Kids and ear infections: What to look for and when to see a doctor

Ear infections are one of the most common complaints seen in a pediatrician’s office. While they can occur anytime throughout the year, they tend to increase in frequency during the winter and are most often preceded by viral colds. While ear infections are common and are usually easily treatable, they can cause discomfort for your child and can be distressing for us as parents.

What is an ear infection?

Ear infections occur when fluid gathers in the middle ear space behind the eardrum and then becomes infected with bacteria that normally hangs out in that area. As the fluid and inflammation expands, it can push on the eardrum and cause discomfort to the child. Kids tend to get more ear infections than adults because their Eustachian tubes (canals that connect the ear space to the nasal cavity) are narrower, shorter, and more horizontal than those of adults. That makes it easier for fluid to get trapped behind the ear drum and become infected.

What symptoms would I expect?

As a parent myself, I know that sometimes it can be hard to tell when your child has an ear infection. Sometimes it seems like kids have colds all winter long — that would add up to a lot of doctor’s visits if you had them evaluated each time they’re sniffling and coughing. While an older child may be able to describe their ear pain, it’s much harder to tell in younger children. Here are some signs to watch for:

• Fevers: While fevers commonly occur in the first 24-48 hours after the onset of a viral cold, fevers that last a few days into illness may be a sign there is an ear infection.
  
  
• Disrupted sleep: A baby who usually sleeps 4-6 hours at night but now is waking up every hour or two could indicate an ear infection.
  
  
• Irritability: Your little one might be acting very fussy and not wanting to eat as much.
  
  
• Ear pain: Older children may tell you they have ear pain. Older infants or toddlers may localize the pain to their ears and tug on or stick their fingers in their ears.

When should we see the doctor?

Okay, so you think your child has an ear infection. Should you get them evaluated?

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If your child is more than 6 months old and symptoms are very mild, you can probably try home treatments first. If symptoms don’t improve quickly, have your child checked out.

Your pediatrician will ask questions about description and duration of symptoms. Then we will check to make sure your child is breathing comfortably and seems well hydrated, and of course we will examine the ears.

Management and treatment options

• Often, we will recommend antibiotics to treat the ear infection … but not always! This will depend on the appearance of the eardrums, the presence of fevers, the age of the child, and the length of time the symptoms have been occurring. Your pediatrician will carefully weigh these factors when deciding how to treat the infection.
  
  
• If antibiotics are required, I recommend giving yogurt and/or probiotics to help prevent or reduce the side effects of diarrhea.
  
  
• If your little one seems in pain, I recommend giving either Ibuprofen (if greater than 6 months old) or Tylenol. You should always dose the medicine based on the weight of the child and follow dosing guidelines listed here.

Occasionally, an antibiotic may not clear up the infection completely. This can happen if the bacteria is resistant to certain antibiotics. In this case, we will switch up the antibiotics and treat with one that should cover for the resistance. If your child is having a significant number of ear infections in a short period of time, we will often refer your child to an ear, nose and throat (ENT) specialist to be evaluated for ear tubes.

Prevention

Here are some steps that you can take to help prevent colds and ear infections:

• Good hand hygiene helps prevent the spread of germs that cause illness. It’s never too soon to start toddlers down the road of proper hand washing techniques. Teach kids to wash their hands for the amount of time it takes to sing “Happy Birthday” or the “ABCs.”
  
  
• Avoiding secondhand smoke exposure is critical for minimizing childhood illness. If you smoke, quitting will not only improve your health but also your child’s.
  
  
• Influenza and pneumococcal vaccines have also been shown to reduce ear infections in children.
  
  
• If a mother chooses to and is able to, breastfeeding can help. Breastfed infants are less likely to have bacterial or viral infections, including ear infections.
  
  
• If you don’t already have one, go pick up a nasal aspirator, otherwise known as a “snot sucker.” When your child starts to develop nasal congestion, use this suction device along with some nasal saline spray to remove those boogers. Trust me, it looks gross but it works incredibly well!
  
  
• You can also run a humidifier in your child’s room to help improve the nasal congestion.

Benjamin Landgraf, MD Pediatrician Southwest Pediatrics

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