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All about ear infections
Q: My 6-month-old has had one ear infection after another. He was given the shot that is supposed to prevent ear infections, but ever since, we can't get rid of his ear infections! He is due for the next shot soon; should we go ahead with it or should we refuse? (In addition, I breastfed him for four months and make sure to sit him up during feedings.)
A: Ear infections are a common problem for infants. Most children have at least one ear infection during infancy; and some, like your son, have repeated ear infections. Dealing with your baby’s discomfort, sleepless nights, trips to the doctor, and giving antibiotics can be exhausting.

Why do infants get ear infections? Behind the ear drum, the middle ear leads to the Eustachian tubes which connect to the back of the nose/throat. The Eustachian tubes help equalize pressure and drain fluid from the middle ear (you may have felt your ears popping on an airplane’s take off and landing). Since infants’ Eustachian tubes are narrower, shorter, and less sloped, any swelling in the infant’s nose or throat area—e.g., caused by a cold, throat infection, or allergies—can block the tubes and cause increased pressure, fluid, and infection in the middle ear. For children who have chronic or repeated ear infections, it’s likely that their ear/nose/throat anatomy predisposes them to infections. The good news is that as children grow over their first three years, they become less susceptible to ear infections.

Most ear infections are caused by viruses, such as the common cold and flu viruses. Viral ear infections get better on their own, usually within three-seven days, and don’t need to be treated with antibiotics. A smaller proportion of ear infections are caused by bacteria and need to be treated with antibiotics. For each ear infection, the doctor will examine your child and determine whether antibiotics are needed and which one is best.

What can you do to try to prevent ear infections? You’re already doing many good things. Breastfeeding can reduce children’s susceptibility to ear infections as well as other respiratory illnesses. To get the maximum benefit, it’s best to breastfeed your baby for a year, if possible. It’s also good to feed your baby sitting upright, and don’t put your baby to sleep with a bottle because it promotes ear infections. The new vaccine, “Prevnar,” protects children against the Pneumococcus bacteria, which is the most common bacterial cause of ear infections, pneumonia, blood infection, and meningitis. It’s very important for your baby to get this vaccine at 2, 4, 6 and 12-15 months of age. Even if your baby has a mild illness, such as an ear infection, he should get the vaccine on schedule. The vaccine can lead to a significant reduction in ear infections but it doesn’t prevent them entirely, since most ear infections are caused by viruses.

Other tips to reduce ear infections: don’t smoke, especially around your baby, in your home, and in the car. Exposure to second-hand smoke makes ear infections more likely. If your baby is in child care, he’s more likely to get ear infections and other illnesses because of exposure to more children and germs. If you’re looking for child care, you might consider a setting that has fewer children.

In all, try to be patient through your baby’s first year. It’s the worst for ear infections, and next year will probably be a lot better.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician