"An ear infection happens when you get infected fluid or pus behind the eardrum," says Jennifer Shu, MD, FAAP. She is a pediatrician in Atlanta and editor of American Academy of Pediatrics Baby & Child Health. The most common cause? Colds. When secretions get trapped in the middle ear, viruses or bacteria can cause an infection and result in a bulging or reddened eardrum.
Children under 3 are most susceptible to ear infections, Shu says. "They don't have strong immune systems. They haven't been exposed to many of these germs before, so it takes them a little longer to fight them off." Young kids also have more horizontal Eustachian tubes (channels that connect the middle ear to the throat), allowing fluid to collect instead of drain.
Fever may come with an ear infection, but not always, Shu says. Parents might spot other symptoms, such as earaches, ear drainage, trouble hearing or sleeping, ear tugging, poor appetite, vomiting, and diarrhea. But "for many children, it's just fussiness, crying more than usual, being clingy," Shu says.
If your child seems ill or has a fever, see a pediatrician. Babies under 6 months usually require antibiotics, Shu says, to prevent the spread of infection to other parts of the body. From 6 months to 2 years, the AAP recommends considering observation without antibiotics, as long as the child isn't severely ill. But at this age, if the diagnosis of ear infection is certain, it's usually best to treat with antibiotics. If your child is 2 or older, don't be surprised if the doctor recommends holding off on antibiotics.
"We try not to treat if it's a very mild infection or if they're not complaining that much," Shu says. According to the AAP, parents may choose to wait 48 to 72 hours and then start their child on antibiotics if there's no improvement.
Preventing Ear Infections
Shu offers these tips to help prevent childhood ear infections.
Breastfeed your baby for the first year. Breast milk contains antibodies and may cut risk of ear infections. If you bottle feed, keep your baby sitting up. Milk flows more readily into the middle ear if a child sucks on a bottle lying down.
Do your best to prevent colds. Clean your child's hands often. If you can, limit their time in group care or choose a setting with fewer children.
Keep your child's allergies in check. When mucus from allergies blocks the Eustachian tube, the chance of getting an ear infection increases.
Don't smoke. According to some studies, children who are exposed to second-hand smoke are two to three times more likely to get ear infections compared with other kids.
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