Doctronic

Understanding and Preventing Ear Infections in Children

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on August 22nd, 2023.

Key Takeaways

  • About 50% of children develop an ear infection before age 2 due to their shorter, more horizontal eustachian tubes that don't drain fluid effectively until around age 3.
  • Classic symptoms include fever above 100.4°F, pulling at ears, increased crying when lying flat, and temporary hearing loss—babies may refuse bottles due to pressure changes during swallowing.
  • Children in daycare face 2-3 times higher risk, while breastfeeding for at least 6 months reduces infection rates by up to 43% compared to formula feeding.
  • The "wait and see" approach is recommended for 48-72 hours since 60-80% of infections resolve without antibiotics, preventing unnecessary antibiotic resistance.
  • When antibiotics are needed, amoxicillin 80-90mg/kg daily for 10 days is first-line treatment, though high-dose amoxicillin-clavulanate may be used in areas with resistant bacteria.

Ear infections, also known as acute otitis media, are a common childhood ailment. About half of all children experience at least one ear infection before their second birthday. As a parent, it's essential to understand the causes, symptoms, and treatments of ear infections, as well as ways to prevent them and keep your child healthy.

What Causes Ear Infections in Children?

The middle ear is a small space behind the eardrum that contains tiny bones that vibrate and help with hearing. This area is supposed to be ventilated by air that passes through the nose, throat, and a passage called the eustachian tube. If anything blocks the air flow, the middle ear can become damp and warm, creating a perfect breeding ground for germs.

In babies and young children, the eustachian tube is often soft and has difficulty staying open. Several factors can prevent enough air from passing into the middle ear, including:

  • Allergies

  • Post-nasal drainage

  • Sinus infections

  • Common cold viruses

  • Problems with the tonsils

Understanding and Preventing Ear Infections in Children

Symptoms of Ear Infections in Children

If your child has an ear infection, they may experience the following symptoms:

  • Fever

  • Pain in the ear (babies may rub or pull on their ears)

  • Vomiting and diarrhea (in babies)

  • Trouble hearing

  • Crying or pain when sucking

  • Loss of sleep or appetite

Treating Ear Infections in Children

About half of ear infections resolve on their own without the need for medication. However, many children will require an antibiotic, usually amoxicillin, for 10 days. The drug typically starts working within a day or so.

In some cases, fluid may build up in the middle ear, blocking the eardrum and causing temporary hearing loss. This is common and can often be cleared up with another round of amoxicillin or a different type of antibiotic.

Preventing Ear Infections in Children

There are several steps you can take to help prevent ear infections in your child:

  1. Remove pollutants from your home, such as dust, harsh cleaning supplies, and tobacco smoke.

  2. If your child has allergies, work with their doctor to control them.

  3. Ensure everyone in your home, including your child, stays up to date on recommended vaccinations, including flu and pneumococcal vaccines.

  4. Make hand-washing a habit for your family.

  5. If your child attends day care, look for a center that monitors children for illness and requires sick children to stay home, especially during cold and flu season.

  6. Breastfeed your baby for at least 6 months, if possible, as formula-fed babies have a 70% higher risk of ear infections.

  7. If bottle-feeding, hold your baby's head higher than their stomach to help prevent eustachian tube blockage.

  8. Avoid group day care during your child's first year, if possible, to reduce exposure to germs.

  9. Avoid exposing your child to secondhand tobacco smoke, as it increases the risk of ear infections.

If your child does develop an ear infection, there are a few things you can do to help them feel more comfortable:

  • Avoid feeding your baby while they are lying down, as this can worsen ear pressure and pain.

  • Give your child over-the-counter acetaminophen (not aspirin) to help relieve discomfort, following the dosage advice on the label.

By understanding the causes, symptoms, and treatments of ear infections, as well as implementing preventive measures, you can help keep your child healthy and reduce their risk of experiencing this common childhood ailment.

For more information on ear infections in children, consult the following resources:

The Bottom Line

Most childhood ear infections resolve naturally within 2-3 days with pain management, making immediate antibiotics unnecessary in many cases. Focus prevention efforts on avoiding secondhand smoke, maintaining vaccinations, and breastfeeding when possible. If you're unsure whether your child's symptoms warrant treatment or have questions about managing their discomfort, Doctronic can provide quick guidance.

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