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    Ear Infections in Children

    Dr. Jung Smith, Family Medicine Family Medicine Physician 06/20/2014

    Did you know that more than three out of four children will have at least one ear infection by their third birthday? In fact, according to UpToDate, one of my reference materials here at Deaconess Clinic, between 60-80% of children have at least one ear infection by their first birthday, and 80-90% will by 2-3 years old.

    I’ll go over what causes ear infections, signs and symptoms, how to treat ear infections and offer some prevention tips.

    Causes of Ear Infections
    Ear infections are caused by both bacteria and viruses (and rarely, fungal infections). More than 90% are bacterial infections, and 70% are viral.  Yes, I know those numbers add up to more than one hundred percent--I often see ear infections that are both viral and bacterial.
    Here are some risk factors associated with ear infections:

    • Age.  The peak age for ear infections is 6-18 months.
    • Family history.  A child who has a family history of ear infections is more than 2.5 times more likely to have ear infections.  The reasons for this aren’t fully clear.
    • Day care. If there are more than four children in a day care setting, the risk is nearly 2.5 times greater than in children who are primarily cared for at home.
    • Lack of breastfeeding.  Not breastfeeding, or limited breastfeeding, is associated with an increased risk of ear infections.
    • Tobacco smoke, air pollution.  A child who is frequently around second hand smoke or overall unclean air has 66% increased risk in developing ear infections.
    • Pacifier use.  A small increased risk is noted among babies and small children who use a pacifier regularly.
    • Social/economic conditions.  Poverty and/or a crowded household can increase risk.
    • Season.  There is an increased incidence of ear infections in the fall and winter months.  This is because colds, allergies and upper respiratory infections are more common in these seasons, and these problems can lead to ear infections.

    Symptoms to Watch For
    Symptoms of ear infections are pretty consistent among children affected, and include:

    • Ear pain
    • Fever
    • Irritability
    • Headache
    • Lack of appetite
    • Lethargy (lack of energy—child just wants to lay down)
    • Sometimes vomiting and diarrhea

    Ear pain is possibly the best clear indicator of an ear infection.  Even small children who can’t yet talk will sometimes pull on their ear, or otherwise indicate that there’s something wrong.  (However, while ear pain is common, it’s not always present with every ear infection.)

    In severe ear infections, there may be discharge from the ear, or the ear may smell bad.  Sometimes there is a decrease in hearing ability, or even hearing loss in the affected ear(s).

    Treatment Options
    Depending on the cause and severity of the ear infections, as well as the age of the child, there are a few treatment options to consider.

    • If the child is two years or older, and they’re healthy overall without severe symptoms, we can watch/monitor the infection. Symptoms, such as fever and pain, can be addressed with acetaminophen (Tylenol).  However, if the symptoms persist longer than three days, antibiotics may be necessary.
    • If a child is younger than two and is exhibiting some or all of the symptoms listed above, they should be seen by their doctor right away. This is because symptoms are often noticed later in these younger children (because they can’t tell you about them), and if the infection goes on untreated, it can cause hearing problems.  Problems with hearing can affect learning.

    Chronic Ear Infections
    Recurrent/chronic ear infections are defined by how the child does over a three month period. For example, having an ear infection that persists over three months without fully resolving itself is considered chronic. Recurrent could mean that the child has had several ear infections—one right after the other—in a short period of time.

    When a child has this problem with ongoing/recurrent ear infections, I will refer them to an otolaryngologist, also known as an ENT (ear, nose and throat) specialist.

    The ENT physician will consult with the parents, and often the decision is made to have tubes put in the child’s ears.
    Ear Tubes

    “Tubes in the ears” means that small tubes are inserted into the ear drum to allow infected fluid to drain out of the middle ear (behind the ear drum) and improves air flow through the ear drum, which helps equalize pressure. This can help prevent the buildup of infection.

    A child having tubes put in their ears is a fairly common procedure, but parents are often anxious about it—which is completely understandable! If you are considering this option for your child, I encourage you to discuss your concerns with your doctor, and keep in mind the benefit of the procedure.

    Preventing Ear Infections
    Obviously, we can’t change family history or age, but we can address other risk factors.

    • Smoking is the biggest modifiable risk factor for ear infections. First of all, tobacco smoke is terrible for a child in lots of ways. In addition to contributing to ear infections, tobacco smoke is associated with asthma, upper respiratory infections/sinus problems, and overall, is not good for a child’s developing body.  So don’t allow anyone to smoke around a child, or even in the child’s home, as particles from smoking stay in the home even when smoking isn’t going on at the moment.  Also, don’t smoke in the car they ride in!
    • Prevent other illnesses with good hygiene. Because many ear infections are secondary to a cold or other respiratory infection, do what you can to keep your child healthy. I know this is easier said than done sometimes—but good hand hygiene, and avoiding crowds in the winter are some good tips. Vaccinations are also important. Some of the vaccinations a baby gets in their first year, such as pneumonia, and Hib, can prevent infections.
    • Breastfeed your baby if possible. Breastfeeding is known to have dozens of benefits for both baby and mother, and one of those benefits is a reduced risk of ear infections. Breastfeeding your child for even just three months measurably reduces the risk of ear infections.
    • If your child goes to daycare, and they’re not feeling well, keep them home. This can help prevent upper respiratory infections from getting worse (which can lead to ear infections), and also, it keeps illness from spreading from child to child.
    • Pacifier use is controversial, as pacifiers have benefits that can outweigh the small increased risk of ear infections. If your child is prone to ear infections, removing the pacifier may be something to discuss with your doctor.
    • Consider the age of your child. If you have an infant who is still breast/bottle feeding, try to maintain a good position. Keep the baby in a more upright position when feeding.

    I hope this has been helpful to any parents who have questions about ear infections in their child(ren).  Always talk to your child’s doctor if you have any questions.

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