BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer
Ear infections are distressing to both children and parents. They can be a viral or bacterial infection that affects the middle ear. The middle ear is the space behind the eardrum that is normally air filled and contains tiny bones that vibrate in response to sound. Frequently ear infections can clear up on their own, but in infants and severe infections antibiotics are indicated. Long term issues such as hearing problems, can be a consequence of frequent or persistent infections.
When a child has an ear infection there is inflammation and fluid can build up in the middle ear. This causes pain. Some children may show little change in behavior, only a slight decrease in activity, whereas others will cry and be very fussy, not want to eat and have difficulty sleeping.
You may also notice your child pulling on their ear, having a fever of 100.4F or higher, acting fussy and irritable, crying a lot more than usual, having difficulty hearing or drainage from the ear.
When your child has an upper respiratory infection, a cold, or they have allergic rhinitis there can be swelling, inflammation and/or mucus in the Eustachian tubes causing an accumulation of fluid in the middle ear. The adenoids are in the back of the throat at the base of the Eustachian tubes. If the adenoids enlarge due to infections or inflammation they can play a role in blocking the normal drainage of the Eustachian tubes and therefore play a role in middle ear infections. This is one of the reasons it is important to keep your infant/toddler nose free of mucus when they have an upper respiratory infection.
The risk factors for ear infections include – the age between 6 months and 2 years as they have an immature immune system; group daycare as they are exposed to frequent infections; bottle fed infants who lie down with their bottle or take the bottle to bed; seasonal allergies and exposure to second-hand tobacco smoke and high levels of air pollution all can play a role in ear infections.
What can be done to reduce the risk of an ear infection? There are several things that can help, such as not exposing infants and toddlers to second hand smoke; if possible breast feed your infant for at least 6 months, but if your infant is bottle fed just be sure to always feed them in an upright position and never allow them to have a bottle in their crib or bed; try to avoid exposing your infant to others with upper respiratory infections (this is not always possible), and if your child does get an cold with congestion use saline nasal spray to loosen the mucus and a bulb suction or Nose Frieda to remove the mucus. The other action you can take is to discuss pneumococcal and flu vaccines with your pediatrician to help decrease the risk of infections.
You might have noticed that your pediatrician has a wait and see approach within the first 1 to 2 days of symptoms, since most ear infections clear up on their own. They will want to monitor your child closely. This is consistent with the recommendations from the American Academy of Pediatrics to adopt a wait and see approach for children ages 6 months to 23 months with mild pain in one ear for less than 48 hours and a temperature less than 102.2F; or a child 24 months or older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2F. Since every child is different and antibiotics may be indicated in many situations, it is important to have an open dialogue with your pediatrician on this issue.
What will help your child feel better when they have an ear infection? If they have fever over 100.4F they can be medicated with acetaminophen and if over 6 months of age ibuprofen. A warm moist compress/washcloth held over the affected ear can lessen pain. There are drops the provider can prescribe that also help. If they are on an antibiotic, giving it as prescribed is very important. It usually takes at least 48 to 72 hours for the majority of the symptoms to subside. Always complete the antibiotic; not doing so can result in a recurring infection and bacteria resistant to antibiotics. If your child has recurrent infections, over 4 in a year with at least one in the past 6 months your pediatrician may refer you to an ENT specialist to evaluate the need for ear tubes.
The good news is that ear infections do decrease as a child ages and the Eustachian tubes become less narrow and less horizontal so they can drain easier.