Ear Infection QA
Chances are there's an ear infection in your child's future. Seventy-five percent of kids will have at least one by their third birthday. And, according to health experts, almost half of those children will have repeated infections, suffering from three or more by the time they turn four. Since ear infections are the most common ailment in babies and young children, it's important to know their causes, symptoms, and cures. Here are the answers to all of your questions.
Q. My two-year-old had four ear infections last year. Why is he so prone to them?
It helps to understand a bit about your child's anatomy: Each ear has three main partsthe outer, middle, and inner ear. When the eustachian tubea small tube that connects the middle ear to the back of the throat and nosebecomes swollen and irritated (usually because of upper-respiratory infections or allergies), there's no ventilation. As a result, the fluid that normally drains out of the ear becomes trapped. Germs flourish in that stagnant fluid, setting the stage for otitis media, which is the medical term for ear infection. Babies and toddlers are particularly vulnerable because their eustachian tubes aren't fully developed yet. They're shorter and less angled, making drainage more difficult.
Q. My toddler seems to get ear infections over and over again. So do a lot of other kids we know. I don't remember having so many as a child. Are children today more susceptible?
Yes, according to a recent study. What's to blame? No one is completely certain, but one theory points to the increase in the number of babies and toddlers in day care. "A generation ago, most children stayed at home until kindergarten," says Ari Brown, M.D., author of Baby 411: Clear Answers & Smart Advice for Your Baby's First Year. "But today, more young children are in group care, where they're exposed to other kidsand their germs. That puts them at risk for the respiratory ailments that lead to ear infections."
Resistance to antibiotics may also play a role. "Over the past 15 years, we've been seeing more bacteria that don't respond to common antibiotics," Dr. Brown explains. "So it may take multiple rounds of antibiotics to fully treat infected ears. As a result, parents may think their kids are getting repeated infections when, in fact, it's just one stubborn bug."
Q. My three-year-old still gets ear infections, but my doctor says she'll probably outgrow them. True?
Yes, for several reasons. As kids' immune systems mature, they're better able to fight off germs. What's more, their eustachian tubes also become longer and more angled, so fluid drains more easily. Finally, the adenoidswhich can become inflamed and infected, sometimes blocking the eustachian tubesbegin to shrink. "Kids are most susceptible to ear infections between six and 18 months, when their eustachian tubes are still developing," says Steven L. Singer, M.D., a pediatric otolaryngologist at Joe DiMaggio Children's Hospital, in Hollywood, Florida. Infections typically disappear almost entirely by the time a child is in first grade.
Q. My son's ear is infected, but my pediatrician wants to hold off on prescribing an antibiotic. Isn't that the only way to make sure the infection clears up?
Not necessarily: Studies show that an estimated 80 percent of ear infections will get better on their own without treatment, and 60 percent of kids have less pain within 24 hours, even without antibiotic treatment. So your doctor is right to be cautious.
In fact, the American Academy of Pediatrics and the American Academy of Family Physicians, concerned about the rise in antibiotic-resistant bacteria, recently issued new, more conservative guidelines for prescribing antibiotics. The doctors' groups now recommend an immediate prescription only for babies under six months who have a diagnosed or suspected infection (because they're more susceptible to complications) and for children who have underlying health issues such as immune disorders or a cleft palate. Antibiotics are also recommended for kids with severe symptoms, such as high fever or extreme pain.
If a child doesn't fall into any of those categories, the pediatrician may choose to wait two to three days and see whether the infection clears up on its own.
Q. If my child doesn't get an antibiotic, what can I do to keep her comfortable?
If she's over 6 months of age, give her acetaminophen or ibuprofen to relieve pain. (If she's younger, talk to your pediatrician.) Prescription ear-numbing drops may also help. Applying pressure to the ear with a warm washcloth or with a heating pad on a low setting can soothe some children. (This isn't advised for infants.) And being in an upright position can make the veins in the ear less distended, relieving some pressure and discomfort.
Ear Infection Treatments
Q. If my child does need an antibiotic, which one is best for treating ear infections?
Amoxicillin or Augmentin are the most commonly prescribed because they're safe, inexpensive, and in most cases, quite effective. The medication is usually taken twice a day for ten days. And it's important that your child finish the entire course of the treatment, even if his infection clears up.
If these medications don't do the trick, your doctor might prescribe antibiotics such as zithromycin, cefuroxime, or cefprozil. "These are broader spectrum antibiotics," Dr. Brown says. "That means they attack a wider variety of bacteria and are better at getting to some of the more resistant germs."
When all else fails, your child may be given ceftriaxone, an injectable medication that's considered the big gun of antibiotics. But most doctors prefer to save thisas well as the broad spectrum medicationsfor more serious illnesses. "Don't ever ask for a stronger antibiotic than you need," Dr. Brown says. "If you use the stronger medications as the first line of defense, your child could develop a resistance, and those drugs won't be as effective if and when she really needs them."
Q. My son has had three ear infections since September. Is there anything we can do to prevent him from getting another?
A child who's had at least three ear infections in six months or four in a year may be a candidate for tympanostomy tubes. These are small plastic devices that are surgically inserted into an incision in the eardrum, helping to ventilate the middle-ear cavity and keep fluid from accumulating. In older children, removing the adenoids may also be recommended. Before deciding on these treatments, however, you should consult with a pediatric ear, nose, and throat specialist.