I just managed to catch yet another cold from my cute, little patients who felt that they could “squeeze in” one more cold before officially closing out the sick season! Parents are so SICK of their children being SICK and I must agree...it is time for everyone to stop coughing and sniffling and get well, and that means fewer ear infections as well.
Ear infections are one of the most common reasons that a parent brings a child to their pediatrician. But, not every child that has a runny nose, cough, fever, or pulls on their ear will have an ear infection. In fact, most will not.
Several important facts about an ear infection: a child’s ears typically do not get infected on the first day of a viral upper respiratory infection, most ear infections occur between day 3-7 of a cold. Most children who will develop an ear infection will have a runny nose, congestion, cough and often develop a fever. It is not unusual for a child to have a fever for the first few days of a cold, but a fever that develops 3, 5, 7 days after the beginning of a cold may be a red flag for an acute ear infection.
The newest guidelines on ear infections are quite clear and state that the pediatrician needs to distinguish between an acute otitis media (AOM), with a bulging and opaque ear drum versus those children who simply have serous otitis media (fluid behind the ear drum). Antibiotics are only recommended for those children with and acute ear infection who are symptomatic.
For children under the age of two years, especially those in day care or school situations who have a first AOM, amoxicillin is still the recommended drug of choice. It is inexpensive and well tolerated (and tastes good too). For children with recurrent ear infections second line drugs will be used.
For a child over the age of two years who is not running a high fever or in exquisite pain, the newer guidelines advise “watchful waiting” with treatment beginning with topical ear drops for pain and acetaminophen or ibuprofen. In the older child the infection is less likely to be bacterial and more likely viral and therefore will not respond to antibiotics. I will give the parents a prescription for an antibiotic with instructions to begin it if the child seems to be worsening over several days, and to call me to let me know they started the antibiotic. In over 75% of my patients, they never begin antibiotics and the symptoms improve and the ear infection resolves on its own.
Discuss options for treatment with your own pediatrician and remember, judicious use of antibiotics is very important. Not every child who pulls on their ear or who has a “bad night” of sleep will require an antibiotic. All children must be seen to decide who has an ear infection. it is not a telephone diagnosis!