My two children, ages five and three, have been complaining of earache since last night. We have no health insurance because my husband just started a new job. I called the pharmacy, and they told me I can't buy anything over the counter to cure an ear infection, just something to relieve the pain. A friend told me to warm up sweet oil and put two drops of it in the ear and this will take out any liquid behind the ear. Is this true? Is there anything else I could do to help my kids without consulting a doctor?

A.K.

Sweet oil is nothing more than olive oil. (I base this on the fact that I recently asked a patient to bring in his bottle of sweet oil, a remedy that he swore by. The label read, "Ingredients: Olive oil." However, there may be other "sweet oils" on the market.)

A variety of oils can be used to soften and liquefy ear wax. Sweet oil, other vegetable oils, mineral oil and baby oil are all commonly used for this purpose. This is a safe practice ASSUMING that the child's eardrums are intact (no holes). If there is a hole in the eardrum, the oil will carry bacteria-laden ear-canal contents into the middle ear, potentially causing a serious ear infection. Other problems may occur if the oil is forced into the ear canal (NEVER force ANYTHING into the ear canal), or if the child is allergic to the oil.

Warm oil may act as a pain reliever. This is very similar to the use of warm packs to treat any other painful area of the body. If you have ever had sinusitis, you probably noticed that you can temporarily relieve the pain by placing a very warm, moist towel on your face, or by taking a hot shower. The same principle applies to warm oil in the ear canal. If your child has fluid behind the ear drum, oil may make him feel better for a short while, but the oil will not remove the fluid from behind the ear. It just ain't gonna happen!

Incidentally, a warm pack held over the ear will be very comforting, and is a good deal less messy than warm oil drops.

Do your children need to see the doctor for every earache? Probably not. Ears can hurt for a variety of reasons, and not all are serious. For example, people can develop ear pain from a sore throat or a bad tooth. This is known as "referred pain." So how do you determine when it's necessary to see a doctor? Trust your gut: Most parents can sense when their child is REALLY sick. Here are a few rules of thumb, however. Take your child to a doctor if:

• The pain is exceptionally severe or persists despite conservative measures (such as children's Motrin or warm packs).
  
• The pain is accompanied by a fever.
  

• The child is listless, lethargic or unusually sleepy.
  
• The child has a stiff neck or is sensitive to bright light.
  
• The child has any other neurological symptoms (for example, seizures or double vision).
  
• Most pediatricians (and most emergency rooms) have a triage nurse who can ask you questions such as these over the phone to determine the urgency of the problem.

One last point may help put the insurance matter into perspective. If your home had a major plumbing catastrophe, you would call a plumber to get it fixed, right? And you would get a hefty bill, which you would be expected to pay all at once. You'd probably gripe about it, but you would pay it and cuss your ill fortune. Can't live without running water and a working toilet, after all.

So you don't have health insurance. Neither do you have insurance to cover the expenses when your car breaks down or when your plumbing goes berserk. Your children are more important than the car or the plumbing If you have any doubts whatsoever, take them to a doctor.