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Ear Infections: What Parents Need to Know
Ear infections are the second most common illness among infants and toddlers, after the common cold. Most children get at least one ear infection in their first 3 years, usually between 3 and 18 months of age. So it's best to be prepared to deal with ear infections—your baby's discomfort, sleepless nights, trips to the doctor, and medications.

Parents often ask their pediatricians, 'Why do young children get ear infections?' 'When our baby is sick, how do we know it's an ear infection and what should we do?' 'Is there anything we can do to help prevent ear infections?'

Causes of Ear Infections
Ear infections, like colds, are most common during the winter when children spend more time indoors, in close contact, and sharing germs. The most common type of ear infection, 'acute otitis media,' is an infection of the middle ear which contains the hearing apparatus behind the eardrum, deep inside the ear canal.

Most ear infections are caused by viruses (such as the cold and flu viruses) and some are caused by bacteria. Germs can enter the middle ear through the Eustachian tubes which connect the middle ear to the back of the nose and throat. The Eustachian tubes are designed to protect the middle ear by helping to equalize pressure and drain fluid from the middle ear. (You might have felt your Eustachian tubes pop during take off and landing on an airplane.) However, since infants' Eustachian tubes are very short, it's relatively easy for germs from the baby's nose and throat to travel up into the middle ear. And since the tubes are narrow and flat, any inflammation or congestion in the baby's nose or throat area—such as from a cold, throat infection, or allergies—can block the tubes and build up pressure, fluid and infection in the middle ear. Ear infections can develop in one or both ears.

Symptoms of an Ear Infection
When your child is sick, it can be difficult to know if the illness is caused by an ear infection. Some of the common symptoms of ear infections are:
  • Pain: Older children can tell you, 'My ear hurts.' Babies usually show you they're in pain by pulling at their ears, losing their appetite, being irritable, and crying a lot. Your baby might also have trouble sleeping or may cry at night because the pressure on the middle ear and the pain tends to be most severe when he's lying down.
  • Fever: Fever from 100-104 degrees F. is common with ear infections. This is a sign that the baby's own immune system is trying to fight off the infection.
  • Ear drainage: Rarely, an ear infection can burst the eardrum to drain the infection from the middle ear. You might see fluid coming out of your child's ear that's white, yellow, or tinged with blood.

Treatment for Ear Infections
If your child is ill and you think she might have an ear infection, be sure to call the doctor. The doctor will want to examine your baby because ear infections can only be diagnosed by looking in your baby's ears with a special instrument called an otoscope. Depending upon your child's history, current symptoms, and the exam, the doctor will determine whether this is, in fact, an ear infection (sometimes similar symptoms can be caused by other illnesses) and what's the appropriate treatment. Treatment may include:

1) Antibiotics:
Antibiotics are only sometimes, not always, prescribed for ear infections. In fact, the treatment for ear infections has changed dramatically over the past few years. Most doctors used to treat every ear infection with antibiotics, just in case it was caused by a bacterial infection, but now antibiotics are prescribed for only those ear infections that are likely to be caused by bacteria. Doctors are trying to use antibiotics cautiously because overusing them has caused bacteria to develop resistance, and that leaves our antibiotics less effective when we need them.

Based on your child's history, symptoms and exam, the doctor will determine whether the ear infection is likely caused by a bacteria or virus:
  • For probable bacterial infections: Your doctor will prescribe one of a variety of antibiotics ranging from a 5- to 10-day course. Your child should start to feel better within 2 days of starting the antibiotics. But be sure to continue to give the antibiotics for the whole course, as prescribed, or else the infection can return. If your child isn't feeling better after 2 to 3 days, be sure to contact the doctor since your child might have a resistant infection that requires a different antibiotic.
  • For probable viral infections: The doctor might recommend a 'wait and see' approach rather than prescribing an antibiotic. Your child will probably start feeling better on his own within 2 to 3 days. If he's not feeling better, be sure to contact the doctor since he might have a bacterial infection that requires antibiotics.

2) Pain and fever relievers:
  • The doctor might prescribe anesthetic ear drops to help numb the pain of the eardrum. Ear drops cannot be used if your child's eardrum has burst or if your child has surgical tubes in his ears (see below).
  • The doctor might recommend giving your child acetaminophen or ibuprofen, which are available over-the-counter and can relieve both pain and fever. Be sure to follow the doctor's recommendations for the appropriate dose, and never give your child aspirin since it can cause a serious illness called Reye syndrome.

3) Commfort measures:
As with all illnesses, provide your baby comfort, rest, and plenty of fluids. Your child can return to child care or school when he's feeling well.

Possible Complications of Ear Infections
Most children have only a few ear infections which resolve without any problems. But a small proportion of children are more prone to problems with ear infections. In some children, fluid can remain in the middle ear for months after the infection is gone—this is known as 'otitis media with effusion.' Some children experience repeated ear infections or 'chronic otitis media,' which require long-term antibiotic treatment and sometimes surgery to insert tiny metal or plastic tubes into the ear drum. Persistent or recurring ear infections can affect a child's hearing and language development, so it's important to have your child's hearing checked.

Helping to Prevent Ear Infections
Thankfully, there are some things you can do to help reduce your baby's chance of getting ear infections:
  • Don't smoke and don't let anyone smoke around your baby. Exposing your baby to tobacco smoke increases her chance of getting ear infections, colds, bronchitis, pneumonia, and asthma. If you smoke, get help to quit smoking. And ask others not to smoke around your baby, in your home, or in your car.
  • Breastfeed your baby. Try to breastfeed for at least a year, if possible. Breastmilk contains antibodies that help protect your baby against many illnesses including ear infections, colds, and diarrhea
  • Feed your baby sitting upright. Don't put your baby to sleep with a bottle because the milk can enter the Eustachian tubes and make ear infections more likely.
  • Make sure your baby gets his vaccines on time. The new vaccine Prevnar protects children against the Pneumococcus bacteria, which is the most common bacteria causing ear infections as well as pneumonia, blood infection, and meningitis. Your baby should get this vaccine at 2, 4, 6 and 12-15 months of age.
  • Limit your baby's exposure to germs. Follow good hygiene and handwashing practices at home and in child care. Infants who attend child care with larger groups of children are exposed to more germs, so consider looking for a child care setting with fewer children.

Above all, be patient. Once you've made it through the first few winter seasons and your child turns 3, he has a good chance of having outgrown his susceptibility to ear infections.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician