It's invariably the day before you're leaving for vacation or 4:30 P.M. on a Friday when panic starts to set in: You suspect your child has an ear infection, and there's a good chance you're right. Besides the fact that Murphy's Law and motherhood often go hand in hand, studies show that more than 80 percent of kids will be diagnosed with at least one middle-ear infection (acute otitis media) before their third birthday.
Although the incidence of ear infections has decreased in the last decade, thanks in part to the pneumococcal vaccine, they still send about 16 million kids to the pediatrician each year. Kids under age 2 are particularly vulnerable because their immune system is still developing and their eustachian tubes -- the passageway in each ear that drains normal fluid from the middle ear to the back of the throat -- are more narrow and horizontal."When a child gets a cold, the tiny tubes can swell and prevent fluid from draining," says Amanda Dempsey, M.D., Ph.D., assistant professor of pediatrics and communicable diseases at the University of Michigan Health System, in Ann Arbor. "The fluid can get trapped behind the eardrum and create an ideal moist environment for viruses or bacteria in a child's throat and ears to multiply and cause an infection."
And once pesky germs settle in and the fluid backup puts painful pressure on the eardrum, your child can be pretty miserable. While the scenario is not always avoidable, knowing these five key facts about ear infections will prepare you to battle the illness -- and help keep your child healthy in the future.
When your toddler starts tugging on his ear, you may assume that's a telltale sign of an ear infection. He might do the same thing, though, if he's cutting teeth; nerves in the back teeth branch out to the middle ear, so it can feel like his pain is coming from his ear. If he has a fever and seems to be most uncomfortable lying down, it's more likely he has an ear infection, says Dr. Dempsey. Red, swollen gums are a sign of teething. In general, the symptoms of ear infections could describe a variety of illnesses -- or a child who's just having a bad day: He might push his food away, have trouble sleeping, or cry more than usual. But if your instincts tell you that there's something wrong, especially if your child has a fever, it makes sense to have your pediatrician take a look.
About 60 percent of ear infections are believed to be bacterial; the other 40 percent are sparked by viruses and can't be cured by antibiotics. (Unfortunately, there's no way for your doc to tell from looking in your child's ear whether an infection is viral or bacterial.) In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) jointly issued guidelines for treating acute ear infections in kids. The main message to doctors: Hand out fewer unnecessary prescriptions for antibiotics, and give the body's immune system a chance -- about two to three days -- to fight off the infection on its own. Studies have shown that approximately 80 percent of middle-ear infections in children go away without antibiotics in a week or so, and about 60 percent of kids have fewer symptoms after 24 hours, whether they take antibiotics or not. "Watchful waiting" is appropriate for a healthy child between 6 months and 2 years of age when her symptoms aren't severe (her fever is less than 102.2?F and she doesn't seem to be in a lot of pain) and her doctor isn't sure after looking in her ear that there's an infection. It's also appropriate for kids over 2 without severe symptoms. During the waiting period, your pediatrician will probably suggest a pain reliever such as acetaminophen, ibuprofen, or anesthetic ear drops. If your child's symptoms don't improve, contact the doctor.
Why not just take antibiotics ASAP? In the past, doctors overprescribed these drugs, experts say, giving them to kids whose symptoms were mild, who didn't have a clear-cut diagnosis, or whose infection was likely viral. With children everywhere slurping down the "pink stuff," a scary problem began to arise: Some bacteria became resistant to the antibiotics. These strains can no longer be defeated by the traditional go-to remedies, which forces doctors to search for other alternatives. In Rochester, New York, a small group of kids had ear infections that didn't respond to any drug that's used to fight them in children, and doctors had to treat the bacteria (called the 19A strain) with a drug that was only approved for adults. The AAP/AAFP guidelines urge doctors to prescribe antibiotics more prudently to prevent resistant bacteria from spreading widely and putting all children at risk.
Pediatricians typically refer a child to an otolaryngologist -- an ear, nose, and throat specialist (ENT) -- when he's had three infections in six months or four within a year, but this isn't set in stone. "Kids who have frequent infections spend a lot of time feeling ill, and if fluid in their ears doesn't clear between infections it can interfere with hearing and language development," says Nancy Young, M.D., head of otology at Children's Memorial Hospital, in Chicago.
When an ENT examines your child, she'll discuss whether it's a good option to insert a tympanostomy tube (most commonly in both ears) to reduce the risk of infections and improve hearing. Although there's no maximum or minimum age for tubes, children usually get them between 1 and 3 years old. With about 500,000 kids a year undergoing the procedure, it's the most common surgery with anesthesia performed on children. The surgeon makes a tiny cut in the eardrum, suctions out the fluid, and then inserts a cylinder the length of an infant's pinkie nail into the hole to keep it open. Once the tubes are in, you won't be able to see them, but they allow air to flow into the middle ear and fluid to drain out. "Ear tubes don't improve the eustachian-tube function," says Max M. April, M.D., chairman of the pediatric committee of the American Academy of Otolaryngology-Head and Neck Surgery. "The hope is that once the tubes come out on their own after about a year, the child's eustachian tubes will have grown enough that his ear problems resolve." One study at Kaiser Permanente Medical Center, in Oakland, California, found that 90 percent of parents reported that their child's ear problems and overall quality of life improved in the year after tube surgery.
Unfortunately, the nail-biting experience of putting your young child through surgery doesn't come with guarantees. Many children will still get an occasional ear infection, especially when they have a cold. However, your child should definitely get fewer infections, and they'll usually cause less fever and pain. "In fact, painless drainage from the ear is the most common sign of an infection in a child who has tubes," says Dr. Young. However, you may not have to fight with your kid to swallow spoonfuls of antibiotics: Children with tubes in place are able to use antibiotic ear drops instead because the opening in their eardrum allows the medicine to get right into the middle ear.
Some factors that make your child more prone to getting ear infections are out of your control. For example, being male (although doctors don't know why), living with more than one sibling (lots of germs), and having a family history of ear infections all raise the probability. Fortunately, there are specific ways you can help.
Protect him from secondhand smoke. A number of studies, including one that was recently published in the Medical Journal of Australia, strongly link childhood ear infections with exposure to cigarette smoke.
If you're making a decision about child care, choose a smaller setting. "The more children there are in a room, the more germs and colds there will be for your child to catch," says Dr. April. "Although ear infections themselves aren't contagious, the upper respiratory illnesses that can lead to ear infections are. Also, when your child is with a larger number of other kids, who are probably going to be taking a lot of antibiotics, she's more likely to be exposed to drug-resistant bacteria."
Breastfeed for at least six months. Long recognized as an immunity booster, breast milk can even protect children who are particularly susceptible to ear infections (such as those who've had three or more ear infections within six months), according to a study at the University of Texas Medical Branch at Galveston. "This protection probably lasts well after a child has stopped breastfeeding," says Dr. Dempsey.
Limit pacifiers. Binkies may introduce bacteria into the mouth, which can then travel to the ear. Research in Finland has found that if you give your child a pacifier only at naptime and bedtime, you can lower his chance of getting ear infections by 33 percent.
Bottle-feed your baby in an upright position. When a baby drinks from a bottle while she's flat on her back, the formula (or pumped milk) tends to pool in her mouth, increasing the chance for liquid to flow into the middle ear and cause infection. Breastfeeding is thought to be less risky because the nipple is farther back in a baby's mouth, which prevents milk from pooling, and the flow of milk is more controlled and slower than it is from a bottle.
Kids began receiving the pneumococcal conjugate vaccine, Prevnar, in 2000 to help fight the most common strains of pneumococcus, the bacteria responsible for up to half of bacterial ear infections as well as more serious infections such as meningitis. Since the vaccine's availability, studies have shown that there's been up to a 20 percent decrease in doctor visits for ear infections," says Pekka Nuorti, M.D., a medical epidemiologist at the Centers for Disease Control and Prevention. A new formulation of Prevnar that includes the drug-resistant 19A strain should be available this year.
Originally published in the January 2010 issue of Parents magazine.