Nancy Dover knows all too well the relentless discomfort caused by ear infections. As the mother of two, she's had her share of sleepless nights, last-minute trips to the doctor and frantic calls to the pharmacy.
She's become something of an expert in detecting the symptoms—especially the most obvious one. "I can always tell when one of my kids has an earache," says Dover, of Carmichael, CA. "That child cries all night."
It's a cry that most parents of young children quickly learn to interpret: Next to colds, middle-ear infections (called otitis media) are the most frequently cited reason for visits to the doctor. Seventy-one percent of children have at least one incident by the age of 3, and 46 percent have at least three.
Typically, a middle-ear infection sets in after a cold has been raging for at least two or three days. Normally, the middle-ear cavity produces small amounts of fluid that usually drains out through the eustachian tube, which connects the middle ear to the back of the nose. When the eustachian tube becomes swollen because of a cold, sinus infection or allergy and stops functioning properly, fluid begins to accumulate.
Otitis media actually comes in two forms: otitis media with effusion (OME), where there is fluid in the middle-ear canal but no signs of acute infection; and acute otitis media (AOM), where there is both fluid and a bacterial or viral infection that causes inflammation and pain (see page 85 for the differences between the two).
The fluid accumulation and the resulting pressure on the eardrum can cause anything from discomfort and temporary hearing loss to extreme pain. For parents of children who've never before been through either form of middle-ear infection, however, it can be difficult to figure out what's wrong, especially if their child isn't talking yet. But there are several symptoms to look for, and if you see any of them, you should call the doctor.
- Loss of appetite and sleeplessness.
- The desire to be held more than usual.
- Yellow or white discharge from the ear, caused by a tiny rupture in the eardrum.
- A fever ranging from 100 to 104 degrees, but only in a child suffering from AOM.
- Ear tugging, though this isn't as common a clue as many people believe; but if your child is constantly poking his finger into his ear or shaking his head, that may indicate a problem.
- Some loss of hearing, although in most cases it gradually returns to normal after the infection subsides. If your child keeps asking you to repeat what you just said, that could be a sign. With babies, it's more difficult to tell and potentially more worrisome, since hearing loss could affect your baby's language development. If you suspect a problem, have your child's hearing checked with an audiometer.
Benjamin Spock, M.D., is a contributing editor and the author of Dr. Spock's Baby and Child Care.
Soothing The Ouch
When an infection strikes, there are several things you can do to soothe your child until you can get her to the doctor.
Give acetaminophen or ibuprofen (never aspirin) for pain, but don't bother with cold medicines.
To ease some of the pressure, keep your child's head elevated. If she's over 2 and no longer sleeps in a crib, it's fine to use a pillow when she lies down. Keep a baby upright in a car seat. Once she's begun to feel better, put her to sleep in her crib again. But never use a pillow with an infant.
A warm, moist towel applied to your child's face near the ear can also help. With an older child, you can use a heating pad, but be cautious: Put it on the lowest setting, wrap it in an additional towel or receiving blanket, and keep it away from water. Never use a heating pad on a baby.
If there is no discharge, alleviate the pain by using a dropper to put two to three drops of room-temperature sesame or olive oil into the external ear canal. If there's pus, gently tuck a cotton ball into the external ear.
Swallowing opens the eustachian tube and drains the fluid from the middle ear, so you can try having a child 4 or older chew sugarless gum. Have babies drink plenty of liquids. In fact, both of these may also help prevent a cold from turning into an ear infection in the first place.
At the doctor
While antibiotics are still recommended when the infection is severe enough to cause distress, many doctors now prefer to hold off prescribing them to give the body an opportunity to fight off the infection on its own. (This is especially true with OME, since the fluid tends to disappear by itself in about 85 percent of cases.) The principle reason for this wait-and-see approach is to avoid creating drug-resistant strains of bacteria. When an infection is treated with drugs, some of the hardier bacteria can survive and pass on their resistance to that particular antibiotic to their descendants.
Drugs can always be prescribed later if your child gets worse. If the pediatrician does recommend an antibiotic, be sure to give the entire dosage over the prescribed length of time—even if symptoms disappear. Otherwise, some bacteria may survive and cause another infection.
Ear infections usually show signs of improvement in two to three days with treatment, but some children suffer from them repeatedly. If this is the case, or if an infection lasts longer than three months, the doctor may suggest inserting tympanostomy tubes. After making a small incision in the eardrum and draining the fluid from the middle ear, the doctor fits a tiny plastic or metal tube into the incision. Effective in about 80 percent of cases, the tubes keep the air in the middle ear circulating and help prevent the accumulation of fluid. They usually fall out on their own within 9 to 15 months. In some cases, they need to be removed by the doctor. The greatest disadvantage, however, is that they have to be surgically inserted, a procedure that requires general anesthesia.
What makes your child more susceptible?
If you have one child who consistently suffers from ear infections, your other children are likely to as well. Boys also tend to get more infections than girls.
Babies who are on a bottle are more vulnerable because they don't benefit from the partial immunity passed along through breast milk. And those who drink while lying down or who fall asleep with their bottles are at particular risk, since milk can drain through the eustachian tube and into the middle ear, where it can become a perfect medium for bacteria. Nor is it advisable to prop a bottle on a pillow and leave your baby unattended while he drinks. You can reduce the chance of infection by holding your baby upright when you feed him.
Sucking on a pacifier may also increase the likelihood of a middle-ear infection. Some experts believe the constant sucking motion may pull fluid out from the nose and throat and into the middle ear. Pacifiers can also be carriers for germs, so if your child has already had several ear infections, you may want to take the pacifier away.
Children who breathe secondhand tobacco smoke are more likely to have ear infections, as are children who regularly play indoors with others, either in day care or preschool, since they are exposed to more colds and viruses. This doesn't mean children should avoid such groups, but if yours has frequent ear infections, you may want to consider changing to a small-group setting.
In a few cases, an allergy to cow's milk and dairy products can also be a factor. If you suspect your child has an allergy, consult with your doctor and try eliminating all dairy products from her diet for six to eight weeks. Then monitor her closely for any signs of improvement.
The younger a child is at the onset of his first ear infection, the higher his chance of coming down with repeated bouts. Fortunately, the risk tends to subside at around age 4, probably because the eustachian tube lengthens, widens, and becomes more vertical, making it harder for bacteria-laden fluid to back up. Then, finally, children (and their parents) can be assured of a good night's sleep.