How can I tell whether my baby has an ear infection?
The easiest way to tell if your baby might have an ear infection (or any other illness, for that matter) is by observing a change in his mood.
If your baby turns fussy, or starts crying more than usual, be on the lookout for a problem. If he develops a fever (whether slight or high) you have another big clue. Ear infections tend to strike after a common cold or sinus infection, so keep that in mind too.
You may also notice the following symptoms:
- Your baby pulls, grabs, or tugs at his ears. This could be a sign he's in pain. (Babies do pull on their ears for all kinds of reasons or for no reason at all. So if your baby seems otherwise fine, he probably doesn't have an ear infection.)
- Diarrhea or vomiting. The bug that causes the ear infection can also affect the gastrointestinal tract.
- Reduced appetite. Ear infections can cause gastrointestinal upset. They can also make it painful for your baby to swallow and chew. You may notice your baby pull away from the breast or bottle after he takes the first few sips.
- A yellow or whitish fluid draining from the ear. This doesn't happen to most babies, but it's a sure sign of infection. It also signals that a small hole has developed in the eardrum. (Don't worry – this will heal once the infection is treated.)
- Unpleasant smell. You may detect a foul odor coming from your child's ear.
- Difficulty sleeping. Lying down can make an ear infection more painful.
How common are ear infections?
Ear infections are the second most commonly diagnosed illness in children in the United States (after the common cold). About half of babies have at least one ear infection by the time they turn 1 year old, and most have had at least one ear infection by their third birthday.
What causes ear infections?
An ear infection can be caused by bacteria or a virus. It happens when fluid builds up in the area behind your baby's eardrum and then becomes infected.
Normally any fluid that enters this area leaves pretty quickly through the eustachian tube, which connects the middle ear to the back of the nose and throat. But if the eustachian tube is blocked – as often happens during colds, sinus infections, even allergies – the fluid gets trapped in the middle ear.
Germs like to grow in dark, warm, wet places, so a fluid-filled middle ear is the perfect breeding ground. As the infection gets worse, the inflammation in and behind the eardrum also tends to worsen, making the condition more painful.
Fever may develop as your baby's body attempts to fight the infection. The medical term for this condition – a painfully inflamed middle ear, an accumulation of fluid, a red eardrum, and occasionally a fever – is acute otitis media (AOM).
Using a pacifier may increase the risk of middle ear infections in babies and young children. In one study, the incidence of ear infections was 33 percent lower in babies who didn't use pacifiers.
Babies are particularly susceptible to ear infections because they have short (about 1/2 inch), horizontal eustachian tubes. As children grow to adulthood, their tubes triple in length and become more vertical, so fluid can drain more easily.
When should I call the doctor?
Call at the first sign of an ear infection. The doctor will need to look in your baby's ear with an instrument called an otoscope. An eardrum that's red, bulging, and possibly draining is probably infected.
The doctor may also check whether the eardrum moves in response to a device called a pneumatic otoscope, which releases a brief puff of air into the ear. If it's not moving, that's another indication that fluid is collecting in the middle ear and may be infected.
How will the doctor treat my baby's ear infection?
Most ear infections clear up on their own, but severe cases need to be treated with antibiotics. The American Academy of Pediatrics (AAP) urges doctors and parents to discuss whether it's best to take a wait-and-see approach or start antibiotics when symptoms are still relatively mild.
For years, antibiotics were the first line of defense against ear infections, but now doctors are prescribing them more judiciously. Getting too many antibiotics is a concern because it can set children up to be vulnerable to antibiotic-resistant infections.
If your baby is at least 6 months old, your doctor may recommend that you give him infants' acetaminophen or ibuprofen to relieve pain caused by the infection. (Never give your baby aspirin because it makes him more susceptible to Reye's syndrome, a rare but potentially fatal disorder.)
Don't hesitate to call your doctor if your baby seems to be getting worse or hasn't improved significantly after a few days. If your baby isn't doing better after 48 to 72 hours, the doctor may want to start antibiotics and have you come back for a follow-up exam. If your baby is taking an antibiotic but doesn't improve after a few days, the doctor may want to switch the medication or examine your child again.
If your doctor does prescribe antibiotics, make sure to give your child the full course. You may have to follow up with another ear exam a few weeks later so the doctor can determine how well the medication worked.
How can I prevent future ear infections?
Ear infections aren't contagious, but the respiratory infections that often precede and accompany them are. The best way to reduce the spread of germs is to wash your hands (and your child's hands) often – and always after using the toilet, changing diapers, and before eating or preparing food.
You can also:
Keep your baby's vaccinations current.
Immunizations help prevent certain illnesses that can lead to an ear infection. For example, the Hib vaccine has helped tremendously in reducing the number of ear infections in babies, and the pneumococcal vaccine can help prevent them as well.
If your baby has suffered repeated ear infections, especially after bouts of the flu, talk to your doctor about whether your child should get an annual flu vaccine. (Only children at least 6 months old can get a flu shot.)
Breastfeed your baby for at least six months.
A study from the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration, published in the journal Pediatrics, showed that children who are breastfed for the first six months of life are less likely to develop ear infections. In fact, the risk of ear infections was 70 percent greater in formula-fed babies.
Some practitioners, including otolaryngologist Robert Ruben, believe that mothers transfer certain immune-building antibodies to their babies through breast milk. However, those antibodies seem to diminish after six months.
Keep your baby away from all tobacco smoke.
Researchers have concluded that kids whose parents smoke are more likely to get ear infections and have hearing problems.
Children living with a smoker have a 37 percent higher risk of middle ear infections and hearing problems and a 62 percent higher risk if the mom is the household smoker. Kids are also 86 percent more likely to receive surgery for their middle ear problems when their mothers smoke, compared with children who have no smokers in their household.
Even a weekend spent in a house with a smoker can significantly harm a baby and raise his chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your baby to fight off infection. Don't let people smoke in your house, and keep your baby out of smoky environments.
My baby gets repeated ear infections. Can ear tubes help?
Babies who get multiple ear infections – which can actually be one ear infection that lingers for months despite antibiotic treatment – may be good candidates for ear tubes. This procedure is performed on about 670,000 children in the United States each year.
Inserting ear tubes is done under general anesthesia. An otolaryngologist makes a tiny incision in the child's eardrum and inserts a small tube into the slit. The tube releases pressure and acts as a vent, letting air in and fluid out so bacteria can't flourish.
"It's an artificial eustachian tube that allows the ear to 'breathe' until the real eustachian tube regains its normal function," explains Ruben.
Your child's doctor may suggest this surgical solution because a baby with persistent fluid in his ears (or otitis media with effusion) is a prime candidate for repeated ear infections and hearing loss.
Also, although the research is inconclusive, some experts suggest that hearing loss resulting from persistent fluid in the ears can lead to delays in language development.
Ruben cites research that found children with persistent ear problems have specific hearing difficulties later in life, especially when listening to speech in a noisy environment like a classroom.
In addition, he says, "some of these children – especially those with developmental delays and those who have specific language delays – are more susceptible to behavioral problems." The length of time the child suffered hearing loss as well as the extent of the impairment are important factors, Ruben says.
The AAP recommends tubes for children with a hearing loss of over a certain level, for children with structural damage in the middle ear, and for children with persistent middle ear infections or persistent fluid accumulation.
What should you do? Talk to your doctor and weigh the pros and cons for you and your baby.
Are ear infections ever serious?
They can be. A severe or untreated infection can rupture your child's eardrum. Ruptures don't happen very often and generally heal quickly, but it's important to follow up with your child's doctor to make sure the infection has cleared up and the eardrum is healing well.
Repeated ear infections can sometimes cause hearing loss and scarring. And in very rare cases, untreated ear infections lead to mastoiditis (a skull infection behind the ear) or meningitis.