How can I tell if my child has an ear infection?
An earache is often the first noticeable symptom. Your child may tell you that his ear hurts. If you have a toddler and he can't talk yet, but seems cranky or is tugging at his ear, an ear infection is a definite possibility.
You may also notice the following symptoms:
- Reduced appetite. An ear infection makes it painful for your child to chew and swallow.
- Trouble sleeping. Lying down can make an ear infection more painful.
- Diarrhea or vomiting. The bug that causes the ear infection can also affect the gastrointestinal tract.
- Yellow or whitish fluid draining from the ear. This is an uncommon symptom in children, but it's a sure sign of infection. It also signals that a small hole has developed in the eardrum. (Don't worry – this will heal once the infection is treated.)
- Unpleasant smell. You may detect a foul odor coming from your child's ear.
- Trouble hearing sounds. Fluid buildup in the middle ear can block sound.
- Difficulty with balance. The ear helps with equilibrium, so you may notice that your child seems a bit unsteady.
How common are ear infections in children?
Ear infections are the second most commonly diagnosed illness in children in the United States (after the common cold). About half of babies have at least one ear infection by the time they turn 1 year old, and most have had at least one ear infection by age 3.
What causes ear infections in children?
An ear infection can be caused by bacteria or a virus. It happens when fluid builds up in the area behind your child's eardrum and then becomes infected.
Normally, any fluid that enters this area leaves pretty quickly through the eustachian tube, which connects the middle ear to the back of the nose and throat. But if the eustachian tube is blocked – as often happens during colds, sinus infections, even allergies – the fluid gets trapped in the middle ear.
Germs like to grow in dark, warm, wet places, so a fluid-filled middle ear is the perfect breeding ground. As the infection gets worse, the inflammation in and behind the eardrum also tends to worsen, making the condition more painful.
Fever may develop as your child's body attempts to fight the infection. The medical term for this condition – a painfully inflamed middle ear, an accumulation of fluid, a red eardrum, and sometimes a fever – is acute otitis media (AOM).
Using a pacifier may increase the risk of middle ear infections in babies and toddlers. In one study, the incidence of ear infections was 33 percent lower in babies who didn't use pacifiers.
Babies and young children are particularly susceptible to ear infections because they have short (about 1/2 inch), horizontal eustachian tubes. As children grow to adulthood, their tubes triple in length and become more vertical, so fluid can drain more easily.
When to call the doctor about an ear infection
Call at the first sign of an ear infection. The doctor will need to look in your child's ear with an instrument called an otoscope. An eardrum that's red, bulging, and possibly draining is probably infected.
The doctor may also check whether the eardrum moves in response to a device called a pneumatic otoscope, which releases a brief puff of air into the ear. If it's not moving, that's another indication that fluid is collecting in the middle ear and may be infected.
How to treat your child's ear infection
It depends on your child's symptoms.
Guidelines from the American Academy of Pediatrics (AAP) recommend watching your child for 48 to 72 hours to see whether his condition improves without antibiotics. (Eighty percent of children with AOM get better without antibiotics.)
If your child has severe symptoms, he may need antibiotics right away. For years, antibiotics were the first line of defense against an ear infection, but now doctors are prescribing them more cautiously. Taking too many antibiotics is a concern because it can set children up to be vulnerable to antibiotic-resistant infections.
The doctor will consider your child's age and symptoms and decide what's best. If your child does get a prescription, make sure you give him the entire course of antibiotics and follow up with an ear recheck a few weeks later so the doctor can gauge whether the medicine did its job.
Keep in mind that the antibiotic will not relieve your child's pain in the first 24 hours – in fact, it will only minimally affect it after that. What's more likely to help is the correct dose of acetaminophen or ibuprofen.(Don't give your child aspirin as it makes him more susceptible to Reye's syndrome, a rare but potentially fatal disorder.)
Holding a warm compress to his ear or using eardrops may also bring relief. (Ask your child's doctor which drops to use.) It may also be helpful to elevate your child's head when he's lying down.
If your child isn't getting better after a few days – or he's getting worse – call his doctor. The doctor may want to switch medications or start a course of antibiotics if you took the wait-and-see approach.
How to prevent an ear infection in your child
Ear infections aren't contagious, but the respiratory infections that accompany them are. Here's what you can do to prevent them:
- Wash hands. The best way to reduce the spread of germs is for everyone in your household to wash hands often – and always after using the toilet, changing diapers, and before eating or preparing food.
- Keep your child's vaccinations current. The pneumococcal vaccine has been shown to help reduce the number of ear infections. If your child has suffered repeated ear infections, especially after bouts of the flu, you may also want to consider an annual flu shot for your child.
- Keep your child away from all tobacco smoke. Researchers have concluded that kids whose parents smoke are more likely to get ear infections and have hearing problems.
Kids living with a smoker have a 37 percent higher risk of middle ear infections and hearing problems and a 62 percent higher risk if the mom is the household smoker. Kids are also 86 percent more likely to receive surgery for their middle ear problems when their mothers smoke, compared with children who have no smokers in their household.
Even a weekend spent in a house with a smoker can be harmful and raise your child's chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your child to fight off infection. Don't let people smoke in your house, and keep your child out of smoky environments.
Do ear tubes help to prevent ear infections?
Kids who get multiple ear infections – which can actually be one ear infection that lingers for months despite antibiotic treatment – may be good candidates for ear tubes. This procedure is performed on about 670,000 children in the United States each year.
Getting ear tubes inserted is done under general anesthesia. An otolaryngologist (an ear, nose, and throat doctor) makes a tiny incision in the child's eardrum and inserts a small tube into the slit. The tube releases pressure and acts as a vent, letting air in and fluid out so bacteria can't flourish.
"It's an artificial eustachian tube that allows the ear to 'breathe' until the real eustachian tube regains its normal function," explains Robert Ruben, an otolaryngologist at Montefiore Medical Center in New York.
Your child's doctor may suggest this surgical solution because a child with persistent fluid in his ears (or otitis media with effusion) is a prime candidate for repeated ear infections and hearing loss.
Also, although the research is inconclusive, some experts suggest that hearing loss resulting from persistent fluid in the ears can lead to delays in language development.
Ruben cites research that found children with persistent ear problems have specific hearing difficulties later in life, especially when listening to speech in a noisy environment like a classroom.
"In addition," he says, "some of these children – especially those with developmental delays and those who have specific language delays – are more susceptible to behavioral problems." The length of time the child suffered hearing loss as well as the extent of the impairment are important factors, Ruben says.
The AAP recommends tubes for children with a hearing loss of over a certain level, for children with structural damage in the middle ear, and for children with persistent middle ear infections or persistent fluid accumulation.
What should you do? Talk with your child's doctor and weigh the pros and cons for you and your child.
Are children's ear infections ever serious?
They can be. A severe or untreated infection can rupture your child's eardrum. Ruptures don't happen very often and generally heal quickly, but it's important to follow up with your child's doctor to make sure the infection has cleared up and that the eardrum is healing well.
Repeated ear infections can sometimes cause hearing loss and scarring. And in very rare cases, untreated ear infections lead to mastoiditis (a skull infection behind the ear) or meningitis.