Easing childhood ear infections

April 23, 2014 Providence Health Team

Ear infections are a common problem for pre-schoolers and young children, but antibiotics aren't the only answer.

Although they rarely develop into anything serious, ear infections usually lead to a lot of sleepless nights and suffering, plus in some cases, temporary hearing loss at a crucial time in a child’s language development.

However, the approach towards treating childhood ear infections is changing – moving towards avoiding unnecessary use of antibiotics and surgery.

Based on growing concern about overuse of antibiotics, the American Pediatric Association issued guidelines recommending an “observation option” for certain otherwise healthy children with uncomplicated ear infections. In such cases, antibiotics would be withheld for 48 to 72 hours to see if the condition improves on its own. In the majority of cases, it does.

What causes ear infections?

A middle ear infection occurs when fluid builds up behind the ear drum, creating a breeding ground for bacteria. The infection then causes more fluid to accumulate, creating pressure, pain and difficulty hearing. An ear infection is not contagious although it usually follows a cold that is.

The Eustachian tube is a narrow passage that connects the middle ear to the back of the throat behind the nose. When the Eustachian tube becomes clogged, usually following a cold, fluid can build up in the middle ear, which is ordinarily filled with air. As pus and other fluids accumulate, they push on the ear drum, causing pain. When a child tugs at his ear, it’s an attempt to relieve some of this pressure.

Children are more vulnerable than adults to ear infections because:

  • Their immune systems are still in a stage of development.
  • They have Eustachian tubes that are shorter and in a position that is more horizontal than vertical.
  • Their adenoids, located nearby, are larger than they are in adults and can become inflamed.

Ear infections can be more painful for our children when they lie down or chew/suck on a pacifier or bottle. This helps explain any changes in mood, reduced appetite and trouble sleeping. Other symptoms include fever, nausea, vomiting and dizziness.

How to treat ear infections

An ear infection is more than just an earache, and in rare instances it can lead to serious complications, particularly in children who have other medical conditions. A trip to your primary care provider is essential but, keep in mind, antibiotics may not be part of your treatment plan.

  • Antibiotics do not bring relief from the pain for at least 24 hours and have minimal effect after that.
  • Antibiotics will not help a viral (as opposed to bacterial) infection.
  • Antibiotics will not eliminate the fluid in the middle ear, which may linger for several weeks, with or without treatment.
  • Frequent use of antibiotics can lead to strains of antibiotic resistant bacteria that can be increasingly difficult to treat. 

Your child may be prescribed acetaminophen or ibuprofen to relieve the pain and fever, regardless of whether antibiotics are used.

Preventing ear infections

Some children are simply more prone to ear infections but parents can minimize risk by:

  • Preventing exposure to second-hand smoke.
  • Holding the baby at an angle when bottle feeding rather than allowing the child to lie down with the bottle.
  • Practicing good hand-washing hygiene in the household.
  • Limiting your child’s exposure to large groups of children when upper respiratory infections are making the rounds. In one study of children with viral upper respiratory tract infections – colds or flu – 61 percent eventually developed fluid in their middle ears, with or without infection. This leads us to believe the best strategy for preventing ear infections in your children is to reduce their exposure to colds and flu.

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