Treating Ear Infections: What Parents Need to Know

Ear infections, known in the medical field as acute otitis media (AOM), are one of the most common childhood illnesses. Some kiddos are lucky enough to experience only a handful of ear infections, while others are affected so frequently they're members of the "ear infection of the month club." All kidding aside, ear infections cause pain and discomfort for many children and lead to missed days of daycare, school, and work. As a parent or caregiver, understanding AOM and its treatment options can help you provide the best care for your child. This guide will explain what AOM is, how it's diagnosed, and the current recommended treatments based on official guidelines.

What is Acute Otitis Media?

Acute otitis media is an infection of the middle ear, characterized by inflammation and fluid buildup behind the eardrum. It's most common in infants and young children, often occurring as a complication of an upper respiratory infection like a cold or the flu. Congestion builds up, and the fluid in the ear stays still, providing the perfect breeding ground for germs to take hold. A young child's anatomy makes them especially prone to AOM; the tubes in the ear canal lie horizontally, making fluid backup even more likely to occur.

Signs and Symptoms

The main symptoms of AOM in children include:

• Ear pain (otalgia)
• Fever
• Irritability or fussiness
• Trouble sleeping (laying down may be uncomfortable!)
• Tugging or pulling at the ear (debatable, but often anecdotally reported by parents)
• Decreased appetite
• Difficulty hearing or responding to sounds

In infants, symptoms may be more general and can include:

• Increased crying
• Restlessness
• Difficulty feeding

Diagnosis

If you suspect your child has an ear infection, reach out to your child's doctor. Only a healthcare provider can diagnose an ear infection, as they must visualize the middle ear. Your doctor may evaluate:

1. History of symptoms: How long have the symptoms been present? How is your child acting?
2. Physical examination: Using an otoscope, the doctor will examine your child's ears, looking for redness and fluid behind the eardrum. They will also assess for other signs of illness.
3. Pneumatic otoscopy: This involves using a small puff of air to see how the eardrum moves, which can indicate the presence of fluid. This might be done at a specialist's office in the setting of recurrent ear infections.

Treatment Options

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have established guidelines for treating AOM in children. One of the main goals of these guidelines is to ensure that healthcare providers are using antibiotics judiciously. As parents, we all want our child to feel better, fast! But we also must be good antibiotic stewards, meaning that our kids get the right drugs at the right time – and this includes NOT receiving drug therapy when it's not needed.

The overall AOM approach depends on several factors: the child's age, severity of symptoms, and how certain the provider is that there is an infection.

Pain Management

Regardless of whether antibiotics are prescribed, managing your child's pain is important. Even if your child does not need an antibiotic, it is recommended to treat their discomfort. The AAP recommends using acetaminophen or ibuprofen as needed. Never use aspirin in a child due to the risk of Reye's syndrome.

Antibiotics vs. Observation

Sometimes, ear infections can clear up on their own thanks to the body's own natural defenses! A healthcare provider can discuss your child's unique case with you and provide a recommendation on whether antibiotic treatment is needed.

In general, the decision to use antibiotics or observe without antibiotics (also known as watchful waiting) depends on a patient's age and how severe their infection is.

For children under 6 months:

• Antibiotics are recommended for all cases of AOM.

For children 6 months to 2 years:

• If the diagnosis is certain (big red bulging eardrums), antibiotics are recommended.
• If the diagnosis is uncertain, antibiotics may be recommended if:
  • The ear pain is moderate or severe
  • The ear pain has lasted more than 48 hours
  • The temperature is 102.2°F (39°C) or higher
  • Both ears are affected
• If the diagnosis is uncertain, watchful waiting may be recommended if:
  • The ear pain is mild
  • The ear pain has been going on for less than 48 hours
  • The patient is afebrile or has a low-grade fever
  • Only one ear is affected

For children 2 years and older:

• If the diagnosis is certain and symptoms are severe, antibiotics are recommended.
• If symptoms are mild to moderate, observation for 48-72 hours may be appropriate.

Antibiotic Treatment

When antibiotics are prescribed:

• Amoxicillin is typically the first-choice antibiotic, unless there's a penicillin allergy. Amoxicillin is preferred in children because it can be given twice a day and it tastes better than penicillin. Bubblegum flavor, anyone?
• The dose of amoxicillin for ear infections is dependent on your child's weight. Higher doses of amoxicillin are used for ear infections than for other illnesses like strep throat.
• The usual course of therapy is 10 days, though shorter courses may be considered for older children with mild AOM. Research on duration of therapy is ongoing.
• It's crucial to complete the entire course of antibiotics as prescribed, even if symptoms improve. Not doing so could lead to a recurrence of infection and antibiotic resistance!

Watchful Waiting

If your doctor recommends watchful waiting:

• Use pain relievers as needed. Acetaminophen or ibuprofen are usually appropriate.
• Monitor your child's symptoms closely. If severe pain emerges, reach back out to your pediatrician.
• Follow up with your doctor in 48-72 hours if symptoms don't improve or worsen.
• Be prepared to start antibiotics if necessary.

What if the Ear Infections Keep Coming Back?

Some children get recurrent ear infections. Your doctor will evaluate how much time has elapsed since their last course of antibiotic treatment. If several ear infections occur in a short span of time, your provider will likely recommend trying amoxicillin-clavulanate (Augmentin), which is a combination antibiotic that contains an extra ingredient known as clavulanate.

The clavulanate – or "clav" as the cool pharmacists call it – helps the amoxicillin be more effective against bacteria that are resistant to amoxicillin. If amoxicillin-clavulanate doesn't work, healthcare providers will move on to a drug class known as the cephalosporins. Cefdinir is a cephalosporin commonly used for amoxicillin-resistant ear infections or for those with amoxicillin allergies.

If cephalosporins stop working, children are often referred to see a specialist known as an ENT, or ears, nose, and throat doctor. These specialists will evaluate your child and may recommend a procedure such as ear tube placement.

Prevention

Unfortunately, AOM is difficult to prevent. Kids catch respiratory illnesses like a catcher catches a baseball. As we know, respiratory illness + small ears = increased risk for ear infections. While not all cases of AOM can be prevented, some strategies may help reduce the risk:

• Breastfeeding infants for at least six months may provide some protection against ear infections.
• Avoid exposure to secondhand smoke. This is important for so many other health reasons, not just for preventing AOM.
• Keep your child's vaccinations up to date, including the annual flu shot.
• Good hand hygiene will reduce the likelihood of catching a virus that can lead to upper respiratory infection. (I chuckled as I wrote this. Toddlers and hand hygiene...)

Conclusion

Acute otitis media is a common childhood illness that, while uncomfortable, can usually be managed effectively. By understanding the symptoms, treatment options, and when to seek medical care, you can help ensure your child receives appropriate treatment and recovers quickly. Always consult with your healthcare provider for personalized advice and treatment.

The following references were used to compile this information:

American Academy of Pediatrics. (2013). The Diagnosis and Management of Acute Otitis Media. Pediatrics, 131(3), e964-e999.

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., ... & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999.

This article has been reviewed by Andrea Morrissey, PharmD, Board Certified Pediatric Pharmacy Specialist, and Chief Content Officer of Kids Med Guide. The content is for educational and entertainment purposes only and does not replace professional medical advice. Always consult your healthcare provider for medical guidance, and call 911 in an emergency.

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