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Must-Read Guide to Babies and Ear Infections

"Doctor, I think my baby has an ear infection!" I hear this every day in my practice, and because ear infections are such a common cause of sleepless nights and missed work (not to mention just downright painful!), I spend a lot of time explaining what can be done to prevent them. Now, if you came to see me in my office (and you're always welcome to), here's how I would answer your questions.

Why are ear infections so common in babies?

Let's venture inside the middle ear to see how germs and tiny ears make such frequent contact. A canal called the eustachian tube connects the middle ear to the back of the throat and helps to equalize pressure. But the throat, along with the nose, serves as a moist breeding ground for bacteria. Because a baby's eustachian tube is short, wide and horizontal, throat and nose secretions—and any germs they may be harboring—travel more easily through it. Any fluid trapped in a cavity (such as the middle ear) acts as a medium for germs to grow, hence the frequent ear infections we see in many young children.

Why is it important to treat ear infections properly?

Your child's hearing depends on the proper vibrating of the eardrum and the structures of the middle. Repeated infections can damage the eardrum, while repeated fluid accumulation dampens the vibrations, both of which interfere with hearing. That's why it's imperative to take ear infections seriously, especially when your baby is learning to talk. Periodic hearing loss can lead to speech delays or even language problems that can affect her school performance later.

How can I spot an ear infection?

The following signs are babies' way of saying, "There's some painful stuff going on in my ear. Please take me to the doctor!" Early treatment makes for a better outcome, so if your baby has had several ear infections, learn to read his unique "sore-ear language." One sign you likely won't see is a fever. High temps don't often accompany an ear infection unless there's a more severe respiratory infection.

The nose knows In babies, middle-ear infections usually follow a cold, so what's coming out of the nose often reflects what's going on in the ear. A common scenario is that baby is mildly stuffy and has clear, watery nasal drainage, but isn't that sick—until a few days later when crankiness kicks in and the discharge becomes more yellow or green and snotty.

It's been a hard day's night

If baby is waking more frequently at night and seems to be in pain, especially with a worsening cold, that's also a red flag. As the infected fluid places pressure on the eardrum, he may not want to lie flat when napping or sleeping. To alleviate the pressure, position him so that the sore ear faces up.

The eyes have it

The rule in our practice is that when a parent tells us their baby has a cold and eye drainage, we see them that day. In the early months, eye drainage may simply signal a clogged tear duct, but when accompanied by a cold, especially in an older infant, it usually means an underlying sinus and/or ear infection.

If I suspect an ear infection, should I always take my baby to the doctor?

Usually. Ear infections are hard to treat blind—sort of like drawing a map when you're not sure where you're going. Your doctor needs to examine both the eardrum and the whole respiratory tract to make what is called the right "drug and bug" match.

Most mild to moderate ear infections will completely heal without the use of antibiotics, which is why the American Academy of Pediatrics recommends the "watch and wait" approach. "Watch" means to observe your child for signs that she is becoming sicker. "Wait" means the doctor may not immediately prescribe antibiotics for her, even if there is fluid behind the middle ear, unless she fails to improve on her own within two or three days.

He's tugging at his ears a lot, so why does the doctor say he's fine?

Ear-tugging doesn't necessarily signal an ear infection. It can be referred pain from teething or that baby is simply discovering his ears and likes pulling on them. However, if a baby has a cold, especially with nasal or eye drainage, and is pulling at his ears, the problem is likely not teething. Tugging, rubbing or banging on the ears can also be a sign that your child has some ear pain from persistent or chronic middle-ear fluid, a condition known as otitis media with effusion. In my practice I find that a mother's intuition is useful in alerting me that her baby is feeling worse. If you feel there's something more to your baby's symptoms, talk to your pediatrician.

How can I prevent ear infections altogether?

Now that you know how germs make their way into those little ears, here are some guidelines to keep that germy fluid from collecting behind your baby's eardrums:

  • Breastfeed: Mother's milk provides increased natural immunity.
  • Bottle-feed upright:  Feed baby in an upright position (at least 30 degrees) and keep her upright at least 30 minutes afterward.
  • Keep allergens at bay:  Irritants can cause fluid to build in the nasal passages and middle ear. Keep stuffed and real animals and other fuzzy things away while baby sleeps. And absolutely no smoking around baby!
  • Pass on pacifiers:  Studies show a correlation between the frequency of pacifier use and ear infections. Limit pacifier use to when baby is falling asleep at night, especially once she is 6 months or older.
  • Boost immunity:  Fruits, veggies and seafood have been shown to improve babies' developing immune systems.
  • She'll outgrow it:  The good news is that as your child grows, the eustachian tube becomes longer and narrower, and slants more acutely, making it more difficult for germs and fluid to collect in the middle ear. At the same time, her immune system matures, minimizing those pesky ear infections.

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