One of the most common illnesses in children is ear infections. Even though they are one of the most common illnesses, they are one that many parents don’t understand much about.
What is an ear infection?
Ear infections can be in the inner, middle, or outer ear and they can be caused by bacteria or viruses.
Often times ear infections will clear up on their own without the use of antibiotics. Many times treatment is based more on comfort and waiting for it to clear up, but persistent and unresolving ear infections may require antibiotic treatment.
What are the symptoms of an ear infection?
The signs and symptoms of an ear infection can come on suddenly, especially in children. Common signs and symptoms include:
- Ear pain
- Pulling on the ear
- Difficulty sleeping, especially if laying on the infected ear
- Difficulty hearing
- Balance issues in a child who previously didn’t have issues
- Fever of 101 degrees or higher
- Fluid or pus draining from the ear
- Loss of appetite
- Complaint of ear pain when swallowing
Even if your child is showing signs of an ear infection, or any other infection, it is not always necessary to see the doctor. Many infections will clear up on their own without need for treatment. You should see the doctor if:
- Your child is not drinking enough to stay hydrated and you notice that she is not peeing. Not eating is not a big deal because she is sick, all that matters during an illness is that she is drinking, appetite will come back as she gets better.
- If symptoms last for more than a couple of days without getting any better.
- If fever is over 100 degrees in a child under a month old, or over 104 degrees in older children
- You notice pus, drainage, or bloody discharge from the ear.
An ear infection is not contagious, even with a fever. There is no need to keep a child with an ear infection away from other children.
Is there anything that increases the risk of an ear infection?
There are several risk factors that may increase your child’s risk of getting an ear infection and cause your child to have repeated infections.
- The age of your child is a major risk factor. Because of the size and shape of their eustachian tubes and their poorly developed immune systems, children between the age of 6 months and 2 years are more susceptible to ear infections.
- How your infant is fed can increase their risk. Babies who are fed from a baby bottle, especially if they lay flat on their back, are at a greater risk than babies who are breastfed or drink from a bottle in a slightly elevated position. This is why it is always encouraged that you do not prop a bottle and always hold your baby during feedings. I understand that this can be difficult though in older babies, once mine figured out how to hold her bottle she refused to let me hold her. Often though, because older babies can roll over once they are done eating, this can reduce the risk as they are not lying still.
- The seasons play a large role in the risk of a child developing an ear infection. Ear infections are more common in the fall and winter when colds and flu are more common. Those with seasonal allergies are also more at risk.
- Being exposed to tobacco smoke and air pollution also increases a child’s risk of having frequent ear infections.
Are there any complications of ear infections?
There can be some complications related to ear infections, but they are rare. Many of these complications will not occur after just one ear infection or an occasional ear infection; these complications often occur when a child has frequent ear infections or ear infections that do not get better.
- The most common complication of ear infections is mild hearing impairment. Often times during the infection children have some hearing loss due to the fluid and swelling of the ear. Generally once the infection clears up the hearing will return to normal.
- Speech or developmental delays may occur in children who have frequent ear infections early in life because of the hearing impairment.
- In rare cases, the infection can spread throughout the body. If an ear infection goes untreated (think a week or more, not just a couple of days) or it is not responding to treatment, the infection can spread to the tissues and bones surrounding the ear. This will require more aggressive treatment and may require hospitalization.
- Tearing of the eardrum may occur because of swelling and fluid buildup. A torn eardrum will generally heal in 72 hours or less, but on rare occasions surgical repair may be required.
How are ear infections diagnosed?
Ear infections are one of the easiest illnesses to diagnose because there are no painful tests to be done. Your doctor will look at your child’s symptoms and determine from there if she has an ear infection. Your doctor will ask you about your child’s fever and how she has been acting and look in her ears.
How are ear infections treated?
There are a couple of different treatment options that the American Academy of Pediatrics recommends. Which treatment option is best for your child depends on the situation.
The first approach is to wait and see what happens. Antibiotics only work for bacterial infections, meaning if your child’s ear infection is caused by a virus, the antibiotics will do nothing for the infection, but instead expose your child to antibiotics that she doesn’t need. She can have an allergic reaction to the antibiotics and giving antibiotics can create super bugs that are resistant to common antibiotics.
With the wait and see approach you basically wait to see if the symptoms improve in the next couple of days. This treatment option is relatively new because it has been found that antibiotic use doesn’t change the outcome of many ear infections. Most of the time symptoms will improve over a couple of days and the infection will be completely cleared up in 1-2 weeks. This option works best for:
- Children from 6 months to 23 months old with ear infection in one ear for 48 hours or less with a fever less than 102.2 degrees.
- Children 2 years and older with an ear infection in one or both ears for 48 hours or less and a fever less than 102.2 degrees.
With this option many parent feel like they are not doing anything to help their child feel better. There are many things you can do during this time to help your child.
- You can place warm compresses against the child’s ear. A warm compress often helps ease the pain, just make sure that it isn’t too hot and doesn’t burn your child. A washcloth warmed up with warm water is often the best option.
- Cuddle with your child. If you are worried about placing a warm compress on your child’s ear for fear of it being too hot you can always just have your child lay with the affected ear on your chest. The warmth of your body is not too hot and will be comforting to your child.
- Treat the fevers and pain with Tylenol and Motrin. I have mentioned before that every parent should keep these handy because you never know when you will need them. Treating the fevers can help keep your child comfortable and also help ease the ear pain.
The second option for treating ear infections is the use of antibiotics. After the initial period of observation, if your child’s symptoms are not getting better, your doctor may suggest that you start treatment with antibiotics. There are a couple of instances where this would be an option:
- Children over 6 months of age with an ear infection in one or both ears for over 48 hours with a fever over 102.2 degrees.
- Children under the age of 6 months are more likely to be treated with antibiotics.
There may be other instances that your doctor will want to use antibiotics. For example, if your child has recurrent ear infections and is consistently having to be treated with antibiotics, your doctor may just start with antibiotic treatment.
The last option for treatment is having tubes placed. Often times when kids have recurrent ear infections it is because of a defect in the eustachian tube in the ear causing the fluid to be improperly drained or fluid coming into the tube through the sinuses. This is a minor surgery to place the tube and often times this will solve the problem. The biggest issue here is that often they like the ear infection to be cleared up before the surgery, and this can be hard in some children.
Knowing the signs and symptoms of ear infections and your treatment options can help you and your child’s doctor make the best choices for how to treat your child. Every child and every infection is different so what works this time may not work the next time and what works for one child may not work for the next.
Did your child have frequent ear infections? Did your doctor take the wait and see approach or just start with antibiotics?