Ear Infections: What Every Parent Should Know
Ear infections are so common in early childhood. Here are some tips to help.
What is an Ear Infection?
There are two kinds of ear infections:
1. Outer ear infections, or “otitis externa” – also known as swimmer’s ear, and
2. Middle ear infections, or “otitis media” – what we’ll be talking about here. Otitis media is an infection of the middle ear, the space behind the eardrum.
Why Do They Happen?
One of the most common questions parents ask me if their children get ear infections is “Is this a problem with my baby’s immune system?” For most kids, it’s much more related to anatomy rather than immunity.
We all have eustachian tubes that connect our noses/throats to the middle ear. Kids tend to get ear infections more than adults because:
Their eustachian tubes are smaller and flatter, which allows viruses or bacteria to get in more easily
They have bigger adenoids (tonsil-like structures) in the back of their nose/throat, which can prevent eustachian tubes from clearing out germs.
There is also a small genetic component – it’s not uncommon for parents of children with recurrent ear infections to say that one of them had a ton of ear infections growing up as well.
What Signs Should I Look For?
Many children with ear infections have classic signs of fever or obvious pain (tugging at ears, crying and holding ears, etc.).
But many children, especially babies and toddlers, don’t always have those classic presenting symptoms.
Some Other Clues:
Crying or fussiness when you change baby’s position (i.e. when you lay them down for bed or diaper changes) - the pressure in their ears can cause pain with position changes.
Discomfort during feeds - the pressure in their ears can feel worse with the suction they use during feedings
Sudden change in sleep patterns (interrupted sleep, etc.)
Vomiting
Tugging at ears
Associated nasal congestion, cough, or pinkeye symptoms
Sometimes no other signs - they are sometimes incidentally discovered at your baby’s check up
Note: Teething and ear infections can look very similar - the teeth and ears have the same nerve distribution, so it’s not uncommon to have similar symptoms.
If you are concerned that your baby may have an ear infection, this is one of the times when we do recommend having someone examine your baby directly. Your care team will use an otoscope to examine your baby’s ears for any redness, bulging of the eardrum, and other signs. You can then work with them to decide if + when to treat the infection.
What Can I Do To Help With My Child’s Symptoms?
There are a lot of things you can try at home for your child’s comfort:
Place a warm washcloth against the ear(s)
Massage warm olive oil along the outer ear
Children’s Tylenol or Children’s Ibuprofen (kids>6 months old) if needed
Adjust feeds (shorter, more frequent feeds can help)
Try to keep baby upright as much as possible (baby carriers help a lot)
Clear out nasal congestion with nasal saline and a snot sucker (reduces pressure)
How Do You Treat Ear Infections? Are Antibiotics Always Necessary?
This is one of the most important points of this post. Not all ear infections require antibiotics. It depends on your child’s age and their symptoms. The AAP guidelines for treatment of otitis media in infants + toddlers are specific and evidence-based. My IG post breaks down these recommendations by age for quick reference.
I think that it’s so important, especially in pediatrics, to be judicious with antibiotic use - of course, when children need medicine and the evidence supports its use, we don’t want them to suffer. But it’s also so important to know that there are clear rules to help us understand the time and place for antibiotic use.
Note:
A lot of parents want to know how to prevent ear infections - remember that so much of it is based on anatomy. The one thing you can try is to help clear out nasal congestion as best you can (nasal saline and snot suckers as needed for comfort). But know that it’s not your fault in any way if your child is prone to them.
My Child has had Multiple Ear Infections. Should They See a Specialist?
Here are some general indications based on our clinical pathways at the Children’s Hospital of Philadelphia for an ENT (Ear, Nose, and Throat Specialist) referral.
>= 3 ear infections in 6 months
>= 4 ear infections in 12 months (at least 1 in the preceding 6 months)
Requires multiple courses of antibiotics to clear an infection
Has C. Dificile (a bacterial infection that can happen after antibiotic use)
Has speech delay or hearing loss
Has other complications from infection
I hope that this helps you to feel calm + confident caring for your child and empowered when talking with your child’s medical care team. Please know that I’m here with you, cheering you on. You’re doing so great.