By Nancy Gottesman
Some toddlers get them every month. Others, a few times a year. Even the most robust young children will likely come down with at least one during their preschool years.
In fact, three out of four kids will have a minimum of one ear infection by their third birthday, and half of those kids will have more than three!“In our clinical setting, ear infections are the second most common reason [the first being common cold/upper respiratory infections] for a child’s sick visit,” confirms Lisa deYbarrondo, MD, a pediatrician and an assistant professor of pediatrics at the University of Texas Medical School at Houston.
Although acute otitis media—as you’ve probably heard your pediatrician call an ear infection—mainly affects infants and toddlers, the condition becomes a family problem when you have to keep your sick child at home.
The National Institutes of Health estimates that in America, parents’ lost wages and toddler medical costs amount to $5 billion a year due to ear infections alone. Here’s what you need to know about treating and preventing this common childhood ailment. What causes an ear infection?
Have you ever wondered why you and your adult friends never seem to come down with ear infections? The first reason: Your immunity is stronger than your toddler’s developing immune system and keeps you from catching everything your child gets. Second, child-size anatomy actually promotes otitis media, the clinical term for inflammation or infection of the middle ear. (Swimmer’s ear, in case you’re curious, affects a different part of the ear and is called otitis externa.)
A toddler’s eustachian tube— which allows air into the middle ear and equalizes pressure there—is shorter and more horizontal than an adult’s. Because of this formation, the tubes are susceptible to blockage from mucus and can’t easily drain. When fluids collect in these normally air-filled tubes, it creates a breeding ground for germs.
An infection ensues, causing swelling, redness, hearing problems and sometimes a whole lot of pain. Whether the germs are bacterial or viral—or a mix of both—disease-fighting white cells in the bloodstream enter the middle ear, leading to the formation of pus as the cells kill the bacteria and die off themselves.
What all of this means is that even a minor case of barely noticeable kiddie sniffl es can result in a much more worrisome ear infection. So can a cold virus, influenza and RSV (respiratory syncytial virus, the most common cause of lung inflammation in young children).
“Germs can even get blown into the middle ear from sneezing or nose-blowing and cause infection,” says Dr. deYbarrondo. The good news is that by the time your child is in preschool, she’ll have a great deal fewer ear infections. “After she’s 3 years old, you’ll see a rapid decline in the amount of ear infections your child will get,” deYbarrondo says.
NEXT: WHEN SHOULD YOU CALL THE DOCTOR?
When should you call the doctor?
A 3- or 4-year-old is able to communicate that his ear hurts or feels funny and plugged up. But how can a parent ID a possible ear infection in a 1- or 2-yearold? What are the signs and symptoms? “Older toddlers can usually articulate discomfort,” says Nancy Young, MD, a pediatric otologist at Children’s Memorial Hospital in Chicago. “With younger children, it usually comes out in their behavior.” Here’s what to look for:
» Crying more than usual
» Fluid coming out of the ear
» Unresponsive to quiet sounds or other signs of hearing problems like turning up the TV volume or inattentiveness
» Difficulty sleeping (because lying down can cause uncomfortable pres sure changes in the ear)
» Fever, nausea or vomiting » Lack of appetite
» Pain (caused by fluid buildup pushing on the eardrum)
» Ear tugging (though this is a lot less common than you may think) Ear infections are often associated with upper respiratory symptoms such as a cough or a runny-stuffy nose. Many times, however, your child won’t have any nasal-related signs.
He may simply tell you that he hears “popping” sounds and appear to be normal otherwise. If your child exhibits any of the symptoms we’ve outlined here, be sure to call your pediatrician, who will determine whether you need to bring your child into the office. Although uncommon, complications can result if an ear infection is not caught and treated.
NEXT: WHAT’S THE BEST TREATMENT?
What’s the best treatment?
Your pediatrician will check your child’s ears with an otoscope, enabling him to detect infl ammation and fLuid. What a doctor can’t determine is whether the ear infection is viral or bacterial.
Antibiotics have no effect on viruses— which cause up to one-third of all ear infections—or even on some types of bacteria that have become resistant due to overuse of antibiotics. Another downside: Antibiotics kill off beneficial organisms in the body and, hence, can lead to rashes as well as gastrointestinal problems like diarrhea and nausea. Not long ago, antibiotics were prescribed if there was even a hint of an ear infection.
Recent research published in the Journal of the American Medical Association, however, has shown that most ear infections resolve on their own in two to three days without antibiotics.
This study found that the “WASP” approach— a “wait-and-see prescription” for antibiotics, which parents are asked not to fi ll unless the child isn’t better in 48 hours—substantially reduced unnecessary antibiotic use. “In the U.S., there seems to be a fear that if a child doesn’t get antibiotics, he won’t get better,” says David M. Spiro, MD, director of pediatric emergency medicine at Doernbecher Children’s Hospital at Oregon Health & Science University in Portland, and one of the coauthors of the study. “But in Europe, the observational approach is used by doctors 80 percent of the time, and has proven very successful and not dangerous.”
Spiro believes the WASP method is the smart way to go in most cases. Of course, there are exceptions to this observational WASP approach. Waiting two days to fi ll an antibiotic prescription just isn’t a realistic option in some cases. The American Academy of Pediatrics recommends antibiotics for children less than 2 years old who have a fever over 102 degrees, have fluid in their ears and have had a rapid onset of ear-infection symptoms.
Older toddlers with severe earache or high fever should also be prescribed antibiotics. For everyone else, waiting and seeing (though difficult for parents) is the best way to go. If your child is better in 48 hours, tear up the prescription. If not, head to the pharmacy—but not before calling your pediatrician, who may want to examine your child again. One more thing to remember: “Antibiotics don’t address ear pain,” reminds Spiro. “It’s important that parents ask their doctors about prescribing ear drops to reduce the earache.” Also ask about children’s ibuprofen, which can relieve your child’s ouch factor and promote pain-free sleep.
NEXT: THE BEST STRATEGIES TO PREVENT EAR INFECTIONS
The Best Strategies to Prevent Ear Infections
» Nurse as long as possible. Breastfed kids have far less incidence of ear infection.
» Steer clear of secondhand smoke. Children who live with smokers are more prone to otitis media.
» Wash hands frequently! Keep all the hands in your family squeaky clean to reduce the risk of person-to-person transmission of germs.
» Immunize on time. An ear infection vaccine applied to the surface of a child’s skin may be on the horizon. For now, keeping up with vaccines will keep your child healthy and less likely to develop ear infections.
» Don’t let your toddler drink from a bottle while lying down. Some studies suggest a causal link between milk accumulation in the eustachian tubes and infection, although it hasn’t been proven.
What doesn’t work?
Antihistamines, decongestants and tonsillotomies (removal of a child’s tonsils). And even though a 10-year-old study showed that gum containing xylitol seemed to prevent ear infections in young children, there were minor side effects. “Prevention was only indicated in some of the children who chewed at least five pieces a day,” says the University of Texas’ Lisa deYbarrondo, MD. “And some of these kids got stomachaches from chewing too much gum.”
NEXT: A RUPTURE, OR MORE?
A rupture, or more?
Untreated ear infections can result in a lot more than a distressing earache. The one that worries moms and dads the most—but shouldn’t—is a ruptured eardrum caused by the pressure of fluid buildup in the middle ear. “Ruptures are the body’s way of resolving an ear infection and aren’t serious in young children,” explains Nancy Young, MD, a pediatric otologist at Children’s Memorial Hospital in Chicago. “Parents are very concerned about permanent damage, but that’s very uncommon.” A ruptured eardrum typically heals all by itself within two months. More serious complications include:
Persistent fluid and hearing loss.
This occurs when fluid doesn’t go away and the eustachian tube becomes blocked repeatedly due to allergies or numerous ear infections. The constant presence of fluid in the middle ear can lead to fluctuating hearing loss. “Parents need to be attuned to this,” Young says. “They assume it’s an attention issue when it’s really about a child’s hearing.” To treat this, a tube is inserted into the affected ear, which aids drainage and keeps the pressure equalized. After about a year, the ear pushes out the tube naturally and spontaneously. In most cases, new tubes will not be necessary.
This is a rare but severe infection of bone behind the outer ear that can result from otitis media and lead to bone deterioration. It’s curable with intravenous antibiotics and surgery, but treatment can take a long time.
This infection, which causes inflammation in the brain and spinal cord, is also a rare but very grave complication that can result from untreated otitis media. Meningitis is a medical emergency that requires hospitalization for treatment.
Nancy Gottesman, a writer in Santa Monica, Calif., remembers inspecting the “monkeys” in her son’s ears when he was a toddler.
With school back in session, you’ll want to be on the lookout for this common toddler ailment.