Ear Infections: What’s the Best Treatment for Your Child?

An interview with Dr. Monica Singer, medical director, Sutter Pacific Medical Foundation’s Bayview Child’s Health Center

A Childhood Ailment

As a parent, you probably remember calling your doctor when your fussy baby had a fever and the nurse suddenly mentioning the possibility of an ear infection. “Acute otitis media is actually the top reason why children show up at the pediatrician’s office,” says Monica Singer, M.D. In fact, most kids have had a middle ear infection by the time they’re two.

Ear infections usually begin as an upper respiratory infection. Children have some nasal congestion. The mucus then backs up into the ear tubes, stays there, and bacteria grow.

Fever, as well as ear pain, effusion, inflammation, redness, and bulging, are all symptoms of an ear infection. When doctors look into infected ears, they might see a red, inflamed, or immobile eardrum. While older children can communicate their pain, infants and preverbal toddlers often pull on their ears to signal discomfort. They might also be extremely fussy.

It’s all in the Anatomy

“Infections are especially common in children because their ear tubes are narrow, so mucus has more opportunity to get stuck,” explains Singer. “Children’s bodies are also not as efficient at reabsorbing the fluid.”

In fact, ear infections most often happen in the smallest kids—babies from six to 18 months old. They then spike again when children hit the age of four or five, since starting school can expose kids to new pathogens.

Children who are not breastfed have a higher chance of getting an ear infection, as do kids in day care, since they come in contact with more viruses and get sick more frequently. Recent studies have also shown a link between pacifier use and ear infections.

Preventive measures can counteract some of the risk factors. Saline rinses, humidifiers, and nasal sucking help keep younger children’s tubes clear when they’re sick. By teaching older children to use hand sanitizers and good hand hygiene, parents can limit their exposure to germs.

Pneumococcal is the leading cause of ear infection, so getting the vaccine against the bacteria can also dramatically decrease the risks.

Treat or Wait?

It’s important for parents to bring their kids to the doctor whenever they suspect an ear infection. Untreated, it can lead to eardrum ruptures, hearing loss, balance problems, and language delay.

Since their immune systems aren’t fully developed, children under six months get treated with antibiotics right away. Kids six months to two years old are treated if they have severe pain or a fever over 102 degrees. Older children also get antibiotics if they are in a lot of pain.

If a child has low or moderate pain, otherwise looks well, and has no cold or fever, pediatricians are more careful about using antibiotics and often recommend a 48- to 72-hour watchful waiting period to see if the pain worsens or a fever surfaces. Often parents can manage the pain using ibuprofen, acetaminophen, or a topical anesthetic.

Even distraction can be good medicine. “I’m not an advocate of media exposure,” laughs Singer, “but when my daughter is miserable, I let her watch Elmo. Sometimes your child needs it, and you need it, too.”

“Some worried parents want to treat at any sign of a cold,” says Singer. “But if you keep giving him antibiotics when it’s unwarranted, you’re putting your own child at risk.”

That’s because over-prescription can cause bacterial resistance not only in the society at large but also within your child. “If we prescribe an antibiotic inappropriately, a child may not respond to it later when they need it because they were given the medication when it was unnecessary”, says Singer. Other possible side effects from antibiotics include nausea, diarrhea, and allergies.

“If you do the watchful waiting, treat when it’s warranted, and follow up with your pediatrician, the infection should resolve,” assures Singer.