✈️ Points to note when children under 6 years old (especially under 2) fly on an airplane
Regarding barotrauma (ear pain during flights)
✈️ Points to note when children under 6 years old (especially under 2) fly on an airplane
Regarding barotrauma (ear pain during flights)
The air pressure changes rapidly during airplane takeoffs and landings.
Adults can equalize pressure by swallowing or yawning, but infants' Eustachian tubes (narrow tubes connecting the back of the ear to the nose) are underdeveloped, making it difficult for them to regulate pressure properly and increasing their susceptibility to ear pain (aerotitis media).
It is said to have a high incidence rate, especially in children under 2 years old, and caution is necessary until around 6 years of age.
Reference) Comparison of barotrauma otitis media and acute otitis media
| Item | Aerotitis media (ear pain from flying) | Acute otitis media |
| Reason | Sudden changes in air pressure due to airplane takeoffs and landings | Viral and bacterial infections, such as the common cold |
| Where it happens | Middle ear (behind the eardrum) | Middle ear (behind the eardrum) |
| Mechanism of onset | The Eustachian tube doesn't open properly, causing a pressure imbalance between the middle ear and the outside air. | Inflammation, pus, and effusion accumulate in the middle ear due to infection. |
| Main Symptoms | Ear pain, ear fullness, eardrum bleeding/perforation | Ear pain, fever, red and bulging eardrum, irritability |
| Peak age | Infants (especially under 2 years old) to around 6 years old | Common in infants and toddlers (peak at 1-2 years old) |
| Conditions that increase risk | Runny nose/cold, recovering from acute otitis media, immature Eustachian tube function | Cold, group living, passive smoking |
| Prevention methods | Swallowing during takeoff and landing (nursing, milk, tea, pacifier), flying on a day when your child is feeling well | Vaccinations, handwashing, breastfeeding, and avoiding secondhand smoke |
| Treatment | Many resolve naturally; if pain is severe, use painkillers. | Antibiotics as needed (depending on age/severity) |
Reasons why barotrauma of the middle ear is likely to occur
Eustachian tubes are short, horizontal, and immature in function.
The Eustachian tube is prone to swelling after a cold, runny nose, or middle ear infection.
Difficulty adjusting middle ear pressure in response to barometric pressure changes.
As a result, the eardrums are strongly pulled during takeoff and landing, causing pain and a feeling of fullness in the ears.
Preventive measures for children under 2 years old
Increase "drink, suck, swallow" during takeoff and landing.
Give small amounts of breast milk, formula, tea, etc.
Use a pacifier
Drink from a straw cup
Swallowing and "slurping" motions help open the Eustachian tubes, making it easier to adjust pressure.
You do not need to take it continuously.
※Be aware that pain is most likely to occur during landing.
👶 Preventive measures for children aged 1 to 6
Drink water frequently.
Snacks that can be chewed gently, such as Ramune candy and Boros, within a safe range to prevent choking.
Pacifier
Swallowing and chewing open the Eustachian tube.
Things to avoid
Boarding with a cold or severe runny nose
・Recovering from acute otitis media (the Eustachian tube is still swollen)
・Use of nasal congestion medication and preventive use of antihistamines
It has not been shown to be effective in children and may cause side effects.
Children with a history of otitis media require special attention.
After acute otitis media, or in children who experience it repeatedly, the Eustachian tube's function tends to weaken.
The risk of barotrauma to the middle ear increases.
It's safer to fly after your symptoms have subsided.
Consult with an ENT doctor if necessary.
Things you can do before boarding a plane
Board when you are feeling well.
When you have a lot of nasal discharge, gently suction your nose beforehand.
Wake the child before landing (as fewer swallows occur when they are sleeping).
References
American Family Physician: Medical Advice for Commercial Air Travel
・CDC Yellow Book: Air Travel with Children
The Journal of Laryngology & Otology: Otic Barotrauma
・Pediatrics / Otitis Media Guidelines
・NEJM: Otitis Media in Young Children