One of the most common problems in the pediatric world is ear infections. Everybody has had at least one in their life and everybody has taken the “pink medicine” to get it better. But times have changed and the approach to ear infection management has changed as well. Today, we will talk about why kids get ear infections, signs and symptoms of a current infection, treatment options (even when not to treat!), and the dreaded need for “tubes.”
So first, why does my baby always get ear infections and other kids rarely have them? Well, let’s think about a few things. First, did you or your spouse have ear infections or other sinus problems as a child or adult? Family history is a good predictor of increased ear infections mainly because of the genes you pass on to your child that determine the anatomical structure of their ears. Our ears are a complex series of bones, nerves and drainage tubes that are responsible for hearing. If the drainage tubes are small, tortuous, or obstructed, then ear infections can occur. Now the obstruction can be from several things. Snot or congestion from allergies, viruses, or bacterial infections can be a culprit as well as enlarged tonsils. Once the drainage tubes are blocked, then the fluid behind the ear drum can’t drain, and infection can set in.
So, now we know why, but how do I know if my child has an ear infection? First, a child or infant pulling on their ears without any other signs or symptoms is rarely an ear infection. That symptom by itself usually represents teething or a sleepy habit or just discovering one’s ears! So, what signs are concerning for an ear infection? Well, you have to look for direct and indirect signs. They usually have congestion for several days and sometimes fever is found as well. But oftentimes, you see crankiness, waking up frequently at night, decreased feeding, maybe vomiting, and/or just an overall change in temperament in your child.
So, what now? My baby has an ear infection and has kept me up all night. Well, most infants and young children need to be treated with antibiotics and oftentimes need special drops for pain management until the infection can be resolved. Now, the issue over the last twenty years or so has been an overuse of the “pink medicine” or amoxicillin. While still a great medicine, the treatment plan has changed. Higher doses and other classes of antibiotics are also used to rid the ears of infection and hopefully not have continued resistance by the bacteria to the antibiotics. But what about older kids? And what about kids who don’t have symptoms? Oftentimes, these children can be observed off antibiotics for several days to see if any new symptoms arise or if the child improves on their own. These decisions can be discussed with your healthcare provider.
So now you have an infection, but it won’t go away. Your child took every dose of medicine as prescribed and it’s still there! Well, as
per above, sometimes your anatomy or continued obstruction from congestion prevents complete clearance. Also, sometimes the bacteria that are causing the infection have some resistance to the antibiotic and need another one. But won’t all these antibiotics hurt my child or weaken their immune system? No! If a child has an infection, then the antibiotics are appropriate and will work with your immune system to fight off the infection. The only times they are not indicated are if the child has just a viral illness and then treated with antibiotics.
So, what now? My child continues to have ear infections and now I’m worried about what this is doing to my child and what about hearing loss? These are valid concerns that need to be addressed with your healthcare provider; but overall, a few ear infections do not indicate a need for “tubes.” But, infections that are unable to be cleared, a child that has abnormal hearing, or multiple infections over a period of months might indicate the need for an evaluation by a specialist. And remember, just because you see a specialist doesn’t mean you have to get tubes! Ear infections are an unfortunate part of growing up, but you now you are armed with info.