If your child has ever had an ear infection and/or suffers from recurrent ear infections; then you know they can really hurt and sideline your child for a few days.
But for most children, did you know that most ear infections will resolve spontaneously (up to 70% of cases) without the need for antibiotics?
I think this is great news for both parents and pediatricians alike. We see children all the time for parental worry that there might be an ear infection brewing behind that ear drum. Ear checks are important clinic visits even if you leave without a prescription.
The AAP recently updated their guidelines for diagnosing and treating ear infections in children and these guidelines highlight the importance of accurate diagnosis, the judicious use of antibiotics, and parent/provider working closely as a team.
So, parents, here’s what you should know:
Not all ear tugging and/or pain is an ear infection
Little ears will be tugged at and/or hurt for a variety of reasons and ear pulling alone is not a reliable sign of an inner ear infection (aka acute otitis media). Now, severe pain in conjunction with a history of cold symptoms and new onset fever is a different story.
But the true diagnosis is not something that can be made over the phone. Your child’s doctor needs to look into the ear to visualize the ear drum (tympanic membrane). This is where our handy otoscopes (aka “ear flashlights”) come in. If we see bulging in the presence of fluid behind that ear drum, then we can make the diagnosis of acute otitis media fairly confidently.
Remember ears can hurt if congested due to a run of the mill cold and/or seasonal allergies. This does not mean they are infected but does mean that supportive treatment of the underlying cause (i.e. ibuprofen/acetaminophen, allergy medication, and cold symptom relief) and pain control are important.
Who should get antibiotics?
Any child who presents with severe ear pain in the presence of a high fever (over 102 F) and bulging of the ear drum on exam or a ruptured ear drum (fluid draining from ear) will benefit from prompt treatment with antibiotics.
In addition, infants/children 6 months-2 years old with a double ear infection will need antibiotics.
If eyes and ears are infected (the conjunctivitis/otitis combo), then your child will be receiving a different antibiotic to take care of that bug (Augmentin vs. Amoxicillin).
Why it might be better to wait
For everyone else? Waiting 2-3 days could save your child from a full 10 day course of antibiotics knowing that you have access and close follow up with your child’s doctor. Just remember to treat that pain with the appropriate amount of acetaminophen and/or ibuprofen.
Antibiotics are not without risk
I see so many children who end up with a rash and/or allergic reaction while on antibiotics. Granted some of these children may simply have a viral rash (there are so many), unrelated to the antibiotics at all. So, those unnecessary antibiotics can surely cloud the picture.
In addition, overuse of antibiotics can lead to bacterial resistance and the evolution of “superbugs” and believe me, there is nothing super about having one of those.
Personally, I’d choose to go antibiotic free if it were my child and her ear infection was a “mild” one. Getting a reluctant child to take a medicine twice a day for 10 days is no easy feat for many of us!
Prevent
More than anything though, prevention is so important.
- Don’t expose your child to second-hand smoke.
- DO breastfeed for as long as possbile.
- DO make sure your child is up to date on his vaccines.
- DO treat any underlying seasonal allergies.
- DO seek help for recurrent and/or persistent infections. Untreated/unresolved infections can affect hearing and speech!
So, now you know…ear infections don’t always mean antibiotics and this is a good thing. Just make sure you have close follow up with your pediatrician so you can work together to get through the years of coughs, colds, and those pesky ear infections.
More reading on new AAP otitis media guidelines:
The Diagnosis and Management of Acute Otitis Media
Pediatricians Urged to Treat Ear Infections More Cautiously
Is It Really an Ear Infection?
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