What's normal: Two infections a year in children birth to 3.
What's not: Fever and ear pain that persist for more than two days.
Why your child may be vulnerable: Little kids are more prone to middle-ear infections -- also known as acute otitis media (AOM) -- than are older kids and adults because their eustachian tubes (which drain the ears) are shorter, thinner, and more horizontal. During a cold, these tubes swell, trapping fluid in the middle ear, which becomes a perfect breeding ground for bacteria and viruses.
Children who have extra-short or extra-slim tubes are at even greater risk of getting AOM, says Margaret Fisher, MD, chair of Monmouth Medical Center's pediatric department, in Long Branch, New Jersey. Kids with a certain type of bone structure may have problems as well.
"The flatter the middle of a child's face, the less the eustachian tube will be angled," says Dr. Fisher. Living with a smoker and inhaling secondhand smoke raises a child's risk of ear infection by 13 percent. And lying flat while drinking a bottle or inheriting low levels of maternal antibodies to pneumococcal bacteria also increase the odds.
There's yet another reason for the uptick in AOM. "One of the most worrisome trends of the past few decades has been the emergence of antibiotic resistance among the 'big three' bacteria that cause most cases of AOM," says Ali Andalibi, PhD, a researcher in the department of cell and molecular biology at the House Ear Institute, in Los Angeles. Researchers have found that between 25 and 95 percent of these germs are currently resistant to penicillin, and some are resistant to other antibiotics as well.
Advice for parents: If your pediatrician suggests watchful waiting -- a pain-and-fever reliever but no antibiotics for 48 to 72 hours -- consider this approach. "Most kids get better with or without antibiotics," Dr. Kimberlin says. "Some kids need them. But antibiotic overuse is leading to serious problems."
If your child has had three ear infections in a six-month period, or four in one year (with the most recent in the past month), talk to your doctor about whether she should get ear tubes, says Anthony Magit, MD, associate clinical professor of pediatrics and otolaryngology at the University of California, San Diego School of Medicine.