Most children will have at least one ear infection by the time they are 3 years old. In fact, ear infections account for 24.5 million visits to the pediatrician each year.
Middle-ear infections are the second most common childhood illness, surpassed only by the common cold, says Dr. Sylvan Stool, a pediatric ear-nose-and-throat specialist at Children’s Hospital in Denver.
The good news is that most children will outgrow ear infections by the time they are 4 or 5 years old. Here’s what you need to know until then.
Q: Why are children so susceptible to ear infections?
A: Infants and young children are particularly susceptible to middle-ear infections, also known as otitis media. Acute otitis media is a painful inflammation of the middle ear, accompanied by symptoms such as earache and fever. Otitis media with effusion refers to the presence of fluid in the middle ear, which may cause some mild, short-term hearing loss.
Young children are prone to ear infections for several reasons. For one thing, their immune systems are still developing, making them more susceptible to colds and other viral infections.
Also, a child’s eustachian tube, the duct that connects the middle ear to the back of the throat, is short and positioned somewhat horizontally, making it easy for bacteria to pass from the throat to the ears.
When children are sick with a cold, their eustachian tubes become blocked, and the middle-ear space between the eardrum and the eustachian tube fills up with fluid. This fluid can put painful pressure on the eardrum and become a breeding ground for bacteria.
By the time kids enter school, however, their middle-ear structures begin to grow, their immune systems improve and the number of middle-ear infections usually begins to decrease.
Q: If ear infections are so common, why are they cause for concern?
A: Frequent ear infections or those that go untreated may lead to persistent hearing loss, which can cause speech delays in a young child.
Since normal hearing is critical for speech and language development in the first three years of life, it’s important to contact your pediatrician if you suspect an ear infection in your child.
In rare cases, untreated ear infections can lead to more serious complications, such as mastoiditis, an infection of the skull behind the ear, and meningitis, an inflammation of the membranes around the brain and spinal cord, as well as balance problems and permanent hearing loss.
Q: How can I tell if my child has an ear infection?
A: It’s reasonable to suspect that your child has an ear infection if she complains of persistent pain or pressure in her ears and develops a fever of 100F to 104F, particularly if she has had a recent case of the sniffles.
Ear pain will be most noticeable in infants at feeding time, when sucking and swallowing may be painful, or at night when lying down increases pressure on the eardrum.
Other symptoms include fussiness, difficulty hearing, loss of appetite and yellow-, white- or blood-tinged fluid draining from the ears.
If your child shows any of these symptoms, call your pediatrician.
Q: What is the standard treatment for an ear infection?
A: If your pediatrician determines that your child has an ear infection, she will most likely prescribe a 10-day course of antibiotics.
Once your child begins the antibiotics, symptoms such as ear pain and fever should go away within 24 to 48 hours.
Even after the symptoms disappear, however, your child should continue to take the medication as prescribed. If the antibiotics are stopped too soon, the infection may not clear up completely.
Once your child is feeling better, he can return to his normal routine as long as he continues to receive his medication as prescribed. If symptoms persist, call your pediatrician. A different antibiotic may be required.
Q: How can I relieve my child’s pain until the antibiotic starts working?
A: You can ease your child’s discomfort with a non-aspirin pain reliever, such as acetaminophen or ibuprofen. Your pediatrician can advise you on the proper dosage. You should never give aspirin to a child, because it has been linked with Reye’s syndrome, a serious disease that affects the liver and brain.
Cold medicines, such as decongestants and antihistamines, are not effective in treating ear infections.
Non-medicinal treatments include placing warm compresses or a heating pad, set on low, against your child’s ear. You can also keep your child sitting up as much as possible to relieve pressure on her eardrum, and give older children an extra pillow at night.
Q: Are antibiotics the best way to treat ear infections?
A: The use of antibiotics to treat ear infections has come under scrutiny in recent years. When they were introduced about 50 years ago, antibiotics were truly wonder drugs, able to halt bacterial infections nearly overnight.
But today some experts feel that antibiotics have been overused and, as a result, antibiotic-resistant strains of bacteria have emerged and are spreading.
For this reason some pediatricians are taking a more conservative approach and adopting a wait-and-see attitude before prescribing antibiotics to children who exhibit only mild symptoms. In many cases, a mild ear infection will clear up on its own.
Q: Can recurring middle-ear infections be prevented?
A: Children who have persistent fluid in the ear or who get one ear infection after another — as many as four infections in six months — and have noticeable hearing loss may be candidates for preventive treatment.
One option is to keep these children on a low dose of antibiotics, which has been shown to reduce the frequency of ear infections.
Another option is to surgically insert pressure-equalization tubes in the child’s eardrums. In this procedure, called a tympanostomy, a small incision is made in the child’s eardrum, and a tiny plastic tube is fitted into the slit to act as a ventilator, allowing air into the middle ear and decreasing the risk that harmful bacteria will become trapped there.
The tubes usually fall out on their own within six to 18 months.
TIPS ON PREVENTION
There’s no sure-fire way to prevent ear infections, but there are some things you can do to reduce their frequency.
Breast is best. Experts report that breast-fed babies suffer fewer ear infections than bottle-fed ones. A study, conducted by the University of Arizona Health Sciences Center in Tucson, found that babies who were nursed for at least six months had half as many ear infections as bottle-fed infants.
Sit up to sup. Keep your infant seated upright, at a slight angle, for feeding, and don’t let her fall asleep with a bottle in her mouth. The liquid can back up into her eustachian tubes and block them, causing bacteria to breed.
Protect your child against colds. Colds often lead to ear infections, so helping your child avoid the sniffles may help him to escape ear infections as well.
If your child is in a child-care arrangement with other kids, he will be exposed to more viruses, so make sure he practices good hygiene.
Stamp out smoke. Children who are exposed to secondhand tobacco smoke are at risk for developing a number of health problems. According to a recent study by the University of Massachusetts Medical Center in Worcester, passive smoke may be responsible for as many as 2.2 million ear infections each year.
