Dr. Jackson

One of the interesting things about being a pediatrician is getting questions that they don’t prepare you for in medical school. It turns out that there is not a randomized controlled trial on how to wash kids’ ears. Or when it is safe to pierce a baby’s ears if they have [insert rare condition] or which children’s TV show is least likely to cause parental nightmares. Doctors have to look at things that are tangentially related to the subject, or sometimes take an educated guess.

Cleaning body parts can be one of those subjects. For newborns, we recommend sponge bath until after the umbilical cord falls off, and if a circumcision was performed, until that area heals. After that, parents are on their own. So good luck!

Just kidding. Here are some of my tips. Again, most of these are not based on extensive research, but more on things I have learned that are tangentially related, and on experience with my own children and hearing stories from other people’s children.

• Ears: There are two major cleanable parts of the ear, and the cleaning of these should be handled differently. First, there is the external part of the ear. The part that sticks off the head and is covered with skin. This part of the ear can be cleaned with regular soap and water. Sometimes kids can get dry patches either behind the ear in the crease or in the folds at the top of the ear. Don’t overly scrub if you notice that there are dry patches. Use an emollient like petrolatum jelly or other moisturizer earlier in the day, and then you should be able to clean the area by evening without causing damage or bleeding to the dry areas of skin.

Second, there is the ear canal, the hole that extends toward the center of the head and contains the ear wax. This is where people have traditionally “cleaned” ears with cotton swabs, etc. As it turns out, ear wax is helpful and should not be cleaned out. There are very few situations in which the wax needs to come out. It has a little bit of its own self-cleaning mechanism. If there is wax coming out of the ear that is visible externally, sure, go ahead and clean it off with a rag and soap/water, but you don’t have to stick anything in there to get it deep.

There are times, if you have concerns for an ear infection, or your child seems to be having trouble with hearing, that your doctor may need to look in your child’s ear to see the eardrum. If wax is in the way, they may have to clean out the wax. That is OK. You are not a bad parent if your kid has waxy ears. Using the tools you have at home (I.e., cotton swabs), you may actually push it in farther such that it would make it more challenging for a doctor to see the eardrum.

• Teeth: Brush your kid’s teeth! And floss as they get older! Listen to your dentist and do what they tell you. For kids (especially toddlers) who won’t hold still or who fight the tooth brushing, it is OK to hold them down. Seriously. Without anger, you can restrain your child for teeth brushing in a way that does not hurt them but that allows you to keep those teeth healthy.

• Diaper area: Most people are pretty familiar with cleaning this area if they have ever changed a diaper. Diaper wipes are super convenient, but you don’t HAVE to use them if you don’t mind doing some extra laundry cycles with small washrags that might be a little poopy. This comes into play particularly for babies with sensitive skin and frequent rashes in that area. Some wipes have preservatives and baby skin reacts easily and sometimes unpredictably. A gentle spray of water can be helpful in these situations, too. Even for the older child, if there are diaper-area rashes, injury from straddle toys, or recent diarrhea problems causing discomfort, using a spray bottle of water and patting with a clean washcloth can be much more comfortable than toilet paper.

• Skin: Kids do need baths/showers, sometimes. For babies and younger children, they don’t necessarily need a bath every day. As kids get older and closer to puberty, a daily bath/shower becomes important, if only for the sake of their family members. Especially early in life when the skin is most sensitive, or for children with history of eczema/frequent rashes, I recommend unscented (fragrance-free), sensitive skin soaps. Some baby soaps particularly are tempting because they smell amazing, but they can be more irritating because of their lovely scents.

Keep your kids clean, but don’t obsess about it too much. And if they have dirt under their fingernails, you can always claim “Hygiene Hypothesis”.

Be flexible, be smart and be patient. You can do this.

Katie Jackson, M.D., is a pediatrician with Utica Park Clinic Claremore.

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