Ear Infections in Children

Seventy-five percent of kids will have at least one by their third birthday. And, according to health experts, almost half of those children will have repeated infections, suffering from three or more by the time they turn four. Since ear infections are the most common ailment in babies and young children, it's important to know their causes, symptoms, and cures. Here are the answers to all of your questions.

1. When to worry?

Ear infections often begin after a cold when fluid gets trapped in the middle ear and becomes infected by a virus or bacteria. Your baby pulling at her ear is not a very reliable sign that she has an infection. So look for these instead: 

• She’s crying more than usual.
• Ear infections are painful, so your baby may seem fuzzy and have trouble sleeping. An infection is especially likely if your baby becomes upset when she’s lying down.
• She’s had a cold for several days and now seems like she’s in pain. If your child has cold symptoms, and then suddenly seems more uncomfortable, have her ears checked.
• Many children with ear infections will have fever ranging from 101 to 104F. However, fever alone does not mean that your child has an ear infection. Usually, they’ll see other symptoms such as congestion, and ear pain, too.

2. My 2-year-old had four ear infections last year. Why is he so prone to them?

It helps to understand a bit about your child's anatomy: Each ear has three main parts -- the outer, middle, and inner ear. When the eustachian tube -- a small tube that connects the middle ear to the back of the throat and nose -- becomes swollen and irritated (usually because of upper-respiratory infections or allergies), there's no ventilation. As a result, the fluid that normally drains out of the ear becomes trapped. Germs flourish in that stagnant fluid, setting the stage for otitis media, which is the medical term for ear infection. Babies and toddlers are particularly vulnerable because their eustachian tubes aren't fully developed yet. They're shorter and less angled, making drainage more difficult.

3. My 3-year-old still gets ear infections, but my doctor says she'll probably outgrow them. True?

Yes, for several reasons. As kids' immune systems mature, they're better able to fight off germs. What's more, their eustachian tubes also become longer and more angled, so fluid drains more easily. Finally, the adenoids -- which can become inflamed and infected, sometimes blocking the eustachian tubes -- begin to shrink. Kids are most susceptible to ear infections between 6 and 18 months, when their eustachian tubes are still developing, but infections typically disappear almost entirely by the time a child is in first grade.

4. My son's ear is infected, but my pediatrician wants to hold off on prescribing an antibiotic. Isn't that the only way to make sure the infection clears up?

Not necessarily: Studies show that an estimated 80 percent of ear infections will get better on their own without treatment, and 60 percent of kids have less pain within 24 hours, even without antibiotic treatment. So your doctor is right to be cautious. In fact, the American Academy of Pediatrics and the American Academy of Family Physicians, concerned about the rise in antibiotic-resistant bacteria, recently issued new, more conservative guidelines for prescribing antibiotics. The doctors groups now recommend an immediate prescription only for babies under 6 months who have a diagnosed or suspected infection (because they're more susceptible to complications), and for children who have underlying health issues such as immune disorders or a cleft palate. Antibiotics are also recommended for kids with severe symptoms, such as high fever or extreme pain. If a child doesn't fall into any of those categories, the pediatrician may choose to wait two to three days and see whether the infection clears up on its own.

5. If my child doesn't get an antibiotic, what can I do to keep her comfortable?

Applying pressure to the ear with a warm washcloth or with a heating pad on a low setting can soothe some children. However, this isn't advised for infants. And being in an upright position can make the veins in the ear less distended, relieving some pressure and discomfort.

6. My son has had three ear infections since last month. Is there anything we can do to prevent him from getting another?

Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things parents might want to do to lower your child’s risk for ear infections.

• Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year.
• It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated.
• Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu.
• Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections.
• Don’t allow sick children to spend time together. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.