The Real Reason Babies Scream on Airplanes and How to Prevent It

Why do babies cry on airplanes? It’s not just them being fussy, there’s a real medical reason behind it. In this episode of We Nose Noses, Dr. Greg Smith and Dr. Nishant Reddy explore the often-overlooked reason why babies scream on airplanes: ear pressure. Dive into the science of how pressure changes during flight affect the delicate Eustachian tubes in babies (and adults). From tips on pacifiers and feeding to innovative treatments like balloon dilation, we share real solutions for preventing and managing ear pain during air travel. Whether you’re a parent or a frequent flyer, you won’t want to miss these insights.

What you’ll learn:

Next time you travel, be prepared for pressure changes by applying these tips to manage ear discomfort for both you and your little ones. Listen to the episode now for a smoother flight experience!

Dr. Reddy:

Hi, I’m Dr. Reddy. This is Dr. Smith. Welcome to another episode of We Knows Noses. In today’s episode, we will be discussing screaming babies and airplanes.

Everyone’s favorite thing, right? But the big question is, why are the babies screaming in the first place? That’s what we’re really going to be focusing on. We’re going to be focusing on why babies scream on airplanes, specifically from an ear, nose, and throat perspective, because there are many other reasons. We’ll also cover what we can do about it, as well as how we can help not just babies, but adults with similar problems. Okay. Do you want to get started?

Dr. Smith:

Sure. Nobody knows entirely for sure why a baby might be screaming on an airplane, but it’s thought to be likely due to the problem of equalizing pressure within the ears. A lot of that has to do with when the plane takes off, you need to equalize your ear, which is your middle ear sinus that ventilates into the back of the nose through the eustachian tube we’ve talked about in previous episodes.

Of course, as most people who have had babies know, babies can scream and cry for a whole host of reasons—hunger, fear, all the same things that stress us out as adults also stress babies out. But they just can’t vocalize it as much. So it’s presumed that many times kids might start screaming during takeoff or landing because of pressure equalization problems.

Dr. Reddy:

Yep, and adults are doing the same thing these days. They’re acting like babies on planes. It’s trending nowadays when you’re flying. The medical term we use to describe this problem is called eustachian tube dysfunction.

Basically, the pressure equalization tube doesn’t open and close as easily or as well when you’re experiencing pressure changes during flying. Another thing that might happen is something called sinus barotrauma, where pressure changes not only affect your ears but also your sinus cavities. These have very narrow openings that can get swollen shut during altitude changes.

Dr. Smith:

Right. I used to think, before experiencing it myself, how bad could that possibly be? We’ve all had sinus pressure and pressure when diving underwater into the bottom of a pool, that ear pressure, sinus pressure. But having had it myself one time, the sinus barotrauma and ear barotrauma can be exquisitely painful. It can get to the point where you start to break out into a sweat and feel extremely uncomfortable. Pain medications like Tylenol and Motrin may not help much.

If you’ve ever had it before, I certainly sympathize with you. It’s very uncomfortable. No wonder a baby might cry if they were experiencing something like that.

Dr. Reddy:

So, any tips that we have for babies and adults? We can group this into two separate categories because a lot of the treatment options to help manage this on a flight involve some type of medication.

Dr. Smith:

Right.

Dr. Reddy:

For adults, that’s usually fine. But with kids, especially babies, try to avoid medications.

Dr. Smith:

Correct. Normally, the first thing we suggest to help equalize the ear tubes is to yawn or pinch the nose and blow air into it. You can’t really do that with an infant or a baby. So a pacifier can help because the sucking motion uses the muscles that attach to the eustachian tube and pull them open. Feeding helps as well. Moms who are breastfeeding, or giving a bottle, can help with that sucking motion to equalize ear pressure.

For adults, we tell them to chew gum, try to yawn, or pinch and blow air into their ears. The medical term is insufflation—insufflating your middle ear with air to equalize the pressure.

Dr. Reddy:

Yep. And there are specific times of the flight where this is most important. When you’re ascending is one, but really the worst time for most people is during descent. The pressure changes experienced in the ear tend to be much more painful then. Doing these techniques during those times is more helpful.

If you’re an adult, trying not to sleep during ascent or descent is helpful too, so you don’t wake up with muffled ears when you get off the plane. With babies, it might actually be easier to get them to nap during that time.

We talked about insufflation. What about medication? Any tips?

Dr. Smith:

Sure. I normally give patients my “fly and die” instructions. Typically, it’s a decongestant protocol. If someone commonly gets this problem, I may have them start a nasal steroid a couple weeks ahead of time to reduce inflammation. I usually recommend pseudoephedrine, as long as they don’t have blood pressure issues.

I tell them to take pseudoephedrine about an hour or two before the flight. I also recommend Afrin, a nasal decongestant, right before boarding. Oral decongestants take longer to work, while nasal ones act quickly. Do you usually tell patients to redose during the flight?

Dr. Reddy:

Yes. Afrin works quickly, usually within a few minutes. Right before ascent and descent, a couple sprays can be helpful. In severe cases, if patients are traveling and don’t want problems, we can prescribe a short course of steroids as a backup.

There are also little devices called EarPlanes. I don’t know if any of your patients use them.

Dr. Smith:

I often recommend those too.

Dr. Reddy:

I’ve had mixed results, but the idea is that they smooth out pressure changes so the drops aren’t as significant. This gives more time to equalize pressure in the ear.

Dr. Smith:

Right. Sometimes people even use AirPods or silicone earbuds for a similar effect. Earbuds fully seal the canal, so you might need to take them out slowly to reduce pressure changes. EarPlanes have a valve that slowly dissipates air pressure.

We also had a colleague say that if you’re dealing with a screaming baby on the airplane, noise-canceling headphones work pretty well.

Dr. Reddy:

Or just don’t travel with babies. That’s another option.

Dr. Smith:

We used to have a partner who carried silicone earbuds in a case labeled “for baby foreign body removal.” I thought it was for the baby’s ears, but he said, “No, they’re for my ears so I don’t hear the baby screaming.”

For the baby, be sympathetic to the family. For you, AirPods might help equalize pressure and block out the screaming as well.

Dr. Reddy:

Another tip—if you know your baby has trouble on flights, you can prepare in advance. You can’t use many medications because they’re not FDA approved for infants, but simple things like saline nasal spray help.

In the week before the flight, use saline spray to keep the nose clean and ventilate the eustachian tube.

Dr. Smith:

Yep. Nasal suction tools and saline sprays are very helpful for babies.

Dr. Reddy:

If the baby has allergies, treat them. Try to avoid allergens and viral exposures before flying. Frequent handwashing helps. The worst-case scenario is flying sick with eustachian tube problems.

Dr. Smith:

Before we close, we should mention procedures. For kids, most of us know ear tubes are common if they have recurring eustachian tube dysfunction. Usually it’s for infections, not flights, but adults sometimes get ear tubes if they struggle flying. Tubes vent directly into the middle ear.

Another option for adults is balloon eustachian tube dilation.

Dr. Reddy:

Yes. This is a minimally invasive office procedure, less invasive than ear tubes, and you don’t have to worry about water in your ears. It helps your natural eustachian tube function better. Balloon sinuplasty can also help if you have sinus barotrauma with narrow sinus passages.

Dr. Smith:

Exactly. We’ve had patients with frequent barotrauma who became fearful of flying. Some even avoided international flights or struggled as pilots and flight attendants. Many of them had successful dilations and now do well flying.

So barotrauma is now an indication for dilation procedures, not just infections. If you experience these symptoms frequently, see an ENT experienced in minimally invasive procedures. They can significantly improve quality of life when it comes to flying and diving.

Dr. Reddy:

Agreed. That’s all we have today. Thank you for joining us, and remember to be sympathetic to those screaming babies on airplanes. We’ll see you next time.