Some wait until the child can decide. I am happy to offer this once they are 6 months of age after they have received their necessary immunizations.

There are risks involved – mainly infection at the site or scarring. We reduce these risks by using sterile equipment and having you clean the site every day with alcohol or peroxide. This is also why we require vaccinating beforehand. If you do develop an infection, it will usually appear very red, swollen, and may have some associated discharge. Infected piercing sites will also often be quite tender. If you do develop an infection, you should contact your pediatrician right away.

Another risk is the development of allergies to metals, especially to nickel. Because of this, we always use nickel-free posts for all of our earrings. Typically we like to use medical-grade titanium posts since this tends to prevent reactions the best. Stainless surgical steel is another standard and safe option for your child. Other good options are medical plastic or gold.

Whether or not you have your child’s ears pierced at your doctor’s office, it is very important to seek out a trained professional for this. Make sure that the individual performing the procedure washes their hands beforehand, wears gloves, and uses sterile products. The part of the product that touches your skin should come directly out of the packaging before coming in contact with your skin and before touching anything else. It is never a good idea to do this yourself or at a friend’s house.

I always get asked if it will hurt, and of course, the answer is yes, but it truly is a brief pinch, and the pain resolves rather quickly. You may even experience a warm sensation for a few moments afterward as well, which is healthy and lasts only momentarily. To minimize discomfort, I recommend icing the site beforehand or taking Tylenol or Motrin. I do offer numbing cream on the earlobes for 20 minutes before the procedure, and due to this, the ear-piercing is separate from other appointments.

Some clinics might have people trained to do them simultaneously, but in my clinic, I do lobe piercings one at a time to assure the earrings have been placed in the correct position in regards to the other.

What can you expect later on? Generally, we have you keep the first earrings in for six weeks. It is important to turn the earrings and clean them with either alcohol or peroxide every day. Don’t remove the earrings too early, because the holes will actually close up right away. Avoid swimming, especially in a lake or ocean, because of the risk of infection. Be careful when removing clothing or when playing sports, etc. that the earrings do not get caught and/or pulled. If this is happening, it would be best to cover them with bandages over the earlobes to prevent this. Also, when applying make-up, hair sprays, hair dye, etc. it would be best to cover your earlobes to protect them.

It can take a whole year for the holes to completely heal, so consider wearing earrings for the entire year to keep the hole from shrinking. Keep the area around the earrings clean and dry, wash your hands before changing earrings and make sure to wash the earrings or sanitize them with alcohol before using them as well. Take care when changing earrings. Because the skin within the hole is still delicate for almost a year after piercing, there is always the risk of infection if that skin should tear.

Again, there is no medical reason to have your ears pierced. But – if you’re going to have it done, get it done right. If you decide to have it done by a physician, I am all for it; however, if you choose to go outside of the medical community, that’s OK, too – just be sure to seek out a professional who will perform it correctly for you or your child. Remember, there are some risks involved. Make sure you and your child are ready to care for the site properly.

So if you are ready for your child's piercing? Don't worry, I'm ear for you!

Will and Anna Esler, Ayla's parents, answered a few questions for us to help us learn more about Ayla and what the family has experienced over the past year.

How did you find out Ayla was deaf?

Ayla failed her newborn screening at the hospital, and after we took her back and she failed it again, we were referred to a great audiologist here in Amarillo who helped us begin to discern the depth of her loss. From there we started working with Early Childhood Intervention, who helped us learn what life is like for kids with hearing loss and introduced us to an amazing community of parents and kids with hearing loss. We also started working with Ayla’s speech therapist, has become a dear friend and has done so much for our whole family—she even came with us to Fort  Worth for Ayla’s surgery and her activation—and she’s helped us learn what Ayla’s loss and now her newfound hearing means for the whole family. After a few months in, we were connected to the amazing team at Cook Children’s, who have gone above and beyond to help our daughter hear. The care that we’ve received from them has been extraordinary, and we’re so grateful for them.

What was going through your mind when Ayla’s implants were activated?

Anna: Every child responds differently when their cochlear implants (CIs) are activated, and so we didn’t know what kind of reaction she would have. And even though I knew it would work, there was still some doubt in my mind, so when I saw her responding to sound I was overwhelmed by thankfulness to God and to everyone else who has been a part of this journey.

Will: Ayla has had a lot of family and friends praying for her, and we saw God answer those prayers when her devices were activated. Like Anna, I was excited and scared and nervous and hopeful all at the same time. I thought she would probably cry and scream when her CIs were activated—and she did do that later when it became overwhelming—but to see her hearing sound and enjoying it was just incredible.

What was it like getting to this point?

Being deaf isn’t bad, it’s just different, and so we had spent a lot of time preparing ourselves for what life would be like without Ayla hearing. We had to let go of some things, like her knowing the sound of our voices, the sound of music, the sound of laughter. We had to prepare ourselves to see her enjoy those things in a different way, through the vibration of them, to “hear” with her eyes. When we found out that cochlear implants were an option for her, sound became a reality for her again, and we are so grateful for that. 

How is Ayla responding now, what kinds of changes have you seen?

She still has challenges ahead of her—we have a year’s worth of catch up to play, and whereas most kids learn to hear naturally we will actually have to teach her to hear, to teach her that sound has meaning. But she’s already responding positively—sometimes she turns to sounds (which she had never done before), she dances to music, she’s starting to calm down when we sing to her if she’s upset. We really couldn’t be more thankful for the new opportunities our little girl has thanks to everyone in her life.

Ear, Nose and Throat Program at Cook Children's

We know it's about more than medical expertise and advanced technology. It's about working together to tackle even the most complex ear, nose and throat conditions. At Cook Children's, our expert pediatric specialists diagnose and treat many ear, nose and throat conditions. The Ear, Nose and Throat (ENT) staff also collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. Meet our team by clicking here. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-6850 or click here.

The article published in the Journal of Pediatrics found that almost three dozen children go to a hospital emergency department in the U.S. as a result of using cotton-tipped swabs to clean the ears.

I should call this: "The Eustachian Tube - Dictator of Ear Happiness." More later on that.

Few things I want to put out there first:

1) There are two kinds of ear infections: middle ear infections (otitis media - the type you get tubes for) and otitis externa (outer ear infection, no tubes for this)

2) "Water in the ear" from a bath or pool typically does NOT cause middle ear infections! It CAN cause something called "otitis externa," or, "swimmer's ear," which is an ear canal/skin infection that may require ear drops to improve. I'm not going to talk about that kind of ear infection today. From here on out when I say "ear infection," I mean the middle-ear kind.

3) Ear infections are incredibly common. Do NOT freak out if your child gets one. Five out of six kids will have at least one by their third birthday (and most will have more than one).

4) A "red ear" does not mean a child has an ear infection.

5) A "baby messing with an ear" does not necessarily mean they have an ear infection.

6) A fever with your child's cold does not necessarily mean an ear infection is happening. The only way to know if your child has an ear infection is to have the ear drum examined by a medical provider.

Why do ear infections happen? Well....snot. And inflammation. Snot and inflammation from colds. Snot and inflammation from allergies. Snot and inflammation from just walking into the door of daycare or that play date.

The inflammation blocks a vital little guy called a eustachian tube. Look at the picture to the left. Find the eustachian tubes. See how they're a little exit canal for the inner part of the ear? They drain the ear. An infant's eustachian tube is smaller than an adults', and more horizontal. That causes problems. It just doesn't drain well.

It swells up, gets blocked off, and the snot in the middle ear has nowhere to go. Once the cold or allergies are better, it de-swells, opens up, and voila!, ear infection is gone. All the junk drains out. The baby's eustachian tube is different than an older kid's, or adult's. This fact along with the fact that babies and toddlers are snot machines and always putting things in their mouths - that's why they get more ear infections. We hope they "outgrow" this eustachian tube problem (and hands in mouth problem) by age 2-3.

It can take 3 weeks to 3 months for the fluid to drain out of the ear. And your kiddo may have an ear infection and you'd never know about it, and that's ok - because they usually get better on their own! Most ear infections are VIRAL! That means the fluid just has a virus in it, and it will all go away on its own thanks to our great immune systems.

When I look into a child's ear, I examine the ear drum to know if they have an infection or not. When there is no infection, an ear drum is translucent, kind of like a shower door. When it is infected, it is red, bulging out, and full of what looks like pus. Sometimes this is just viral fluid. But sometimes, while that eustachian tube is all swollen and blocked off, the liquid stuck in the inner ear gets bacteria in it. We can tell the difference by looking in there. And that is why some children need an antibiotic for some ear infections. To kill the bacteria while we wait for the eustachian tubes to un-swell.

So...who needs "tubes?"

There are a few things that cause kids to get lots of ear infections:

1. Being in a child care setting (lots of kids...lots of snot).

2. Secondhand tobacco smoke exposure (as if you needed another reason to quit).

3. Taking a bottle to bed (when the child lays down and drinks, the milk actually puddles in the area where the eustachian tube meets the nose/throat and causes swelling and bacteria to hang out back there - this habit also causes cavities - no bottles in bed, folks!!)

Some kids have really tiny eustachian tubes that stay really swollen all the time. If they're around other kids a lot, like day care, they get tons of colds each year, and that's normal. However their little eustachian tubes mostly stay swollen shut, sometimes for months at a time. And we see them in our office 1-2 times a month for repeated ear infections.

I guess a "rule" I follow is that if a child gets 5-6 bacterial ear infections in a year, or more than 3 months of constant fluid in the ear, I will send them to the Ear-Nose-Throat doctor to get tympanostomy tubes (or just "tubes", as most people know them) put in. This brilliant procedure creates a little "canal" for the fluid to escape from the inside of the ear. They fall out in about a year, when we hope they've "outgrown" the problem.

Sometimes, I send a kid to ENT if I've put them on 3 or more rounds of antibiotics and they're still having fevers and still in pain and I just can't get that dang fluid to go away. Who wants a kid on antibiotics for that long!? Another reason to see the ENT is if the fluid is making it hard for a child to hear. When a small child can't hear, they can't learn to speak. I've seen kiddos get ear tubes and within 1 week they are talking up a storm! It's amazing.

However, surgeries and anesthesia comes with risks. If you're worried your child has had too many ear infections, talk to us. We will let you know if we think it's time to see the ENT.

Wow...this was long. I hope it helped you learn something about one of the most common ailments we see in the office!

Ear pain can be caused by many different factors. Often kids just play with or point to their ears. If the child is otherwise cranky, sick or not sleeping well, parents will assume there is an ear infection. However, a study from 1998 showed that parents only identified 70 percent of their children with ear infections and when they suspected an ear infection, it was only present 50 percent of the time. (Translation-they could have just flipped a coin rather than trying to guess.)

This is why getting an antibiotic called in when your child has ear pain is a bad idea - whether it is from your doctor or from one of the new insurance nurse lines that many people are using. Every exposure to antibiotics is a potential risk for allergy or side effects. Unnecessary exposure is not worth it.

2. All ear infections have fever.

Studies are all over the place about what percentage of ear infections have fever. They generally fall between 1-2 out of 3. Regardless, that means a lot of kids with ear infections won’t have fever.

3. Having your child in the wind or under water causes ear infections.

The location of an ear infection is behind the ear drum way back in the inner ear. External exposure like wind and water don’t affect that area. Grandma will have to come up with another reason for their grandbaby to put on a hat when it is cold outside.

What are risk factors?

• Age (6 months-2 years)
• Family history
• Day care
• Not breastfeeding
• Smoke exposure
• Pacifier use (small effect)

4. You can’t go swimming if you have an ear infection.

Related to the previous myth, there is no reason to avoid swimming if you have an ear infection. Unless the ear drum has ruptured the space where the ear infection is located is walled off from the water. Don’t skip the swim party! If the child feels discomfort or pain while swimming, they can play in the shallow end or just have a snow-cone.

5. All ear infections need antibiotics.

Many children with ear infections will get better without antibiotic treatment. The latest treatment guidelines give the following advice for treating ear infections:

• Children of any age with severe pain, fever or ear drainage should receive antibiotics.
• Children 6 months-2 years with both ears infected should receive treatment.
• Children 6 months and up with 1 ear infected and with mild symptoms can be watched for 2-3 days to see if symptoms improve or worsen prior to starting antibiotics.

6. Amoxicillin is not strong enough for ear infections.

Many studies have looked to compare different antibiotic treatments for ear infections. The bottom line is this, there is nothing better at getting rid of infections than amoxicillin. Other antibiotics may work as well, but they are typically more broad spectrum - meaning they cover more different types of infections that those that typically cause ear infections. Because of this, we should reserve those antibiotics for those situations in which they are necessary. Amoxcillin is cheap, well tolerated by most kids and effective. Therefore, except in penicillin allergic patients, it should be used unless the child has been on the medication in the last 30 days.

7. If your child gets tubes, their ear infections are guaranteed to stop.

After a few ear infections, some parents are eager to move forward with placement of tubes. Tubes can be a life saver with kids who have had multiple ear infections and can prevent recurrence of ear infections, but they aren’t perfect. They are a surgical procedure and the inherent risk associated with anesthesia need to be fully explained to a parent. Continued ear infections occur in about 20 percent of children even after they have had tubes placed.

“He snores just like his daddy.”

Are these things that you have said about your child? If so, you may want to ask your doctor if your child might have sleep apnea. Because pediatricians often forget to ask about snoring during checkups, it is not uncommon for the diagnosis of sleep apnea to be significantly delayed or even missed altogether.

It is probably more common than you think. I spoke with Natalie Roberge, M.D., an ENT (ear, nose and throat) doctor with Cook Children’s, who estimates that obstructive sleep apnea occurs in 1-5 percent of children.

Snoring alone does not make the diagnosis of sleep apnea. Here are some of the other symptoms that could be present:

1. Pauses in breathing. (If your child snores, it might be worth listening to them occasionally to see if you hear these).

2. Bed-wetting.

3. Mouth breathing (at night or during the day).

4. Daytime sleepiness.

After discussing symptoms and examining your child, the doctor may recommend a sleep study. During a sleep study, a child will be observed for many different characteristics of their sleep including: apnea, excessive movement and level of oxygen in the blood during sleep.

There are many causes of sleep apnea but according to Dr. Roberge, “The most common cause in children is large tonsils and adenoids. The next most common, potentially treatable cause is obesity. Other causes include craniofacial, genetic and neurologic disorders.” If your child has any of these risk factors, it is important to pay closer attention to his or her snoring and quality of sleep.

Sleep apnea is treated differently depending on the cause of the apnea. If large tonsils are the problem, the pediatrician and ENT might recommend having them removed. If the child is obese, addressing healthy lifestyle and decreasing excess weight may help to improve the apnea.

It is important to address apnea for many reasons. You can find many different conditions associated with sleep apnea such as bed-wetting, ADHD and other behavioral problems, as well as hypertension and other cardiovascular problems. The consequences of untreated sleep apnea can be missed because they are common in many children.

Despite the fact that it might be fun to tease your child about his or her snoring, it is important that we consider the serious consequences of snoring and sleep apnea. If you have questions, please discuss them with your pediatrician and they can recommend a referral to an ENT if it is necessary.

About our sleep lab

The staff in our Ear, Nose and Throat Center collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. At Cook Children's, we can diagnose and treat many ear, nose and throat conditions. Our expert pediatric specialists have access to many services within Cook Children's system to provide your child with the best care.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joined Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

A young person with a history of depression is obviously at a greater risk of suicide. Parents want to be alert for any changes in their adolescent’s typical behavior. They may have been very active in sports in the past, or band, theater, or cheerleading, and now are less interested or involved. They may be isolating themselves, not only from family, but also from friends. Motivation may be dropping, along with grades. You may see sleep patterns change and the teenager may be sleeping for extended periods of time and be difficult to wake in the morning. One may also notice their need for sleep is decreased or they are having difficulty falling asleep. Appetite may change as well and they may eat a lot more or a lot less, and actually be losing weight.

If a young person is talking more about death, dying, and have a sense of hopelessness, that is a big concern. Drug use and other impulsive or risky behavior can place them at a greater risk of suicide as well.

When there is a suicide in a community, parents should discuss it with their kids, particularly since they have likely already heard about it at school or from friends. Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them. Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.

Even if a young person does not have a desire to harm themselves, their feelings of grief and sadness about a peer’s suicide can be significant, regardless if they were a close friend or just an acquaintance. Again, be a support for them and encourage them to discuss, and work through their feelings. Answer any questions they may have and explain, if appropriate, any similar feelings the parents may have as well. This may also be an opportunity for the adolescent to make a positive out of a negative experience. They may consider starting a grief support group, work on a memorial for the person who has passed away, or engage in volunteer activities. Sometimes putting feelings of sadness into positive activities can be helpful in the grieving process.

Above all, parents should be “tuned in” to their children. When unusual behavior changes are occurring, ask about them. Additionally, reassure your children you are always there for them, no matter what issue they are facing.

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Additional resources:

• Cook Children's Psychiatry and Psychology department
• Dealing with depression
• Resources & education
• 5 ways to fight depression
• When depression is severe

About the author

Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s, sees patients at Cook Children’s Urgent Care and Pediatric Specialties in Southlake, the first such pediatric facility in town. Previously, she worked seven years in Denton at Cook Children’s Psychology. She moved to Southlake to be closer to home. She sees patients Monday through Thursday, and on Friday she evaluates patients for conditions such as ADHD or autism Joy is married to Tim Crabtree and they have three children. If you feel your child needs to speak to a psychologist or psychiatrist, talk to your pediatrician or call 682-885-3917.