“Not another ear infection!” Most children experience a few ear infections during early childhood. For some kids they seems to pop up almost as frequently as the next mortgage or rent payment. Ear infections are most common in children from 3 months to 4 years old. Although ear infections can cause temporary pain and discomfort, you can rest assured that most children will outgrow them.
Ear Infection Causes
Ear infections usually result from an upper respiratory illness, such as a simple cold. The cold causes swelling and mucus to accumulate in the sinuses, throat and the pair of narrow tubes (eustachian tubes) that connect the middle ear to the back of the throat, behind the nasal passages. When these tubes get blocked, fluid gets trapped in the middle ear and your child ends up with an ear infection.
Young children are particularly susceptible to ear infections as their eustachian tubes are shorter and aligned horizontally – not ideal for drainage. This means that the tubes are much more likely to get blocked, resulting in an ear infection.
Fortunately, as children grow, their eustachian tubes will lengthen and their alignment will change so that they are more efficient at draining fluid. This makes an ear infection less likely.
Signs and Symptoms
For children age 2 or younger, identifying an ear infection can be tricky. Babies and toddlers don't yet have the words to explain what's wrong and what hurts. A young child with an ear infection will likely have had a cold and be a lot fussier than usual.
Your child may cry a lot, especially when lying flat. In addition, your child’s nighttime sleep may be disrupted.
Track your child's temperature daily when they're sick. Children often have fevers the first one to three days of a cold, but if your child has a fever that lasts longer than a few days or that returns after it has initially broken, an ear infection is a definite possibility.
Sometimes parents believe ear pulling is a sign of an ear infection, but this is not true. Your child might be pulling on an ear for many other reasons.
Treatment Benefits and Risks
Doctors used to quickly treat all possible ear infections with antibiotics, but now that research has shown the overuse of antibiotics may do more harm than good, doctors employ a more careful approach.
The American Academy of Pediatrics recommends the following evidence-based treatments:
- Under 1 year of age: Antibiotics should be started immediately upon diagnosis.
- From 1 to 2 years of age: For most children this age, antibiotics are recommended. However, your doctor may encourage waiting 48 hours to see if the ear infection resolves by itself. Your doctor will usually provide a prescription for antibiotics you can start using if symptoms don’t seem to be improving or are getting worse.
- Over 2 years of age: Observant management for the next 48 hours is usually recommended as most ear infections get better by themselves. This type of treatment plan is particularly recommended for children who don’t have a fever and have no history of recurring ear infections.
To ease the pain of an ear infection, you can give them over-the-counter pain medication such as ibuprofen (Motrin). Motrin is particularly effective for the discomforts of an ear infection as it provides longer pain relief (approximately six to eight hours) and also has anti-inflammatory properties (reducing the swelling in the sinuses and middle ear areas). If your child does not seem to be getting any better after 48 hours, is experiencing worsening pain and/or develops a new fever, contact the doctor right away. Antibiotics are then usually recommended.
Treatment for Recurring Ear Infections
Some children have recurring ear infections, as many as three or four ear infections during a single season. At this point, your child may need to see a specialist of the ear, nose or throat (ENT), particularly if they're under 2 years old. An ENT can offer expert advice on whether inserting tubes (typanostomy tubes) in their ears may help avoid additional ear infections.
The tubes let fluid drain out of the middle ear into the ear canal more easily. With a drier healthier middle ear, the bacteria and viruses that can cause ear infections have less of a chance to grow. In addition, the tubes can prevent future fluid build-up and a feeling of pressure and pain in the ears. Finally, they may help with possible hearing issues.
The ENT inserts the tubes through a small surgical opening created in each eardrum. Although the surgery is usually done under general anesthesia, it is a simple outpatient procedure that only takes between 10 and 20 minutes.
Most children have little pain and recover quickly after the surgery.
The tubes typically stay in place and function well for six month to a year. After that time, they often they fall out by themselves.
You can replace ear tubes if your child continues to get ear infections. However, by the time the tubes fall out your child might well have outgrown getting ear infections.
Preventing Ear Infections
Ear infections are very much part and parcel of being a little kid, and if your child gets them often tubes can help. As ear infections are mostly due to a child’s anatomy (the eustachian tubes still need to lengthen and align correctly), there are neither home remedies nor medications that will stop him from getting ear infections.
That said, there are two things that may help. The first is to avoid exposure to secondhand smoke. Studies have linked secondhand smoke to a weakening of natural immunity. The second is breastfeeding as infants may receive additional antibodies through breast milk that can help them fight off infections.