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New Recommendations for Treatment of Ear Infections

March 18, 2013

One of the most common illnesses in U.S. children is acute otitis media (AOM), which is a type of ear infection when the middle ear becomes infected. This type of ear infection is the most common condition for which antibiotics are prescribed for U.S. children. The American Academy of Pediatrics (AAP) has recently updated its recommendations to physicians taking care of uncomplicated ear infections in children ages 6 months to 12 years. This new clinical practice guideline will be published in the March 2013 Pediatrics journal. These new guidelines help provide a more specific and stringent definition of a middle ear infection, pain management guidelines, recommendations for initial observation versus immediate antibiotic therapy, and preventive measures.

What is an ear infection?

Usually, a child will get an upper respiratory infection or a cold, and the middle ear can become inflamed. Fluid may build up and become trapped in the middle part of the ear during an acute illness. The tube that helps drain fluid from the middle ear to the back of the nose is called the Eustachian tube, and this tube is smaller and more horizontal in children as compared to an adult’s. So when a child becomes ill with a cold, it is more difficult for this fluid to drain out and bacteria can possibly grow in this fluid that is trapped behind your child’s eardrum.

How do I know if my child has an ear infection?

Symptoms of an ear infection may include:
  • Fever
  • Headache
  • Difficulty sleeping
  • Difficulty hearing
  • Crying more than usual
  • Fluid draining from the ear
These symptoms may be difficult to detect. If your child has a cold and any of the above symptoms, your doctor will be able to use an instrument called an otoscope to look at your child’s ear drums to diagnose an ear infection.

If my child has an ear infection, do I need a prescription for antibiotics from my doctor?

The surprising answer is that your child may not always need antibiotics for an ear infection. In treating non-severe ear infections, less may actually be more because our body’s immune systems can usually handle and take care of ear infections on its own. Studies have shown that children with ear infections usually report similar symptoms after about ten days, whether or not they received or did not receive antibiotics.

Antibiotics may or may not make your child feel better sooner. Also, frequent use of antibiotics may increase the chance of bacteria becoming resistant to the medicine, and that particular antibiotic may not be as useful in the future.

A visit to the pediatrician is still a good idea though, because the doctor will be able to look at your child’s ears. Your doctor might want to wait and see if your child improves in the next 2 to 3 days, instead of prescribing antibiotics immediately. If your child is very young or has signs of a very severe ear infection, your doctor may decide that antibiotics are appropriate for treatment. Your doctor may also discuss numbing ear drops to help ease ear pain, and discuss over-the-counter options for pain control since ear infections can be very uncomfortable for your child.

How can I reduce the risk of an ear infection in my child?

  • Keep your child up to date with vaccines. Studies show that vaccinated children have fewer ear infections. The vaccines that help protect against pneumonia and meningitis also help protect your child from ear infections.
  • Breastfeed your baby for the first year. The protective effects of breast milk can help reduce the risk of your child having bacterial or viral infections.
  • Get a flu vaccine. This vaccine helps protect against the flu, and can also prevent ear infections.
  • Encourage proper hygiene. Teach your children to wash hands frequently to prevent the spread of bacteria and viruses that can cause infections.
  • Avoid secondhand smoke exposure. The exposure to secondhand smoke is associated with many childhood illnesses, including ear infections.
After the reading the new guidelines, I think that an important take-home message for parents is to trust and make a plan with your pediatrician. The doctor can look in your child’s ear to determine if an ear infection is present, and will discuss with you if taking the wait-and-see approach is appropriate, or if immediate antibiotics are necessary. Discuss a plan with your child’s doctor regarding how to treat the symptoms of pain of an ear infection to help your child feel better. Lastly, ask your doctor on what you and your family can do to help reduce the risk of future ear infections for your child.