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Ear Infections Are a Pain!

Ear Infections Are a Pain!
As with most new parents, you've probably heard about - and learned to dread - one of the most common illnesses in infants and toddlers: ear infections. Seventy-five percent of children will get an ear infection before they turn 3, and nearly half of these children will get at least one ear infection a year before they enter preschool, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

What Causes Them?
Ear infections can occur as complications of viral upper respiratory infections, which often result in fluid collection behind the eardrums, says Dr. Linda A. Waggoner-Fountain, assistant professor at the University of Virginia School of Medicine. When the viruses or bacteria that cause sore throats and colds spread to the middle ear and infect this fluid, the eardrum becomes inflamed.

How Will You Know?

Parents often wonder how will they know if Baby is suffering from an ear infection?

"Because an infant can't tell you, 'Hey, Mom, my ear hurts!' most signs and symptoms of infection in babies are very nonspecific," says Dr. Laura Weathers, medical director at Tampa General Hospital in Tampa, Fla. "Parents may notice that the infant is not feeding well or not sleeping as well as usual. The infant may have fever or irritability."

These symptoms don't necessarily indicate an ear infection - they could be signs of a number of illnesses or even teething - but they should alert you that something's not quite right with your baby. For a clear diagnosis, take Baby to the pediatrician, who will use a light instrument called an otoscope to examine the outer ear and the eardrum. If the eardrum is inflamed, your child probably has an ear infection.

Why Do They Occur So Frequently?

One reason infants and young children may experience recurrent ear infections is the structure of the ear itself. The Eustachian tube, which connects the middle ear to the nose and throat, is oriented more horizontally than vertically in the ears of children, making fluid drainage more difficult. If fluid cannot drain, it can become a breeding ground for bacteria. Additionally, babies are less able than adults to fight off infections because their immune systems are still in development.

How Can You Prevent Them?

Before you abandon hope that your child can avoid recurrent ear infections, try to prevent them by following a few simple rules.

One is to "limit daycare exposure if possible," suggests Dr. Lori Bowers, assistant professor of pediatrics at the University of South Florida. Children in close quarters day after day tend to introduce bacteria and viruses to each other, causing repeated infections.

Another preventative measure: Don't smoke or allow your children to spend time around smokers. And, just as importantly, breastfeed as long as possible. Breastfed babies receive protective antibodies that reduce the chances of getting colds and subsequent ear infections. According to the Journal of the American Medical Association, formula-fed infants experienced a "two-fold elevated risk of first episodes of [ear infections] compared with infants exclusively breastfed for six months."

Studies have also shown that use of certain vaccines may help prevent ear infections. "The new pneumococcal vaccine (in the United States, it is marketed under the name Prevnar) was shown in a recent study to reduce the incidence of ear infections caused by the bacteria pneumococcus," says Dr. Weathers.

Pneumococcus is one of the most common causes of bacterial infections in children. Your doctor will have more information about pneumococcal vaccines and can tell you whether this potential preventative measure is appropriate for your baby.

How Are They Treated?

Even if you breastfeed your baby, don't smoke and limit daycare exposure, your child is still bound to get an ear infection at some point. Perhaps your child's weeklong cold suddenly turns into something more: He has a high fever and seems to feel worse, not better.

Once your doctor peers into his ears, and you receive the diagnosis, then what? "Babies with infections that are due to bacteria are typically treated with 10 days of antibiotics," says Dr. Waggoner-Fountain. "The most common is amoxicillin."

If your child experiences repeated infections, your doctor might prescribe a stronger medication or higher dose of amoxicillin to try to knock out resistant bacteria. However, if the infection is viral rather than bacterial, antibiotics will not cure the infection. Your child's illness will eventually resolve itself, but in the meantime, you can give your baby ibuprofen or acetaminophen for fever and pain with your doctor's approval.

Note that not every doctor is enthusiastic about prescribing antibiotics for every ear infection. According to Dr. Bowers, between 50 and 80 percent of ear infections would go away on their own without medication.

"Some [doctors] would advocate a 'watch and see' approach prior to treating, given the increased rates of bacterial resistance," Dr. Bowers says.

In other words, liberal use of antibiotics like amoxicillin may result in an increase of bacteria that no longer respond to traditional treatments. However, many parents are nervous about leaving an ear infection untreated while they "watch and see" if it will go away without antibiotic treatment. Talk to your doctor to discuss both the risks and benefits of using antibiotics for your child's infection before you decide which route to take.

Is There Hope?

The good news: Even if your child experiences recurrent ear infections today, he will get fewer infections as he gets older. "By school age, the Eustachian tubes change to a more vertical angle allowing for better drainage from the middle ear," Dr. Weathers says.

In the meantime, some parents suggest you can comfort your child with massage and other natural treatments. Gently massaging Baby's neck and under or behind his ears in a downward direction can be soothing and might help passages drain mucous. Homeopathic treatments like Hyland's Earache Tablets, which may have a soothing effect on your child, are another option. Always consult your doctor before trying any type of medication - "natural" or not.

Ear infections seem to be a fact of life for parents and their babies. Talk to your doctor, limit your baby's exposure to other children in confined spaces (within reason), don't smoke and watch for symptoms.

Knowing the facts about what causes ear infections, how to prevent them and how to treat them can help reduce the amount of time you and your child spend in the doctor's office - and waking up at night.

How can I tell if my baby has an ear infection?

The easiest way to tell if your baby has an ear infection (also known as acute otitis media) - or any other illness, for that matter - is a change in his mood. If he turns fussy, or starts crying more than usual, you should be on the lookout for a problem. If he develops a fever (whether slight or high) you have another big clue. Ear infections tend to strike after a common cold or sinus infection, so keep that in mind too. You may also notice the following symptoms:

• Your baby pulls, grabs, or tugs at his ears. This may be a sign he's in pain. (However, babies do pull on their ears for all kinds of reasons or for no reason at all, so if your baby seems fine otherwise, he probably doesn't have an ear infection.)

• Diarrhea. The virus that causes ear infections can also affect the gastrointestinal tract.

• Reduced appetite. Ear infections can cause gastrointestinal upset. They can also make it painful for your baby to swallow and chew. You may notice your baby pull away from the breast or bottle after he takes the first few sips.

• A yellow or whitish fluid draining from the ear. This doesn't happen to most babies, 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 on its own once the infection is treated.

• A foul odor emanating from the ear.

What causes ear infections?

An ear infection results when fluid and bacteria build up in the area around your baby's eardrum. 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) when your baby yawns or swallows. But if the Eustachian tube is blocked - common during colds, sinus infections, even allergy season - it traps the fluid in the middle ear. Bacteria like to grow in dark, warm, wet places, so a fluid-filled ear becomes the perfect breeding ground. As the infection worsens, so does the swelling in and around the eardrum, and, as a result, the pain. Fever develops as your baby's body attempts to fight the infection.

Babies are particularly susceptible to ear infections because their Eustachian tubes are short (about 1/2 inch) and horizontal. As they grow to adulthood, the tube triples in length to 1 1/2 inches and become more vertical, so fluid can drain more easily. Ear infections are one of the most common childhood illnesses. Although there are no statistics on how many babies get them, the American Academy of Pediatrics expects that most children will have gotten at least one ear infection by the time they turn 3.

When should I call the doctor?

Call the doctor at the first sign of an ear infection. She'll ask you to come in so she can take a look in your baby's ear with an instrument called an otoscope. An eardrum that's red, bulging, and possibly draining is likely infected. She may also look to see 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, you have one more clue that fluid is collecting in the middle ear and it may be infected.

How will the doctor treat my baby's ear infection?

Though recent research shows that many ear infections eventually clear up on their own without any treatment, when it comes to babies, doctors will almost always reach for an antibiotic. "With young infants it's usually better to err on the side of caution and prescribe something," says Robert Ruben, an otolaryngologist (ear, nose, and throat doctor) at Montefiore Medical Center in New York. In addition, your doctor may recommend that you give your baby children's acetaminophen or ibuprofen to help relieve any pain caused by the infection.

Make sure you give your baby his entire prescription of antibiotics and follow up with an ear re-check a few weeks later so the doctor can gauge whether the medicine did its job. Don't hesitate to call your doctor if your baby seems to be getting worse or hasn't improved significantly after a few days on the antibiotic. She may want to switch the antibiotic or examine your child again.

What can I do to prevent ear infections in the future?

Babies who attend daycare or playgroups with other children are more prone to getting ear infections because they're exposed to more germs. That doesn't mean you should keep your baby home all the time. That's not fun or practical and even if you managed to do it, your baby would still catch an illness here or there. Instead, wash your hands (and your baby's hands) often, and try these prevention ideas:

Keep your baby up to date on his vaccines. They help prevent certain illnesses that can lead to an ear infection. For example, the Hib vaccine has helped tremendously in reducing the number of ear infections in babies, and the new pneumococcal vaccine can help prevent them as well. If your baby has suffered repeated ear infections, especially after bouts with the flu, you may want to consider an annual flu vaccine, but talk to your doctor first. Only children over 6 months old can get a flu shot.

Breastfeed your baby for a minimum of six months. A recent study from the Centers for Disease Control and Prevention and the Food and Drug Administration, which appeared in the journal Pediatrics, showed that children who are breastfed for the first six months of life are less likely to develop ear infections. In fact, the risk of ear infections was 70 percent greater in formula-fed babies. Practitioners such as Ruben believe that mothers transfer certain immune-building antibodies to their babies through breast milk. However, those antibodies seem to decrease after the six-month mark.

Limit your baby's exposure to tobacco smoke. Even a weekend spent in a house with a smoker can significantly harm a baby and increase his chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your baby to fight off infection.

My baby gets repeated ear infections. Can ear tubes help?

Babies with multiple ear infections - which, for many children, is actually one ear infection that lingers on for months despite antibiotic treatment - may be good candidates for ear tubes. This procedure, known as tympanostomy, is the most common surgery performed in North America on children under 4, according to a study in the Canadian Medical Association Journal. In the United States alone, doctors perform roughly one million ear-tube insertions each year.

During the procedure, which is done under general anesthesia, an otolaryngologist makes a tiny incision in the child's eardrum and inserts a millimeters-long tube into the slit. These tubes act as a vent, letting air in and fluid out so bacteria can't flourish. "It helps the Eustachian tube work better," says Ruben.

Your pediatrician may suggest this surgical solution because a baby with persistent fluid in his ears (or otitis media with effusion) is not only a prime candidate for repeated ear infections but also for hearing loss. Babies who have trouble hearing may suffer delays in language development.

Still, the procedure is considered controversial and there's little consensus among doctors on whether it's really necessary. Studies have shown that some babies who've had recurrent ear infections are a little behind when it comes to school readiness. But somewhere between ages 2 and 5 the connection between chronic ear infections and decreased school readiness disappears, says Joanne E. Roberts, a senior scientist at the Frank Porter Graham Child Development Center at the University of North Carolina in Chapel Hill. Children with chronic ear infections eventually perform on par with their peers who didn't battle ear troubles in the first few years.

What should you do? Talk to your doctor and weigh the pros and cons for you and your baby. Unfortunately, there's no definitive answer to the ear tube question yet.

Are 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 they generally heal quickly, but it's important to see your child's doctor for a follow-up to make sure that the infection has cleared and that the eardrum is healing well. Repeated ear infections can sometimes lead to hearing loss and scarring. In very rare cases, untreated ear infections can lead to an infection of the skull behind the ear (mastoiditis), or meningitis.

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