“Why does my son get so many ear infections?” “How can I help him stay well?” “Why does he need two office visits for each ear infection?” “What treatment works the best?” Parents of young children clamor for answers to the riddle of middle ear infections.

Many health care providers diagnose and treat middle ear infections according to a guide that was released by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

This “how-to” guide for clinicians explains that not all children need to be seen right away by a doctor for ear symptoms. In fact, “watchful waiting” (a few days of comfort care at home) can be a good option, for some children. The guide also gives the doctor-tested answers for many questions parents ask.

Who is at risk for middle ear infections? 
Children between 6 and 18 months of age are at greatest risk for middle ear infections.

The busy season for middle ear infections is November to April.

Symptoms of a middle ear infection
Symptoms of a middle ear infection might include new fussiness, trouble sleeping, a drop in appetite, crying during feedings, a fever of 100-104 degrees Fahrenheit, ear pain, tugging on ear, vomiting and diarrhea.

Because these symptoms mimic symptoms of other illnesses, your doctor cannot be sure about the diagnosis until he looks at the child’s ear drum. He will also ask you when the symptoms started, are there other symptoms and how did the child respond to the treatment for his previous ear infection. Two office visits are usually needed: one to diagnose the infection and one to look at the ear drum after 10 days or so. Careful record-keeping helps the doctor decide how to handle children with frequent ear infections.

What treatment works the best? 
The best treatment is the treatment that fits the child, the diagnosis and the situation. “Watchful waiting”, with comfort care, is one treatment; some children clear the bacteria or the virus on their own. Antibiotic therapy, with comfort care, is another treatment. It is nothelpful to give the child medicine left over from a prior infection, stopping the medicine early or storing the medicine at the wrong temperature. 

What is antibiotic resistance?
When exposed to the same antibiotic frequently, the bacteria that normally live in our bodies learn to outwit the antibiotic. Antibiotic resistance puts your child, and all children, at risk for more difficult infections. 

Actions you can take
If you think your child might have an ear infection, jot down the symptoms you have noticed. Measure your child’s temperature. If possible, figure out your child’s weight. Then call your doctor’s office. Your office will advise comfort care and, possibly, an office visit.

Ways to comfort your child depend on the child’s age and situation. Your doctor may advise acetaminophen or ibuprofen. Numbing ear drops are sometimes helpful.

Ways to prevent middle ear infections 
Some of the reasons for middle ear infections are beyond your control. Some are still being studied. There seems to be benefit from being breast-fed (for at least the first 6 months of life), no bottle-propping, head above stomach level during feedings, smoke-free surroundings and less pacifier use in the second 6 months of life. Children cared for at home or in a small-group setting have fewer middle ear infections than those cared for in a large-group setting. Group-care settings need to have adequate space and ventilation and a staff with excellent hand hygiene. 

This article was written by Diane DuBois RN, an Answer Line nurse at St. Louis Children’s Hospital.


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