How To Prevent Ear Infections In Babies And Children
The following are steps you can take to lower your child’s risk of recurring ear infections.
- Breastfeed your baby for at least six months. Breast milk provides antibodies against ear infections. A major study published in the journal Pediatrics showed that children who are breastfed for the first 6 months of life are less likely to develop ear infections.
- Hold your baby upright when feeding him. Hold him so his head is higher than the rest of his body. Babies fed while they’re lying down are more likely to develop AOM.
- Wean your baby off the pacifier if your baby is prone to ear infections. Babies who are 6 months of age or older are slightly more likely to develop ear infections if they use pacifiers. But since using pacifiers in the first year may help protect against SIDS, ask your baby’s doctor about the best time to wean.
- Wash your hands often. Although ear infections aren’t contagious, the respiratory infections that lead to them are. Keep your child’s hands clean, and stay away from people with respiratory infections whenever possible.
What Does The Eardrum Look Like When It Is Infected
When a doctor examines the eardrum through the otoscope instrument, the eardrum normally appears as a thin gray, translucent membrane . When infected, it will look opacified , very reddened, and yellowish. Sometimes, it shows a small layer of pus-like material. During an infection, the eardrum usually becomes rigid because of the accumulation of fluid, and it will not wiggle when the doctor puffs a small amount of air against the eardrum with an otoscope. Use of tympanometry or acoustic reflectometry may help to determine if there is fluid behind the eardrum. Neither instrument distinguishes between infected or uninfected fluid.
From the appearance of the eardrum, the doctor cannot determine the type of bacteria, or whether bacteria or viruses are causing the infection. The eardrum in children with otitis media with effusion appears as an orangish or dull, straw-colored fluid, and it also does not move when air is applied to it.
Who Gets Ear Infections
Ear infections are very common in babies and young children who are more likely to develop them than older children and adults. This is because their eustachian tubes dont function as well as in older children and adults the tubes are smaller, shorter and flatter .
As children grow older, their eustachian tubes work better and they get fewer colds. As a result, they outgrow the tendency to have ear infections at around 7 years of age. But, some children may have problems beyond this age.
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Pediatric Otitis Media: Managing Ear Infections In Children
W. Steven Pray, PhD, DPhBernhardt Professor of Nonprescription Drugs and DevicesCollege of PharmacyWeatherford, Oklahoma
Most pharmacists have been confronted by a parent whose child has an apparent ear infection, usually otitis media. The parent understandably wants to relieve the childs pain, but nonprescription products are of no use in ear pain or otitis media, which greatly limits the scope of advice the pharmacist can offer the parent. However, the pharmacist should understand various facts about the condition in order to answer the parents questions.
Diagnosis Of Ear Infections
The first thing to know about ear infections is that its not always clear a child actually has one, even to a doctor. It seems it should be a straightforward thing to diagnose: You look inside a childs ear and you can see if its infected or not, right? But it can be tough to get a clear view of the inside of a younger childs ear. And its easy to mistake fluid in the ear for an infection, to label redness caused by fever or crying as a sign of infection, or to not be able to even see the eardrum because of ear wax.
One clue that a kid truly has an ear infection is that shes also had some of the classic symptoms: rapid onset of an earache , pulling on the ear , irritability, the drainage of fluid from the ear , and fever.
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Related Resources For Ear Infections
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
Specific Antibiotics Used For Acute Otitis Media
Amoxicillin, a penicillin type of antibiotic, is generally recommended for first-line treatment of AOM. The combination drug amoxicillin-clavulanate is an alternative option. Children who are allergic to penicillin drugs will be prescribed a different antibiotic.
Children who do not respond within 48 to 72 hours to initial treatment with amoxicillin may be given a course of amoxicillin-clavulanate or ceftriaxone. Alternative treatments are ceftriaxone or clindamycin, which may also be accompanied by a different cephalosporin antibiotic.
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How Is An Ear Infection Diagnosed
Once youre at the doctors office, a medical professional will look inside your ear with an otoscope to determine whether you have an infection.
Typical signs include fluid buildup in the ear canal and middle ear, along with a red and inflamed eardrum.
Depending on the severity of your symptoms, your doctor may recommend waiting a few days to see if your ear infection improves.
Some infections resolve on their own. But if the infection is severe, or if symptoms dont improve after this time, then antibiotics may be warranted.
Chronic fluid buildup without an infection warrants additional testing from an ear, nose, and throat specialist.
Its especially important to diagnose young children so that they dont encounter speech and language delays from loss of hearing.
If your doctor recommends antibiotics to treat a severe ear infection, they will likely recommend an oral treatment, such as amoxicillin .
When Are Antibiotics Usually Prescribed
Antibiotics are normally only prescribed for more serious infections with germs .
Most common infections are caused by viruses, when an antibiotic will not be of use. Even if you have a mild bacterial infection, the immune system can clear most bacterial infections. For example, antibiotics usually do little to speed up recovery from most ear, nose and throat infections that are caused by bacteria.
So, do not be surprised if a doctor does not recommend an antibiotic for conditions caused by viruses or non-bacterial infections, or even for a mild bacterial infection.
However, you do need antibiotics if you have certain serious infections caused by bacteria, such as meningitis or pneumonia. In these situations, antibiotics are often life-saving. When you are ill, doctors are skilled at checking you over to rule out serious illness and to advise if an antibiotic is needed. Urine infections also commonly need antibiotics to prevent spread to the kidneys.
Antibiotics can also be prescribed to treat acneâ a less serious condition. For acne, antibiotics can be taken by mouth or applied directly to the skin.
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How Is An Acute Middle Ear Infection Treated
Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain.
If your doctor isnt able to make a definite diagnosis of OM and your child doesnt have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that cant be definitively diagnosed, especially those between the ages of 6 months to 2 years. If theres no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isnt caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics.
If your doctor prescribes an antibiotic, its important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasnt completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. Its also important to return for your childs follow-up visit, so that the doctor can check if the infection is gone.
When Should I Return To My Healthcare Provider For A Follow
Your healthcare provider will let you know when you need to return for a follow-up visit. At that visit, you or your childs eardrum will be examined to be certain that the infection is going away. Your healthcare provider may also want to test you or your childs hearing.
Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.
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How Middle Ear Infections Are Treated
Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.
Antibiotics arenât routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.
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Ear Infection Treatment Options
Due to the variety of ear infections, patients may be given a few different treatment options. Middle ear infections do not always require prescription medication due to the bodys natural ability to fight off the infection. Your doctor or pediatrician may recommend a method of treatment called watchful waiting. This involves two to three days of rest, drinking lots of fluids, and the use of over-the-counter pain relievers as needed. If after two to three days the patient is not improving, the doctor may write a prescription for antibiotics. Alternatively, the physician may write a prescription for an antibiotic but recommend waiting two to three days before filling in case the ear infection clears up in the meantime.
In some cases, using a tympanostomy tube may be necessary to prevent fluid from building up in the ear and to assist with relieving air pressure near the eustachian tube.
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How Can I Prevent My Child From Getting An Ear Infection
- Wash your childs hands and your own often to keep germs away.
- If possible, breastfeed your baby.
- Avoid bottle-feeding your baby when they are lying down. Never put your baby to bed with a bottle.
- Transition your baby from a bottle to a cup by 1 year of age.
- Dont smoke, and keep your child away from any second-hand smoke. Exposure to smoke can increase the risk of ear infections.
- Ensure your child gets the pneumococcal vaccine .
- Ensure your child gets a flu shot every year.
- If your child has had many ear infections, try reducing the use of pacifiers . Using a pacifier may increase the risk of repeated ear infections.
When To Talk To A Doctor
If you notice persistent ear infection symptoms that dont resolve on their own, call a healthcare professional.
This is particularly important for adults, as a middle ear infection can be a sign of a more serious problem in this age group compared to children.
And if you experience chronic ear infections, talk to your primary care provider, an otolaryngologist , or an otologist to discuss treatment options.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
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Cause Of Ear Infections
- A bacterial infection of the middle ear
- Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
- Blockage results in middle ear fluid .
- If the fluid becomes infected , the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
- Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
- The onset of ear infections is often on day 3 of a cold.
- How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
Why Do Children Get Many More Ear Infections Than Adults Will My Child Always Get Ear Infections
Children are more likely than adults to get ear infections for these reasons:
- The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
- The immune system of children, which in the bodys infection-fighting system, is still developing.
- The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.
Most children stop getting ear infections by age 8.
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What Is The Treatment For Ear Infections
Medications used to treat ear infections include:
- Pseudoephedrine to ease ear pressure
- Antibiotic ear drops for infections of the ear canal
- Steroid ear drops for infections of the ear canal
- Oral antibiotics for infections of the middle ear , and severe infections of the outer ear
For mild cases of ear infection, doctors often recommend watching and waiting before starting use of antibiotics, as many cases will go away on their own. Consult your childs pediatrician before giving any over-the-counter medications to your child.
Home remedies to relieve symptoms include:
- Warm compresses applied to the area to help soothe pain
- Over-the-counter pain eardrops
Etiology Of Pediatric Otitis Media
Otitis media occurs as the culmination of a sequence of events. The inciting factor in most cases is another condition that also causes congestion and inflammation of the nasal mucosa, nasopharynx, and eustachian tube.1 Thus, otitis media may follow such causative conditions as allergic rhinitis or an upper respiratory tract infection.
When the patient has an infection, bacteria are able to move through the lining or passageway of the eustachian tube to reach the middle ear.4 Infection causes inflammation of the middle ear lining, obstructing the eustachian tube at its narrowest segment .1,4 White blood cells and bacterial residue collect to form thick, yellowish pus in the middle ear. Middle ear secretions and air cannot exit as they normally do, and they collect .
Eustachian tubes in children are smaller and straighter than those in adults.3 This anatomic distinction lessens the ability of water to drain from the ear, predisposing children to otitis media.
Adenoids, located in the throat in close proximity to the eustachian tubes, are also prone to infection and inflammation, which can block eustachian tube openings and cause the same problems as when the common cold is the cause.3 Adenoids in children are larger than those in adults, predisposing them to adenoid-induced eustachian blockage.
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Who Shouldn’t Use Ear Drops
Ear drops can be helpful when treating an ear infection, but there are times when you shouldnt use them. For example, if you or your child has a perforated eardrum, you should avoid the use of certain ototoxic ear drops because fluid from the drops can get deep into the ear and cause more problems.
Where Can I Find Additional Information About Ear Infections
The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language.
Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on ear infections:
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What Medicines Treat Otitis Media
Some children will get better without specific antibiotic treatment, as many ear infections are viral in nature and do not need an antibiotic. However, doctors typically prescribe antibiotics in infants under 6 months of age, and for recurrent ear infections or severe symptoms. However, using antibiotics too often can cause bacteria to become resistant to the medicine.
The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for children:
- 6 to 23 months of age with a temperature less than102.2 F and middle ear pain in one ear for less than 48 hours
- 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F
Parents will follow-up with the doctor in 2 to 3 days with the wait-and-see approach. Some doctors will still prescribe antibiotics in children under 2 years with AOM. In more serious cases in older children, when there is recent high fever, both ears are affected, or ear drainage, an antibiotic treatment may be appropriate. Talk with your doctor about the potential benefits and risks of using antibiotics.
Antibiotic choice should be based on effectiveness, patient-specific needs like allergies, taste or dosage form preference, dosing convenience and cost. Its important to remember that although most antibiotics used for ear infections are very safe, there may still be side effects such as diarrhea or rash from antibiotic use.