Ever wonder what goes into the decision to prescribe antibiotics for an ear infection or to wait it out? Our experts weigh in on the right way to treat an ear infection.

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baby touching ear

When you have a child with an earache, you want to make it go away. Now. Completely.

Ear infections are the second most common illness of childhood behind colds, which means that nearly all of us have shown up at the doctor's office with a cranky child who is holding his ear(s). It's natural to expect a prescription for an antibiotic. After all, your child has an infection, right?

But it doesn't always work that way. Doctors today are less likely to pull out that prescription pad, because the germs that cause ear infections (and other infections) are becoming resistant to antibiotics. Here's the scoop on understanding an antibiotic prescription when it comes to ear infections, plus other ear infection remedies out there to help relieve you're child's pain.

Antibiotics for Ear Infection

The latest guidelines from the American Academy of Pediatrics say that if a child is older than 2 and isn’t running a fever of 102°F or higher or in extreme pain, you should wait at least 48 hours before starting antibiotics. That’s because most infections will resolve on their own, and antibiotics have side effects: They kill off the “good” bacteria in the body along with the bad and pave the way for Clostridium difficile, an intestinal infection that can cause severe diarrhea.

Frequent rounds of antibiotics also make your child (and the population at large) more vulnerable to antibiotic-resistant infections such as MRSA. Plus, any infections caused by a virus won’t be helped by antibiotics, since they don’t touch viruses, says James Coticchia, M.D., a pediatric ENT with The Studer Family Children’s Hospital at Sacred Heart, in Pensacola, Florida.

All that said, most pediatric practices are flexible when it comes to the guidelines. Your child will typically need a prescription if the pediatrician spots major redness, pus, or bulging (the middle ear is pushing out on the eardrum).

“Otherwise, many doctors will offer parents a paper script to hold on to or tell them that they can call back in a couple of days for a prescription if the symptoms aren’t improving,” says Ari Brown, M.D., a Parents advisor and author of Baby 411.

“But if a kid is really miserable, I will treat with antibiotics right away.”

Over-the-Counter Medicine for Ear Infection Pain

To soothe baby's pain, try an over-the-counter pain reliever, such as ibuprofen or acetaminophen. “Both work fine, but I prefer ibuprofen for kids over 6 months of age because it lasts for 6 hours—acetaminophen only lasts 4—and buys everyone a little more sleep,” Dr. Brown says.

As for those pain-relieving eardrops that docs used to prescribe or you could find in the pharmacy? The FDA removed them from the market in 2015 after concluding that they were ineffective. You might still be able to locate natural remedies such as garlic drops in stores, but Dr. Brown says they’re unlikely to help.

“Your child’s pain is in the middle space of her ear, so placing drops in the external ear space won’t reach the problem. The drops can also make it harder for her doctor to look in and see clearly,” she explains. “And if the eardrum bursts, the oil could end up in the middle ear, which isn’t safe.”

Looking for a home remedy for ear infection? For natural relief, try pressing a warm (not hot) washcloth on the ear, which can help mask the pain and distract your child.

Ear Tubes for Chronic Ear Infections

Ear tubes are only about the size of a grain of rice and are inserted into the middle ear through a small hole in the eardrum. They normalize air pressure in the middle ear and help any trapped fluid drain out. Most experts agree:

If your child has had at least three ear infections in the past six months or four infections in the past year (with one episode within the past six months), then it’s time to talk about tubes. The recommendations are not specific about age, but most kids who get them are between 1 and 3 years old. Not all children who get tubes have hearing or speech problems, but it’s definitely a motivator for lots of parents—as is the desire to get off the infection-antibiotic-infection merry-go-round.

“After having tubes put in, half of kids will never get an ear infection again, and the other half will get one only every once in a while,” Dr. Coticchia says.

Sometimes general anesthesia is required, but nowadays more ENTs are doing this as an outpatient procedure with a mask anesthetic that’s similar to what kids might get at the dentist’s office. Tubes usually fall out on their own within 18 months, and the biggest downside is a possible (but rare) risk of developing holes in the eardrum that don’t close up after the tubes come out.

Parents Magazine