Ear infections can cause serious ear pain, sleepless nights, missed work and school, and plenty of stress for parents. For some children, ear infections can become a chronic problem leading to clinic visits, multiple courses of antibiotics, and sometimes a surgery for tube placement. While most children recover from ear infections in two or three days without any antibiotics, about 25% need help. Ear infections can be caused by viruses or bacteria when excess fluid gets trapped behind the ear drum. When that space fills with mucus or pus, the pressure and inflammation cause pain. Symptoms of ear infections include pain, fever, ear drainage, loss of appetite, difficulty hearing, difficultly sleeping, crankiness, and pulling on the ear. This typically happens during or soon after a cold. The most important medicine you give your child when you first suspect an ear infection is one for pain.
Antibiotics only help if bacteria are the cause. The overuse of antibiotics is a major problem, and we all need to work to be much more careful in how we use these powerful medicines. The inappropriate use of antibiotics leads to bacterial resistance- a serious public health problem. Antibiotics also kill many bacteria we all need for our health, leading to rashes, diarrhea, stomach upsets, yeast infections and other problems. Despite lots of education on this issue, in the US 76% of children who go to see a doctor for ear pain still receive a prescription for antibiotics. In Thailand, the rate may be even higher. The American Academy of Pediatrics (AAP) has released new guidelines to help doctors do a better job treating ear infections. These recommendations also suggest ways to reduce ear infections, such as promoting breast feeding, keeping kids away from cigarette smoke, no bottle propping, and making sure they are properly vaccinated. National Public Radio in the US published a great article on this subject, and I strongly encourage you to listen.
Here are some additional points parents should know.
New Ear Infection Guidelines
- Pain: Use medication like ibuprofen and/or acetaminophen to treat pain when a child has a suspected or confirmed ear infection. These infections really hurt and don’t wait for antibiotics to start to work or make your child tough it out.
- Diagnosis: The AAP recommendations apply more strict criteria for making the diagnosis of an ear infection. For true diagnosis they say, the ear drum has to be bulging, there has to be middle ear fluid and/or draining fluid from the ear. The ear can’t just be red or have a bit of fluid behind it. It’s important that the doctor confirm an ear infection is present before antibiotics are prescribed. If a clinician says to you, “It looks like an early ear infection” or “The ear drum is a little red” or “I think this may be an ear infection” chances are it does not meet criteria and should not be treated with antibiotics. Ask your doctor if the ear drum is bulging and full of fluid. If no proof, antibiotics are probably not necessary. Treatment for the ear pain and time may be the best medicine.
- Most children don’t need antibiotics to heal from ear infections. When a confirmed ear infection is discovered in a child over 2 years of age who has no fever or no severe ear pain, they can be observed without antibiotics. If pain is still present or symptoms not improved in 48 hours, promptly make a follow-up visit.
- Follow up: the recommendations remind us that if you chose not to use antibiotics, you need to have a system in place for a follow-up visit or call in place 48-72 hours later. If symptoms of the ear infection resolve in 2-3 days with use of pain medications and time, the ear infection is likely healing. If symptoms (on or off medications) are not better in 2-3 days, your child needs to be seen again either to start antibiotics or switch medications.
- Antibiotics: Infants under 6 months of age, children 6-23 months of age with an infection in both ears, those with severe infections, and those at risk for complications (e.g. kids with disabilities or underlying disease) all need antibiotics. Amoxicillin continues to be the best first choice of antibiotic.
- Vaccines: Immunizations do a good job preventing many ear infections. Make sure your child is up-to-date on all vaccines but specifically ensure your child is up to date on Hib, Prevnar (pneumococcal vaccine) and their annual influenza Shot.
- Prevention: Breast feeding and avoidance of cigarette smoke are proven strategies to prevent ear infections in children.