Ask the Pediatrician: Ear infections

Q: Ear infections can be a common part of childhood. With recent concerns regarding antibiotic overuse, I understand there is ongoing debate in the pediatric community about when and how to treat this common problem.

A: It may seem like an easy thing to do - to treat an ear infection - but there are a lot of factors that come into play. First, not all ear pain is an infection. Sometimes congestion and pressure from a simple cold can cause ear pain - just like you feel when going up and down in an airplane causes pressure changes that can be uncomfortable. Babies teething, and big kids with cavities can feel the pain in their ears as well as their mouths. Sometimes it’s swimmer’s ear, or an outer ear infection, causing the pain.

The most common scenario with a true ear infection is a routine, viral illness starts things off. A child has a cold for a few days to a few weeks, and then new fever or new ear pain starts. On exam, the eardrum is red with fluid or pus behind the eardrum. Sometimes some discharge from the ear.

Q: Is there anything new to help guide treatment?

A: Several years ago, there were 2 studies that encouraged treatment for ear infections to reduce severity and length of symptoms. Just this month, the American Academy of Pediatrics, or AAP, published revised and updated guidelines using the latest evidence to help guide pediatricians with appropriate and safe decision-making. These apply to children 6 months or older.  Essentially, if there is no fluid behind the ears, if no pain, and temp below 102, there isn’t a need to prescribe an antibiotic. But if there is evidence of ear infection with fluid on exam, with ear pain, then amoxicillin is recommended, or an alternative if the child is allergic. A strong emphasis is to not prescribe antibiotics if the child doesn’t have symptoms. In other words, if the ear looks a little red but the child does not have ear pain, there is no benefit in giving antibiotics, just a potential for side effects.

Q: What can a parent do to prevent ear infections?

A: Most importantly, avoid second hand smoke exposure. If parents aren’t able to quit smoking, then make sure there is no smoking in the house or the car, whether the child is there or not. Breast feeding for the first 6 months of life has been shown to reduce ear infections in young children. Preventing the illnesses that set you up for ear infections is helpful, so vaccinate your child against the flu and the other recommended childhood shots, especially the shot against strep pneumonia.