回来的路上接到爸爸的电话，因为在高速上，所以只是简单问了一下，知道骨头没伤着算是松了口气，爸爸却轻轻带过说了句要去给小宝抓药，说是ear infection，妈妈还以为听错了。等爸爸回家之后仔细问了一下，才知今天刚去时先是常规方法检查腿脚，然后问小宝“Do you like stickers?”小宝一听又跑又跳地跟着去了，于是他们认为小宝腿没问题。后来检查耳朵时意外地发现小宝耳朵内外都红的，很惊讶小宝居然没有发烧。巧的是，虽说不在同一个clinic，来检查小宝的竟是上次那个PED，一见面就对小宝说“I know you!”一个月内居然两次去看PED(Checkup之外)，而且最后都要吃药。
阿莫西林(羟氨苄青霉素、阿摩西林、酚塔西林) (Amoxycillin, Amoxil, Clamoxil)
第二天妈妈送小宝去DAYCARE时，她的老师说她前一天不肯玩，总是哭鼻子，到了外面也只是坐在旁边，与平常大不同，所以担心她伤着了，跟DAYCARE的manager一说就打电话给家长了。没想到小宝到了医院居然好起来了。妈妈在网上查找ear infection的有关资料，发现ear infection居然是小儿见PED最常见的原因之一，难怪每次checkup都要对宝宝的耳朵左照右照的呢！即便宝宝有时抵触得不行。
宝宝有ear infection时因为不舒服会有一些反常表现，如睡眠不好，白天夜里哭闹等，那几天小宝是比较粘人，夜里也总醒来，面部摔伤后那几天小宝鼻子似乎也有些不通。如果不是这次因为腿部受伤去见PED，否则小宝还不知要多受多少罪，想到这里妈妈就很为自己的大意而自责。本来以为是小宝了，带宝宝的经验已经有了，所以不再象以前那样宝宝有个头疼脑热地就紧张得不行了，结果将小宝的病情一次又一次给耽误了。小宝出现的几次问题，从玫瑰疹，到Croup及这次的ear infection，都是以前大宝不曾有的，多多少少都是在宝宝易生的感冒发烧之列，容易被忽视，所以详细写出来，希望不是新妈妈的JMs引以为鉴啊！
妈妈不由得想起前一个周五老师说的话，那时妈妈不加思索就认为是鞋子的错，说不定那时小宝已经受得ear infection的困扰了，是否可以排除鞋子是罪魁祸首，小宝那天总是摔跤其实是ear infection所致？以后有机会时一定要问问PED弄个明白啊。
下面就将我看到的一些中英文资料整理后贴出来供JMs参考啊，英文资料相对比较多，也很系统，不少资料将ear infection和otitis media(中耳炎)放一起，现在想想小宝得的很可能就是急性中耳炎了。宝宝在天气转冷时特别容易生病，有些不及时适当地应对，小病可能会转成大病，JMs千万不要象我这样粗心大意啊！
DOES YOUR CHILD HAVE AN EAR INFECTION? HOW TO TELL.
Your child has a bothersome cold for a week. Her nasal discharge turns a little green and her cough starts to keep you all up at night. Then one night she is up every hour extremely fussy with a fever. You take her into the doctor in the morning almost certain she has another ear infection.
Ear infections are one of the most worrisome illnesses for both parents and children to go through, especially if they frequently recur. They also are the most common reason for antibiotic prescriptions. Here's a guide to help you understand why ear infections occur, how to best treat them, and most importantly, how you can prevent them from happening too often.
【EIGHT MAIN SYMPTOMS OF AN EAR INFECTION】
Your child may have 2 or more of these symptoms:
● Cold symptoms – keep in mind that ear infections are almost always preceded by a cold. Often a clear runny nose will turn yellow or green before an ear infection sets in.
● Fussiness during the day or night
● Complaining of ear pain or hearing loss
● Night-waking more frequently
● Unwillingness to lie flat
● Fever – usually low grade (101º - 102º); may not have a fever.
● Sudden increase in fussiness during a cold
● Ear drainage – if you see blood or pus draining out of the ear, then it is probably an infection with a ruptured eardrum. DON'T WORRY! These almost always heal just fine, and once the eardrum ruptures the pain subsides.
【YOUR CHILD IS UNLIKELY TO HAVE AN EAR INFECTION IF:】
1. No cold symptoms – if your child has some of the above symptoms but does not have a cold, an ear infection is less likely, unless your child has had an ear infection in the past without a cold.
2. Pulling at the ears or batting the ears in infants less than 1 year of age. Infants less than one are unable to precisely localize their ear pain. This means that they cannot tell that the pain is coming from the ear or from structures near the ear. Infants can pull on or bat at their ears for two other common reasons:
● Teething – Baby thinks the pain from sore gums is coming from the ears
● Because they like playing with their ears – Infants are fascinated with these strange appendages that are sticking out of the side of their head. They love to explore them, play with them, and especially to stick their finger into that strange hole in the middle.
3. No complaints of ear pain in a child who is old enough to tell you, usually by age two or three.
Pulls At Ears.
Infants often pull on their ears simply to play with them. Ear pulling in the absence of the above signs is unlikely to signal an ear infection.
【HOW CAN I TELL IF IT'S AN EAR INFECTION OR JUST TEETHING?】
Are you tired of taking your fussy baby into the doctor just to check her ears, only to be told its probably just teething? TO help you decide, with teething:
● Pain usually starts at four months of age and will come and go until the two-year molars are in.
● Tugging or digging at the ears with no cold symptoms or fever
● Fussiness or night waking with no cold symptoms or fever
● May have low fever less than 101
● Teething does not cause a runny nose, only drool.
【HOW DO EAR INFECTIONS OCCUR】
The ear is divided into three parts: the outer ear canal, the middle ear space where infections occur, and the inner ear where the nerves and balance center are. A thin, membranous eardrum divides the outer and middle ear. The middle ear space is also connected to the back of the nose via the Eustachian tube.
Immature Eustachian tube
In infants and young children this tube is much shorter and is angled. It is therefore much easier for bacteria to migrate from the nose and throat up into the middle ear space. As the child grows this tube becomes more vertical, so germs have to travel "up hill" to reach the middle ear. This is one-reason children "outgrow" ear infections.
When your child has a cold, the nasal passages get swollen and mucus collects in the back of the nose. This environment is a breeding ground for the bacteria that normally live in the nose and throat to begin to overgrow. Mucus is also secreted within the middle ear space just as it is in the sinuses.
Germs migrate up through the Eustachian tube and into the middle ear space where they multiply within the mucus that is stuck there. Pus begins to form and soon the middle ear space is filled with bacteria, pus and thick mucus.
This pus causes the eardrum to bulge causing pain. It is this red, bulging pus-colored eardrum that the doctor can see by looking into the ear canal.
The discharge that collects in the middle presses on the eardrum preventing it from vibrating normally. This is what the doctor means by "fluid in the middle ear." Also the fluid plugs the eustachian tube and dampens the sound like the sensation in your ears during air travel.
【ARE EAR INFECTIONS CONTAGIOUS?】
No, the bacteria inside the ear causing the infection are not contagious. The cold virus that can lead to an ear infection is contagious. Oftentimes, if the ear infection occurs a week after the cold begins, the child is no longer contagious.
【HOW ARE EAR INFECTIONS TREATED?】
1. Ear pain – click here for help on how to treat the pain. Getting through the night:
● Acetaminophen or ibuprofen are effective pain relievers for ear pain. You can safely use both medications together if one alone is not enough. Click on each medication for dosage.
● Warm compress – apply a warm washcloth to the ear.
● Warm olive oil, vegetable oil, or garlic oil – put several drops of one of these into the ear. MAKE SURE THE OIL ISN’T TOO HOT.
● Anesthetic eardrops – if the above remedies aren’t enough, these are available by prescription and can numb the eardrum to minimize the pain for an hour or two.
● WARNING – if you see any liquid or pus draining out of the ear, DO NOT PUT ANY OF THE ABOVE DROPS INTO THE EAR. See below under ear drainage.
2. Antibiotics – a seven-day course is the current recommendation, unless your doctor feels a longer course is indicated. The whole issue of antibiotics can be confusing to parents. Here are some general guidelines to help you:
● Amoxicillin – "the pink stuff" – this is the standard first-line treatment used by most doctors, and rightly so. It works well most of the time, is inexpensive, tastes pretty good, and is easy on the stomach and intestines.
● Azithromycin, Augmentin (amoxicillin/clavulinate mix), double dose amoxicillin, cefuroxime – this are all common second and third line choices.
● A new combination of Augmentin plus extra amoxicillin called Augmentin ES has been shown to be very effective in treating resistant ear infections. Your doctor may prescribe both.
● Finish the prescribed course – even if you child is feeling better after two or three days, it is best to complete at least seven days of treatment to help ensure the infection doesn't come back.
3. Ruptured eardrum – if this occurs, your doctor will probably also prescribe an eardrop that is a mix of antibiotic and hydrocortisone. This helps the ear canal heal.
Avoid antibiotic resistance - But doctor, amoxicillin doesn't work for my child, and it's so hard to give it to her three times a day! Can I please have the once a day for only five days stuff? Be careful about doing this. Always taking a stronger, more convenient antibiotic can make the bacteria that dwell in your child more resistant to the stronger antibiotics, and can make future infections more difficult to treat. Even if amoxicillin hasn't worked once or twice in the past, chances are that this new infection is a different bacteria that is sensitive to amoxicillin, especially if more than two months have passed since the last antibiotic. The good news is amoxicillin now comes in a twice-a-day form, and treatment is usually only seven days, not ten.
When to use a stronger antibiotic – it is usually best to start out with the simple amoxicillin. Here are some reasons to go with something stronger:
● If the fever and fussiness are not improving after 48 – 72 hours of an antibiotic, your child may need a stronger one.
● If amoxicillin has not worked two or three times in the past, then it's ok to start with a stronger antibiotic for future infections.
● If your child has taken amoxicillin in the past six weeks, and then develops another ear infection, chances are that this infection is resistant and needs a stronger antibiotic.
● If your child is allergic to amoxicillin
● If the infection is still present after one course of amoxicillin
● Important note – the antibiotics only take care of the bacteria causing the ear infection. They don't treat the virus that is causing the underlying cold symptoms. So don't expect the runny nose and cough to improve for 3 to 14 days.
【ARE ANTIBIOTICS ABSOLUTELY NECESSARY TO TREAT EAR INFECTIONS?】
No, they are not absolutely necessary, but they are very helpful for several reasons:
● Antibiotics will help your child feel better faster by eliminating the bacteria, which in turn reduces the fever and ear pain more quickly. Children generally feel better after one or two days of antibiotics.
● Allowing an ear infection to heal on its own usually subjects a child to four to seven days of fever and ear pain.
● Antibiotics help prevent the very rare, but possible, complications of an ear infection spreading into the brain or bone surrounding the ear.
● New research is suggesting that 80% of uncomplicated ear infections will resolve within 4 to 7 days without antibiotics. Parents who choose not to use antibiotics can treat the pain and fever with Auralgan anesthetic ear drops and ibuprofen or acetominophen.
【MINIMIZING THE SIDE EFFECTS OF ANTIBIOTICS】
Side effects can include:
● Fungal diaper rash
● Oral thrush
CLICK ON SIDE EFFECTS OF ANTIBIOTICS FOR AN IMPORTANT DISCUSSION ON HOW TO MINIMIZE THE SIDE EFFECTS OF ANTIBIOTICS
【HOW EAR INFECTIONS RESOLVE】
There are two components of ear infections that need to resolve:
● Infection – the antibiotics usually take care of the bacteria, which in turn resolves the fever and pain with a few days.
● Middle ear fluid – it takes much longer for this to resolve, anywhere from a few days up to 3 months! The fluid slowly drains out through the Eustachian tube down into the nose. Taking repeated courses of antibiotics does not speed up this process, since the fluid is usually no longer infected with bacteria. Chronic nasal congestion or allergies can block the Eustachian tube and therefore prevent the ears from draining. Your child's hearing may be muffled until the fluid drains out. This is not permanent. See below on preventing ear infections for tips on how to improve ear drainage.
Remember, since the runny nose and cough are usually caused by a cold virus and not bacteria, it may be 3 – 14 days before these symptoms resolve.
【FOLLOW UP WITH THE DOCTOR】
Most doctors will have you follow up anywhere from one to four weeks after an ear infection. There are several reasons for this:
● To make sure the infection is clearing up
● To make sure the middle ear fluid is draining out. If the fluid stays around continuously for more than three months, your doctor needs to know.
● To help determine if the next ear infection is a new one or a continuation of an old infection. This helps determine which antibiotic to use.Your doctor may perform a tympanogram – a rubber probe that painlessly fits into your baby's ear canal and measures how the eardrum vibrates. This helps determine if there is any fluid left.
IMPORTANT NOTE: Try to avoid over-treating with unnecessary repeated courses of antibiotics. At your follow-up visit with your doctor, there may still be fluid in the middle ear. If the ear is not red or bulging, and your child is acting fine, you may not need another course of antibiotics. Doctors will vary in how aggressive they like to treat ear fluid. You may be able to spare your child from an unnecessary course of antibiotics.
【CHRONIC EAR FLUID】
As stated above, sometimes it can take several months for the fluid to drain out of the middle ear space. During this period the hearing can be muffled. This isn't dangerous and does not cause permanent hearing loss. Thankfully, the fluid often drains out within two or three weeks. There are several situations, however, when you do need to worry about this fluid in the ear:
● Eustachian tube dysfunction – this is a condition where the Eustachian tube can't do its job correctly and the middle ear doesn't drain. Causes include chronic sinus infections, nasal allergies and frequent colds.
● Fluid that stays in the ear for more than three to four months can become thick and gooey, a term called "glue ear". This type of fluid often needs to be drained surgically by an ear specialist.
● If this long period of muffled hearing occurs during the first two years of life when language development is crucial, it can cause speech delay. This is usually only temporary, however, but the longer it goes on, the longer the speech and hearing can be delayed.
● If your child has several ear infections over a three to four month period, and the fluid never really has time to drain in between infections, this can cause a prolonged period of muffled hearing.Again, don't worry if it takes one or two months for the fluid to drain out of your child's ear. This is common. We would like to stress, however, the importance of proper follow-up with your doctor to make sure it eventually resolves.
【NINE STEPS TO PREVENTING EAR INFECTIONS】
If your child has had several ear infections already, or you simple wish to lower her risk of getting them in the first place, here are some ways to prevent or at least lessen the frequency and severity of ear infections:
1. Breastfeeding. There is no doubt whatsoever in the medical literature that prolonged breastfeeding lowers your child's chances of getting ear infections.
2. Daycare setting. Continuous exposure to other children increases the risk that your child will catch more colds, and consequently more ear infections. Crowded daycare settings are a set up for germ sharing. If possible, switch your child to a small, home daycare setting. This will lower the risk.
3. Control allergies. If you think allergies are contributing to your child's runny nose and, consequently, ear infections,click on allergies to find out more about how to minimize your child's allergies.
4. Feed baby upright. Lying down while bottle-feeding can cause the milk to irritate the Eustachian tube which can contribute to ear infections.
5. Keep the nose clear. When a runny nose and cold start, do your best to keep the nose clear by using steam, saline nose drops, and suctioning. See colds for more info on this.
6. Cigarette smoke. There is strong evidence that smoking irritates baby's nasal passage, which leads to Eustachian tube dysfunction.
7. Echinacea - this is an herb which can safely and effectively boost the immune system. Click here for more information.
8. Chiropractic care - I firmly believe that chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.
9. Eat more raw fruits and vegetables - these can greatly boost your child's immune system and help fight off infections. If you have a picky eater, click here to read how Juice Plus can provide this nutrition for your child.
【MEDICAL PREVENTION FOR CHRONIC OR FREQUENT EAR INFECTIONS】
If your child is having frequent ear infections, more aggressive prevention may be indicated. There are different opinions as to the definition of chronic ear infections. How many is too many?
● More aggressive doctors may choose to begin medical prevention if you child has more than three ear infections in six months, or more than four in one year.
● Less aggressive doctors may allow your child to have more infections before recommending medical prevention. We lean more in this direction.
● Other factors such as hearing loss and speech delay may warrant more aggressive treatment.
There are three forms of medical prevention:
1. Prophylactic antibiotics. This consists of a once-a-day dose of amoxicillin or similar antibiotic. There are two ways to do this:
● Daily treatment for several months continuously, such as through the winter season.
● Start the daily treatment at the first sign of any cold symptoms, and then continue the antibiotic for 7 – 10 days.
● Advantage to taking prophylactic antibiotics is that you avoid full dose courses of possibly stronger antibiotics.
● Disadvantage is that your child gets and antibiotic possibly more often and this could contribute to antibiotic resistance.
● OUR PREFERENCE is to start the daily amoxicillin at the first sign of cold symptoms.
2. Immunization. There is a new vaccine called Prevnar that came out in 2000. Four doses are given during the first two years of life. For children 15 months and older, one dose is enough. This vaccine helps prevent infections from a bacterium called pneumococcus. This bug causes pneumonia, blood infections, meningitis and ear infections. The main purpose of this vaccine is to prevent the more serious infections. It also can prevent ear infections in two ways:
● Decreased number of ear infections – this effect is minimal. Studies have shown that this shot only decreases ear infections by 10 – 20%.
● Decreased ear infections from resistant pneumococcus – this is considered a much more valuable benefit from the shot. The vaccine has been shown to significantly decrease the number of ear infections caused by pneumococcus that are resistant to standard antibiotics.
3. Ear tubes. These are tiny tubes that an ENT specialist inserts into the eardrum under general anesthesia. They usually stay in place for 6 months to over a year. There are several purposes achieved by tubes:
● To drain chronic ear fluid that may turn into "glue ear".
● To provide an outlet for middle ear fluid to drain out as it begins to collect during a cold. This may help prevent a full ear infection from occurring.
● To preserve hearing and timely speech development by avoiding long months of muffled hearing caused by middle ear fluid.
● To help prevent the rare complication of chronic hearing loss caused by recurrent ear infections.
【THE EAR TUBE CONTROVERSY】
While ear tubes do have their place in treating recurrent ear infections, there does exist some controversy over their use. The advantages are listed above. Some common concerns about tubes are:
● Some doctors may be too quick to recommend ear tubes before exhausting all other preventative measures or before allowing enough time to allow the ears to clear up without surgery.
● As with any surgery, there are risks (though minimal) to general anesthesia.
● The tubes often leave a little scar covering approximately one sixth of the eardrum. This scar is often permanent. There does not seem to be any long-term consequence of this scarring, but we're not completely sure. Please note that recurrent ear infections with or without eardrum rupture can also lead to scarring.
Please note that ear tubes don't always prevent ear infections. Some children will still get as many infections even with the tubes in, but the fluid drains out right away.
OVERALL EAR TUBES DO HAVE A PROPER PLACE IN TREATING RECURRENT EAR INFECTIONS WHEN USED APPROPRIATELY.
● Many children benefit from ear tubes. Parents declare their child is a new person. The ear infections are gone. The hearing is improved. No more sleepless nights with a crying child. No more endless courses of antibiotics.
● General indication for tubes are chronic ear fluid for more than four to six months; or more than three ear infections in six months or more than five in one year. You and your doctor should decide together when it is the right time for ear tubes for your child.
【Ear Infections and Your Child】
Next to the common cold, an ear infection is the most common childhood illness. In fact, most children have at least one ear infection by the time they are 3 years old. Most of the time, ear infections clear up without causing any lasting problems.
In order to understand how ear infections occur, it’s helpful to know how our ears work. The ear has three parts — the outer ear, middle ear and inner ear. A small tube (eustachian tube) connects the middle ear to the back of the nose. When a child has a cold, nose or throat infection, or allergy, the eustachian tube can become blocked, causing a buildup of fluid in the middle ear. If bacteria or a virus infects this fluid, it can cause swelling and pain in the ear. This type of ear infection is called acute otitis media.
Often after the symptoms of acute otitis media clear up, fluid remains in the ear. Acute otitis media then develops into another kind of ear problem called otitis media with effusion (middle ear fluid). This condition is harder to detect than acute otitis media because except for the fluid and usually some mild hearing loss, there are often no other noticeable symptoms. This fluid may last several months and, in most cases, disappears on its own. Hearing then returns to normal.
Your child may have many symptoms during an ear infection. Talk with your pediatrician about the best way to treat your child’s symptoms.
● Pain. The most common symptom of an ear infection is pain. Older children can tell you that their ears hurt. Younger children may only seem irritable and cry. You may notice this more during feedings because sucking and swallowing may cause painful pressure changes in the middle ear.
● Loss of appetite. Your child may have less of an appetite because of the ear pain.
● Trouble sleeping. Your child may have trouble sleeping because of the ear pain.
● Fever. Your child may have a temperature ranging from 100°F (normal) to 104°F.
● Ear drainage. You might notice yellow or white fluid, possibly blood-tinged, draining from your child’s ear. The fluid may have a foul odor and will look different from normal earwax (which is orange-yellow or reddish-brown). Pain and pressure often decrease after this drainage begins, but this doesn’t always mean that the infection is going away. If this happens it’s not an emergency, but your child will need to see your pediatrician.
● Trouble hearing. During and after an ear infection, your child may have trouble hearing for several weeks. This occurs because the fluid behind the eardrum gets in the way of sound transmission. This is usually temporary and clears up after the fluid from the middle ear drains away.
【Ear Infections — Complications or Problems】
Although it’s very rare, complications from ear infections can develop, including the following:
● An infection of the inner ear that causes dizziness and imbalance (labyrinthitis)
● An infection of the skull behind the ear (mastoiditis)
● Scarring or thickening of the eardrum
● Loss of feeling or movement in the face (facial paralysis)
● Permanent hearing loss
It’s normal for children to have several ear infections when they are young — even as many as two separate infections within a few months. Most ear infections that develop in children are minor. Recurring ear infections may be a nuisance, but they usually clear up without any lasting problems. With proper care and treatment, ear infections can usually be managed successfully. But, if your child has one ear infection after another for several months, you may want to talk about other treatment options with your pediatrician.
Because your child can have trouble hearing without other symptoms of an ear infection, watch for the following changes in behavior (especially during or after a cold):
● Talking more loudly or softly than usual
● Saying “huh?” or “what?” more than usual
● Not responding to sounds
● Having more trouble understanding language in noisy rooms
● Listening with the TV or radio turned up louder than usual
If you think your child may have difficulty hearing, call your pediatrician. Being able to hear and listen to others talk helps a child learn speech and language. This is especially important during the first few years of life.
【Ear Infections - Cause】
Middle ear infections are caused by bacteria and viruses.
During a cold, sinus or throat infection, or an allergy attack, the eustachian tubes, which connect the middle ears to the throat, can become blocked. This stops fluid from draining from the middle ear. This fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.
● Bacterial infections . Bacteria cause most ear infections. The most common types are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis.
● Viral infections . Viruses can also lead to ear infections. The respiratory syncytial virus (RSV) and flu (influenza) virus are the most frequent types found. These viruses account for the rise in ear infections from January to May each year.1
Causes of fluid buildup
When swelling from an upper respiratory infection or allergy blocks the eustachian tube, air can't reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. An ear infection begins when bacteria or viruses in the trapped fluid grow into an infection.
Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.
【Ear Infections - What Increases Your Risk】
Some factors that increase the risk for middle ear infection (acute otitis media) are out of your control. These include:
● Age. Children ages 3 years and younger are most likely to get ear infections. Also, young children get more colds and upper respiratory infections. Most children have at least one ear infection before they are 7 years old.
● Birth defects or other medical conditions. Babies with cleft palate or Down syndrome are prone to ear infections.
● Weakened immune system. Children with severely impaired immune systems have more ear infections than healthy children.
● Family history. Children are more likely to have repeat middle ear infections if a parent or sibling had repeat ear infections.
● Allergies. Allergies may be a risk factor for ear infections. Allergies cause long-term stuffiness in the nose that can affect how the eustachian tube works. Blocking this tube, which connects the back of the nose and throat with the middle ear, can cause fluid to build up in the middle ear.
Other factors that increase the risk for ear infection include:
● Repeat colds and upper respiratory infections. Most ear infections develop from colds or other upper respiratory infections.
● Exposure to cigarette smoke. Babies who are around cigarette smoke are more likely to have ear infections than babies who are not. Also, ear infections seem to last longer in babies who are near cigarette smoke.
● Bottle-feeding. Babies who are bottle-fed are more likely to develop ear infections within the first year of life than are babies who are breast-fed. Also, bottle-fed babies may be more likely to get ear infections if they drink their bottles lying down rather than being held in an upright position.
● Child care centers. Children who are around many other children, such as in child care centers, are more likely to have repeat ear infections than children who are not exposed to many other children.
● Pacifier use. A young child who uses a pacifier is more likely to get ear infections.
Factors that increase the risk for repeated ear infections also include:
● Ear infections at an early age. Babies who have their first ear infection before 6 months of age are more likely to have other ear infections.
● Persistent fluid in the ear. Fluid behind the eardrum that lasts longer than 2 to 10 weeks after an ear infection increases the risk for repeated infection.
● Prior infections. Children who had an ear infection within the previous 3 months are more likely to have another ear infection, especially if the infection was treated with antibiotics.
【Symptoms of an ear infection】
Ear infection symptoms usually involve discomfort inside the ear or ear canal or on the skin of the ear. Someone with an ear infection may also have a fever or feel dizzy.
Symptoms of an ear infection include:
● Ear pain.
● Swelling, heat, or tenderness around or behind the ear.
● Redness of the ear, ear canal, or skin around or behind the ear.
● Itching and a feeling of fullness in the ear.
● Drainage from the ear that does not look like earwax. The drainage may have bad smell.
● Severe dizziness (vertigo).
● New hearing loss.
【Ear Infections - Prevention】
You may be able to prevent your child from getting middle ear infections by:
● Not smoking. Ear infections are more common in children who are around cigarette smoke in the home. Even fumes from tobacco smoke on your hair and clothes can affect the child.
● Breast-feeding your baby. There is some evidence that breast-feeding helps reduce the risk of ear infections, especially if ear infections run in your family. If you bottle-feed your baby, don't let your baby drink a bottle while he or she is lying down.
● Washing your hands often. Hand-washing stops infection from spreading by killing germs.
● Having your child immunized. Current immunizations don't specifically prevent ear infections. But they can prevent illnesses, such as Haemophilus influenzae (Hib) and flu (influenza) that may lead to ear infections. Have your child immunized at the ages suggested by national guidelines. For more information, see the topic Immunizations.
● Having your child immunized with the pneumococcal conjugate vaccine (PCV) may help reduce the risk of ear infection.
● Taking your child to a smaller child care center. Fewer children means less contact with bacteria and viruses. Children in child care settings can easily spread germs to each other. Try to limit the use of any group child care.
● Not giving your baby a pacifier. Try to wean your child from his or her pacifier before about 6 months of age. Babies who use pacifiers after 12 months of age are more likely to develop ear infections.
【Ear Infections - Home Treatment】
Rest and care at home is often all children with ear infections need. Up to 8 out of 10 ear infections get better without treatment.2 If your child is mildly ill and home treatment takes care of the earache, you may choose not to seek treatment for the ear infection.
At home, try:
● Using pain relievers. Pain relievers such as nonsteroidal anti-inflammatory medicines (such as Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol) will help your child feel better. Giving your child something for pain before bedtime is especially important. Do not give aspirin to anyone younger than 20 because it is linked to Reye syndrome, a serious illness that needs emergency care.
● Applying heat to the ear, which may help with pain. Use a warm washcloth or a heating pad. Do not allow children to go to bed with a heating pad. They could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
● Encouraging rest. Resting will help the body fight the infection. Arrange for quiet play activities.
● Using eardrops. Doctors often suggest eardrops for earache pain. Don't use eardrops without a doctor's advice, especially if your child has tubes in his or her ears. For more information, see the safest way to insert eardrops.
Decongestants, antihistamines, expectorants, and other over-the-counter cold remedies usually do not work for treating or preventing ear infections. Antihistamines that cause sleepiness may thicken fluids, which can make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than age 2.
If your child with an ear infection must take an airplane trip, talk with your doctor about how to help your child cope with ear pain during the trip.
If your child isn't better after a few days of home treatment, call your doctor.
If your child has a ruptured eardrum or has ear tubes in place, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
【Ear Infections — Pain and Treatment】
Sometimes an ear infection isn’t to blame for your child’s ear pain. There are other reasons, such as the following, that cause your child’s ears to hurt.
● An infection of the skin of the ear canal, often called “swimmer’s ear”
● Blocked or plugged eustachian tubes from colds or allergies
● A sore throat
● Teething or sore gums
Because pain is often the first and most uncomfortable symptom of ear infection, it’s important to help comfort your child by giving her pain medicine. Acetaminophen or ibuprofen are over-the-counter pain medicines that may help decrease much of the pain. Be sure to use the right dosage for your child’s age and size. Don’t give aspirin to your child. It has been associated with Reye syndrome, a disease that affects the liver and brain. There are also ear drops that may relieve ear pain for a short time. Ask your pediatrician whether these drops should be used. There is no need to use over-the-counter cold medicines (decongestants and antihistamines), because they don’t help clear up ear infections.
Not all ear infections require antibiotics. Some children who don’t have a high fever and aren’t severely ill may be observed without antibiotics. In most cases, pain and fever will improve in the first one to two days.
If your child is younger than 2 years, has drainage from the ear, has a fever higher than 102.5°F, seems to be in a lot of pain, is unable to sleep, isn’t eating, or is acting ill, it’s important to call your pediatrician. If your child is older than 2 years and your child’s symptoms are mild, you may wait a couple of days to see if she improves.
Your child’s ear pain and fever should go away within two to three days of their onset. If your child’s condition doesn’t improve within 2 days, call your pediatrician. Your pediatrician may wish to see your child and may prescribe an antibiotic, if one wasn’t given initially. If an antibiotic was already started, your child may need a different antibiotic. Be sure to follow your pediatrician’s instructions closely.
If an antibiotic was prescribed, make sure your child finishes the entire prescription. If you stop the medicine too soon, some of the bacteria that caused the ear infection may still be present and cause an infection to start all over again.
As the infection starts to clear up, your child might feel a “popping” in the ears. This is a normal sign of healing. Children with ear infections don’t need to stay home if they are feeling well, as long as a child care provider or someone at school can give them their medicine properly, if needed. If your child needs to travel in an airplane, or wants to swim, contact your pediatrician for specific instructions.
【Ear Infections - Medications】
Antibiotics can treat ear infections. But most children with ear infections get better without them. If the care you give at home relieves pain, and a child's symptoms are getting better after a few days, you may not need antibiotics.
In the United States, many doctors use antibiotics for middle ear infections in children younger than age 2. This is often because children this young are at higher risk for complications. For children ages 2 and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin (Amoxil) because it works well and costs less than other brands.
Experts suggest a hearing test if a child has had fluid behind his or her eardrum longer than 3 months. Normal hearing is critical during the first 2 years when your child is learning to talk. Your doctor may prescribe antibiotics to help clear the fluid. But that usually doesn't help. The doctor may also suggest placing tubes in the ears to drain fluid and improve hearing.
Other medicines that can treat symptoms of ear infection include:
● Acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory medicines (for example, Advil, Motrin, and Aleve), for pain and fever. Do not give aspirin to anyone younger than 20 because of its link to Reye syndrome, a serious illness that needs emergency care.
● Pain medicines such as codeine and some eardrops, which help with severe earache. But do not use eardrops if the eardrum is ruptured. For more information, see the safest way to insert eardrops.
● Sometimes corticosteroids, known as steroids, are given with antibiotics to get rid of fluid behind the eardrum (otitis media with effusion). Steroids are not a good choice for treating otitis media. Do not use steroids if a child has been around someone with chickenpox within the last 3 weeks.
Decongestants, antihistamines, expectorants, and other over-the-counter cold remedies usually do not work well for treating or preventing ear infections. Antihistamines that may make your child sleepy can thicken fluids and may actually make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.
Antibiotics may help cure ear infections caused by bacteria.
What To Think About
Some doctors prefer to treat all ear infections with antibiotics. Some things to consider before your child takes antibiotics include:
● Risk for antibiotic-resistant bacteria. The greatest problem with using antibiotics to treat ear infections is the possibility of creating bacteria that can't be killed by the usual antibiotics (antibiotic-resistant bacteria). Using antibiotics only when they're needed can slow down this process.
● Side effects of antibiotics. Mild side effects, such as diarrhea and rash, from taking antibiotics are common. Severe side effects are rare.
● Cost. Most antibiotics are expensive. You may want to weigh the cost against the fact that most ear infections clear up without treatment.
If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn't feeling better after 2 days of antibiotic treatment.
【Ear Infections - When To Call a Doctor】
Call your doctor immediately if:
● Your child has a severe injury to the ear.
● Your child has sudden hearing loss, severe pain, or dizziness.
● Your child seems to be very sick with symptoms such as a high fever and stiff neck.
● You notice redness, swelling, or pain behind or around your child's ear, especially if your child does not move the muscles on that side of his or her face.
Call your doctor if:
● You can't quiet your child who has a severe earache with home treatment over several hours.
● Your baby pulls or rubs his or her ear and appears to be in pain (crying, screaming).
● Your child's ear pain increases even with treatment.
● Your child has a fever of 101F or higher with other signs of ear infection.
● You suspect that your child's eardrum has burst, or fluid that looks like pus or blood is draining from the ear.
● Your child has an object stuck in his or her ear.
● Your child with an ear infection continues to have symptoms (fever and pain) after 48 hours of treatment with an antibiotic.
● Your child with an ear tube develops an earache or has drainage from his or her ear.
Watchful waiting is when you and your doctor watch symptoms to see if the health problem improves on its own. If it does, no treatment is necessary. If the symptoms don't get better or get worse, then it’s time to take the next treatment step.
If your child is age 6 months or older and has a mild earache, you might try watchful waiting. Most ear infections get better without antibiotics. But if your child's pain doesn't get better with nonprescription children's pain reliever (such as acetaminophen) or the symptoms continue after 48 hours, call a doctor.
Who To See
Health professionals who can diagnose and treat ear infections (acute otitis media) include:
● Family medicine doctors.
● Nurse practitioners.
● Physician assistants.
● Internal medicine doctors.
● Pediatric otolaryngologists.
Children who have ear infections often may need to see one of these specialists:
● Pediatric otolaryngologist