Expert advice on preventing, treating kids’ ear infections – USA TODAY
Ear infections have been called an “occupational hazard” of childhood, and they’re especially common at this time of year. They’re also a source of worry and torment for parents trying to comfort a crying baby.
To give parents some advice on preventing and treating these ailments, USA TODAY’s Liz Szabo talked to Richard Rosenfeld, a professor of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., who helped write the American Academy of Pediatrics’ guidelines on ear infections.
Q: How common are ear infections?
A: Nearly all kids have had an ear infection by the time they begin school, Rosenfeld says. About 15% of kids develop frequent or recurrent infections — three or more in six months. The average child has a total of two to three infections — even more if they attend group day care.
Q: What causes kids’ ear infections, and why are youngsters so vulnerable to them?
A: An ear infection, also known as acute otitis media, occurs when mucus and bacteria travel up the Eustachian tube from the germy back of a child’s nose into the normally sterile and dry middle-ear space, Rosenfeld says. Youngsters are prone to these infections because of their anatomy: Their Eustachian tubes are “short, floppy, and horizontal.” As kids age, these tubes get longer, firmer and a bit more vertical, making it more difficult for germs to flow up to the ear.
Q: Can ear infections be prevented?
A: About 70% of the risk of ear infections is caused by hereditary factors, so there is not always a lot that can be done to prevent them, Rosenfeld says. But some things can help reduce the risk:
• Breast-feed for at least four months. Mixed feeds, such as half bottle, half breast, do not have a protective effect.
• Keep your child up to date on shots. The vaccine for pneumococcus, which protects against bacteria that can cause ear infections, reduces the risk of these infections by 8% and reduces the risk of needing ear tubes by 25%. The flu shot reduces the risk of ear infections by 30%.
• Avoid secondhand smoke. “Passive smoke” in the home increases the risk of ear infections by 25%.
• Discourage pacifier use in children age 1 or older. Pacifiers after this age increase the risk of ear infections by 30%.
• If the child is in day care, see if any small-group options exist (fewer than six children).
Q: What is the best way to treat ear infections?
A: “Be sure the diagnosis is accurate,” Rosenfeld says. “A true ear infection has a distinctly bulging eardrum, which almost looks like a pimple that is ready to pop. Unfortunately, ear pain or discomfort alone, even with fever, is unreliable for diagnosis, so parents cannot make the diagnosis at home. What they should do is specifically ask their doctor if the eardrum is noted to be bulging or very full; if it is not, then it is likely not a true ear infection and certainly does not need antibiotics.”
If the diagnosis is accurate, the most important treatment is pain medicine (acetaminophen, ibuprofen), especially at bedtime, for the first one to two days, Rosenfeld says. Some parents find analgesic eardrops to also be helpful.
Q: When do kids need antibiotics?
A: Not all kids need them, Rosenfeld says. Doctors can take a “watch and wait” approach for mild ear infections, when pain isn’t severe and fever is under 102 degrees Fahreinheit, that affect only one ear. Two out of three kids like this will improve on their own. Some pediatricians give parents a prescription, to spare them the trouble of returning to the doctor, but suggest that parents fill it only if kids aren’t better in two or three days.
Kids probably need antibiotics “if they worsen at any time or fail to improve in three days,” Rosenfeld says. Children under age 6 months and those with severe ear infections — severe pain, high fever or both — should get prompt antibiotics to prevent complications. Children with draining ears — a sign of a ruptured eardrum — and children younger than 2 with double ear infections also benefit from “prompt antibiotics,” he says.
Q: How else can parents avoid overusing antibiotics?
A: Use the shortest course of antibiotics possible. Children younger than 2 should be treated for 10 days; those 2 to 5 years old for seven days; and those 5 or older for five days.
Q: When is surgery needed?
A: Doctors recommend ear tubes for frequent ear infections — three in six months or four in 12 months — with “persistent fluid in one or both ears,” Rosenfeld says. “Children with frequent ear infections who do not hold on to fluid in their ears between infections do not benefit from tubes. Ear tubes are also effective for persistent ear infections that fail to improve despite several courses of antibiotics, because the tube allows the infection to drain and be treated directly with antibiotic eardrops. Tubes are also appropriate for some children with persistent middle-ear fluid, which is another topic entirely.”