The book is mainly intended for parents of infants who cry a lot and/or have feeding and sleeping problems and for parents of older children who have related problems. It may also be helpful for some medical professionals who work with infants and young children. The book also looks at the sequelae that may follow these earlier problems.

The concept of Eustachian tube Irritation [ETI] is described.

Dr Renée Shilkin has developed the concept of ETI over many years of working with babies who are irritable or cry more than expected.

Many of the infants have reflux and allergies or intolerances [or a background of allergies in their families]. Some of the infants develop middle ear problems—often within a few weeks or months of life. The ear problems may not always be recognised easily.

A chapter gives information about the ear, including how it works and why children are more susceptible than adults to middle ear infections and glue ear.

The book has chapters describing the concept of ETI; the condition of ETI; detailed information about reflux, allergies and intolerances. There is a chapter about ear infections and other middle ear problems including glue ear.

The other conditions that can cause babies to be unsettled are described in a chapter called ‘differential diagnosis’ of ETI. ‘Differential diagnosis’ is the medical term for ‘what other conditions can cause the symptoms’. This chapter includes information about ‘colic’ and the current medical understanding about this difficult condition.

Before developing ear infections or glue ear, infants may have problems with the pressure in their ears, causing pain on sucking and when lying flat. This is often due to swelling near the Eustachian tube [ET] in the nose/throat. It may be difficult to diagnose abnormal pressure by looking at the ears, as the drums may only look mildly abnormal—before progressing to ear infections.

Diagnosing problems related to ET function can be done using a tympanometer. This is a machine that measures the amount of movement of the ear drum and the pressure in the middle ear system. A graph is produced—called a tympanogram.

Doing a tympanogram can help to diagnose early middle ear problems. Serial tympanograms are useful to follow the progress of the child’s ears.

A chapter describes tympanograms and their interpretation. This chapter also describes hearing tests [audiograms] and their use.

The risks for children developing ear problems are discussed in detail. These include having contact with people who smoke, swimming in indoor, heated, public swimming pools, the use of unflued heaters, a family history of ear problems, seasonal variations, racial factors, etc.

By reducing the number of risk factors it is hoped that it may be possible to reduce the number of ear infections for each child.

Ways of preventing infants and children having allergies and middle ear problems are discussed. This includes ways of preventing some of these problems before the next infant is conceived by immunising the mother against particular infections so that the new infant will have better immunity as early as possible—either via the placenta or via breast milk.

Because many of the infants have early middle ear problems they are at high risk of having developmental problems. The book describes these conditions—including speech and language delay, gross and fine and motor skill problems, sensory defensive problems, visual processing problems, school learning problems, difficulties with social interactions, personality development issues, etc.

The book has a chapter about Central Auditory Processing Disorder [CAPD], as this can be a major problem for children who had a history of early middle ear problems. It is hoped that diagnosing and treating ear problems early and effectively may reduce the risk of the child developing this condition. The diagnosis and treatment of CAPD is discussed.

There is a glossary of medical terms that are used in the book. These are terms that are used by doctors when talking to parents about babies and older children with the problems described in the book.

It is hoped that the book will help parents feel more confident and comfortable to discuss their concerns about their infants and children with their doctors.