When to Worry: Ear Infections
How Common Are Ear Infections?
Recently, I noticed my 8-month-old son tugging on his right ear. That, combined with his unusual crankiness, got my attention. Was he teething? Just discovering his ear? Or could he be signaling that he was suffering from an ear infection? He was just getting over a cold, so I decided to call the pediatrician's office. The nurse suggested bringing him in for a quick peek at his ears. The verdict: no ear infection! While I was relieved, the incident did get me thinking. Did I have to drag him in every time he pulled at his ear? That seemed a little extreme. But what if I was too laid back and missed a real ear infection? I decided it was time to learn a little bit more about this common childhood ailment. Here's what I found out.
"Next to the common cold, ear infections are the most common disorder in children," says Margaretha Casselbrant, MD, PhD, chief of the division of pediatric otolaryngology at Children's Hospital of Pittsburgh. The painful facts are that more than 80 percent of children will be diagnosed with an ear infection by the time they celebrate their third birthday, almost half of these kids will have suffered from three or more ear infections by age 3, and the prime time for ear infections is between 6 and 24 months.
Why Are Kids Prone to Ear Infections?
First a quick explanation: ear infections occur when fluid gets trapped in the middle ear (an air-filled space located behind the eardrum) and becomes infected by bacteria or a virus. This is most likely to happen when the eustachian tube (a narrow passageway that connects the throat to the middle ear) becomes blocked. Typically, this blockage is caused by swelling or congestion from a cold, which is why an ear infection often develops on the heels of a cold. Allergies can also cause inflammation that obstructs the eustachian tubes.
Anatomy is a contributing factor as well. A child's eustachian tubes are shorter, less angled, and floppier than an adult's, which means that both fluid and germs are more likely to get trapped in the middle ear. In addition, a child's immune system is still developing, so she has a tougher time than an adult in fighting off viruses and bacteria.
How Can Parents Identify an Ear Infection?
Because infants and toddlers don't yet have the language skills to let you know how they're feeling, detecting an ear infection is especially hard. "Older kids will come to you and say, 'My ear hurts,'" says Max M. April, MD, chair of the committee on pediatric otolaryngology for the American Academy of Otolaryngology - Head and Neck Surgery. "An infant obviously isn't going to be able to do that." So what can parents be on alert for? "In general, a fever above 102 degrees F. is one of the hallmarks of an ear infection in a nonverbal child," Dr. April says. Ear tugging is not a reliable sign, but ear infections are painful, so your child's tears or increased irritability may be a symptom. Also, if your baby becomes more upset when she's lying down, an ear infection may be to blame, because that position puts pressure on the eustachian tubes. Other indicators of an ear infection can include difficulty sleeping, diminished appetite, vomiting, or diarrhea. And you may notice that your child doesn't hear well; she may not respond to sounds around her as she normally would, for example. Rest assured -- her hearing will come back once the infection is gone and her ear is free of fluid.
A definite red flag: fluid or pus draining from your child's ear. This can signal a perforated eardrum, a condition that can develop if the fluid in the middle ear puts so much pressure on the eardrum that it bursts. Although a burst eardrum may sound scary and can be very painful for your child, the hole is not serious and will usually heal by itself.
Are Antibiotics Needed for Ear Infections?
Though antibiotics are very often used to treat ear infections, the latest thinking is that doctors needn't immediately whip out their prescription pads. In some cases, a watch-and-wait approach may be appropriate. "The science is now showing us that 80 percent of the time, kids will get better without an antibiotic," says Ellen M. Friedman, MD, author of My Ear Hurts! A Complete Guide to Understanding and Treating Your Child's Ear Infections (Fireside). That's because one-third of ear infections are caused by viruses, which don't respond to antibiotics. And some of the infections caused by bacteria will improve on their own. Moreover, repeated doses of antibiotics that may be unwarranted can spur the development of resistant bacteria, which is another big problem, Dr. Friedman says.
Whether your child takes antibiotics is based on several factors, including his age and the severity of his symptoms. It's common to prescribe antibiotics for babies and toddlers who have an ear infection. "With children younger than 2, almost everyone agrees on giving antibiotics," Dr. April says. "Kids that age aren't verbal enough to tell you, 'My ear really hurts. It's getting worse.' Plus, they're more prone to complications from ear infections, such as hearing loss or other rarer problems."
or kids older than 2, watchful waiting is an option if the symptoms are mild and if the doctor is uncertain that the child has an ear infection. So if your preschooler is otherwise healthy, doesn't have a high fever, and isn't extremely irritable, and if you're a family who will definitely follow up, your doctor may decide to wait 48 to 72 hours to see if the problem will get better on its own, Dr. Friedman explains. Dr. Casselbrant adds, "Your child doesn't have to be perfectly back to normal within two to three days, but his symptoms should have improved." If they haven't, your doctor will ask you to come back or will simply give you an antibiotic prescription.
Whether or not your child ultimately takes antibiotics, his pediatrician will likely schedule a follow-up visit several weeks later to ensure that the infection is gone. In most cases, the ear infection will be history and your child will be none the worse for the wear. However, for children with recurring ear infections, your doctor might recommend seeing a specialist, called an otolaryngologist. She may discuss placing ventilation tubes in your child's ears to prevent fluid from accumulating. In some children, fluid can remain in the middle ear long after an infection is gone. This fluid not only sets a child up for another ear infection, but it can also cause continued hearing loss that may interfere with language development. "If your child has had five or six ear infections in a year or has had fluid behind his eardrum for more than three months, he may benefit from having tubes placed in his ears," Dr. Friedman explains.
Are Ear Infections Preventable?
There are no guarantees, but you can take these steps to lower your child's odds of ending up in the doctor's office.
- Breastfeed. Studies show that six months of exclusive breastfeeding can protect a child.
- Don't smoke, and steer clear of secondhand smoke. "Cigarette smoke paralyzes the tiny hairs that line the eustachian tubes," Dr. Friedman says. "When that happens, mucus doesn't get moved out of the middle-ear space, which raises the risk for an infection."
- Have your child vaccinated. A 2007 study published in the journal Pediatrics looked at Prevnar, a vaccine that protects against pneumococcal bacteria, which can cause ear infections, meningitis, and other diseases. The study found that Prevnar has helped reduce the number of infants and toddlers who develop frequent ear infections. The vaccine works only for certain strains of bacteria that cause ear infections, Dr. Friedman says, so it's not foolproof, but it is a very good idea.
- Avoid large daycare settings if possible. Children in daycare tend to get more ear infections than those who aren't enrolled. If daycare's a must, the fewer kids, the better, Dr. Casselbrant says. After all, the more kids your little one is around, the greater the chance that someone will have a cold or another illness that she can pick up.
- Don't let your child drink from a bottle or sippy cup while she's lying flat. When your child is drinking, her head should be higher than her stomach so the liquid can't flow from the eustachian tube into the middle ear, Dr. Friedman says.
- Take precautions against allergies. "If you think allergies could be causing your child's ear infections, be proactive by removing as many allergenic items from your home as possible," Dr. Friedman says. For instance, bar pets from your child's sleeping area, keep the rooms where she spends the most time as free of dust as possible, and opt for bedding without feathers or down.
How Can I Ease My Child's Ear Infection Pain?
To lessen your child's discomfort from an ear infection, your pediatrician may recommend acetaminophen or ibuprofen. But avoid over-the-counter eardrops unless your doctor recommends them, as they can cause permanent damage if your child's eardrum is perforated. Also steer clear of flying on a plane when your child has an ear infection because the change in air pressure can significantly increase pain or even rupture the eardrum, Ellen M. Friedman, MD, says.
Doctor Examines a Child with an Earache
Copyright © 2008. Used with permission from the April 2008 issue of American Baby magazine.
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