Childhood Ear Infections

Nancy M. Brenton, MD

Ear infections are common in young children. Symptoms include ear pain and fever, and occasionally vomiting. An infant with an ear infection of course, cannot complain of pain, but may be unusually fussy, may pull at his or her ears, or have trouble sleeping. For some children, especially those who attend daycare, those exposed to cigarette smoke and those with allergies, ear infections can be recurrent and more difficult to treat.

Ear infections often follow a common cold. The back of the nose and the middle ear are connected by a tube called the Eustachian tube. When the nose is congested from a cold or even allergies fluid can build up in the middle ear and become infected. This causes fever and pressure on the ear drum which is usually quite painful.

The American Academy of Pediatrics (AAP) and The American Academy of Family Practice (AAFP) have recently issued guidelines for physicians for deciding how to manage and treat ear infections. The guidelines stress that for proper diagnosis of an ear infection, a physician must examine the ear drum. Symptoms alone are not enough to make the diagnosis. In other words, your physician will want to see your child in the office if an ear infection is suspected. While you are waiting for your child’s appointment, Tylenol or ibuprofen may make your child more comfortable. Old fashioned remedies such as warm oil drops in the ear canal, if done with great care, can also provide pain relief for your child.

If your child is diagnosed with an ear infection, your health care provider will likely offer a prescription for antibiotics. While there is still some disagreement among experts, the AAP/AAFP guidelines do suggest that “watchful waiting” (treatment for pain only for 48 to 72 hours but no antibiotics unless symptoms persist), may be appropriate for some children with less severe infection, as many cases of ear infections will resolve on their own. This approach has been more commonly taken in some European countries without a substantial increase in complications. Due to its effectiveness, low cost, pleasant taste, and minimal side effects, amoxicillin is recommended as the first choice if antibiotics are used, unless the child is allergic to this drug or has been on antibiotics in the preceding month. If symptoms have not resolved within about three days, the guidelines recommend changing to a different antibiotic. If the second antibiotic is not effective then an injectable antibiotic is recommended. If your physician prescribes an antibiotic be sure that you give it all to your child as directed. If need be, many of our local pharmacies can specially flavor your child’s medicine to encourage their cooperation.