What's the best treatment for my child's ear infection?
That depends on the severity of the infection and the age of your child. Your child's doctor may prescribe an antibiotic if your child has a serious infection, but most children with an ear infection, or acute otitis media (AOM), get better without medication. Often, it's best to wait to see if more severe symptoms develop before giving a child any medication (this is called "watchful waiting").
Discuss which course of treatment to take with your child's doctor – prescription drugs or watchful waiting. Here's what your child's doctor is likely to say:
- If your child is between 6 and 24 months old and has mild symptoms in only one ear, or if he's at least 2 and has mild symptoms affecting one or both ears, keep an eye on his condition first.
- If your child doesn't improve in 48 to 72 hours without treatment, then consider starting an antibiotic.
When are antibiotics necessary?
The American Academy of Pediatrics (AAP) recommends treating AOM with antibiotics for:
- Babies 6 months or younger. Infants don't yet have a strong immune system and are especially vulnerable to complications from AOM.
- Children with severe symptoms, such as a high fever, sweating, fatigue, or a rapid heartbeat.
- Children younger than 2 who have mild symptoms affecting both ears.
Why are doctors concerned about antibiotics?
Doctors are generally cautious about prescribing antibiotics because more and more bacteria are becoming resistant to them. And besides contributing to antibiotic resistance, giving a child antibiotic medication kills the good bacteria in his body, which can sometimes lead to conditions like inflammatory bowel disease.
Also, an ear infection can be caused by either bacteria or a virus. Since antibiotics don't work against viral infections, doctors are more judicious about prescribing them.
Drug companies used to stay one step ahead by continually introducing new medications, but bacteria have been mutating rapidly in response, making the drugs less effective. (Doctors say parents can help combat this problem by not requesting antibiotics for every ear infection.)
If your child does need an antibiotic, give him the entire course, even after he seems to feel better. Then have his ear rechecked a few weeks later so the doctor can make sure the medication worked.
Call the doctor if your child doesn't improve after 48 to 72 hours – that is, if he still shows symptoms, has a fever, or is getting worse. She may want to start him on antibiotics or switch medications.
How can I make my child's ear infection less painful?
Eardrops or a warm compress held to your child's ear may also help. Ask your child's doctor or a pharmacist which drops to use. And encourage your child to drink more fluids because swallowing helps to drain the middle ear and relieve painful pressure.
Don't give your child over-the-counter cold medications such as decongestants or antihistamines. These not only won't help him get better, but they can also have dangerous side effects in children.
And never give your child aspirin because it makes him more susceptible to Reyes syndrome, a rare but potentially fatal disease.
What can I do to prevent my child from getting another ear infection?
There are a few steps you can take to make it less likely your child will get recurring ear infections. (The first few are specifically intended for babies.)
- Breastfeed for at least the first six months. Breast milk provides the antibodies against ear infections.
- When feeding your baby, 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.
- Babies who use pacifiers after 6 months of age are also slightly more likely to develop ear infections, so consider doing without if your baby is prone to AOM.
- Keep your child away from tobacco smoke because exposure to smoke raises his risk of infection. Make your home a smoke-free environment, and keep your child out of smoky places.
- Wash your hands often. Although ear infections aren't contagious, the respiratory infections that lead to them are. So keep your child's hands clean, and stay away from people with respiratory infections whenever possible.
- Make sure your child's vaccinations are up to date. The pneumococcal vaccine has been shown to reduce the number of ear infections a child gets. Once he's 6 months old, an annual flu shot can help prevent AOM that often develops after a bout with the flu.
- Consider ear tubes. This advice is controversial, but the surgical route may be appropriate if your child has recurring ear infections. That's because the persistent presence of fluid in the ears makes him more susceptible not only to ear infections but also to hearing loss. And hearing problems can impede language development.
The procedure to implant ear tubes is called a myringotomy or tympanostomy, and it's done using general anesthesia. An otolaryngologist (ear, nose, and throat specialist) inserts a small tube through a tiny incision in the eardrum. This tube releases pressure and acts as a vent, letting air in and fluid out so bacteria can't flourish.