Ear Infection, Easing the Pain

Two out of three children will have an ear infection before their first birthday, and eight out of 10 will have had one or more ear infections before the age of three.

Behind the eardrum is an empty space called the middle ear. When the middle ear becomes filled with fluid infected with bacteria (germs) or viruses, a child may develop a middle ear infection.

Below is a list of frequently asked questions about ear infections:

	Q.	Why do middle ear infections occur?
	Q.	Who are susceptible to ear infections?
	Q.	What are the common signs of an ear infection?
	Q.	When should I call a pediatrician?
	Q.	When should antibiotics be used?
	Q.	How can I ease the pain of an ear infection?
	Q.	What if the fever and pain from an ear infection does not go away?
	Q.	What happens after an ear infection goes away?
	Q.	What are the treatment options for children with chronic fluid in the ear or repeated ear infections?
	Q.	What can I do to prevent my child from getting an ear infection?

Frequently asked questions

Why do middle ear infections occur?

Middle ear infections are usually a complication of the common cold. The middle ear is connected to the back of the throat by a tunnel called the eustachian tube. With the congestion that accompanies a cold, the eustachian tubes become congested and blocked with fluid. An ear infection may occur when the fluid becomes infected by bacteria.

Who are susceptible to ear infections?

Ear infections occur most commonly in young children between the ages of three months and 4 years old. Although ear infections are a complication of the common cold, they can also occur from allergies if the nose and ears become congested. Ear infections may also occur by themselves, without colds or allergies.

Some children with a family history of ear infections are more prone to ear infections. In many cases, these children have middle ears that chronically retain fluid.

What are the common signs of an ear infection?

Pain is the most common sign of an ear infection. Fever is the second most common sign. Occasionally, children will have an ear infection with no fever at all. The pain may be anything from mild to severe, depending on the child and the kind of bacteria causing the infection. The pain is typically worse when a child is lying down, so ear infections often become apparent in the middle of the night. Infants and toddlers will not be able to say that their ears hurt, but they will tug on their ears, put their hands over their ears and act fretful (fussy or agitated).

When should I call a pediatrician?

A good guideline for parents of children older than three months is to call the pediatrician if a child has a fever and you suspect an earache. If it is nighttime and your child is not appearing very ill, the call (and the visit to the doctor's office) can wait until the next morning. For infants younger than three months, it is best to call your caregiver.

When should antibiotics be used?

Children with ear infections may be treated with a course of antibiotics (medications which kill germs).

However, without antibiotics, the majority of children with ear infections may get better within a week. In 60 percent of children, pain from an ear infection will go away within 24 hours with or without antibiotics.

For children with earaches who are not very ill, parents can discuss with their children's caregivers whether an antibiotic is advisable or not. If physicians and parents choose to hold off on starting an antibiotic, they should plan to meet in 48 hours if the symptoms (fever and/or fussiness) have not resolved.

How can I ease the pain of an ear infection?

Whether or not a child is prescribed an antibiotic, parents will want to relieve their child's ear pain. Using a non-aspirin medicine such as Tylenol® or Advil® is very effective if parents use the full dose on the label according to the child's weight. Applying a warm washcloth to the ear is also helpful for many children. Sitting up may also help alleviate your child’s earache. Older children who are able to chew gum without swallowing find that chewing gum helps ease their ear pain.

What if the fever and pain from an ear infection does not go away?

If the ear pain and fever does not improve within the first 48 hours – whether or not an antibiotic has been prescribed – you should get back in touch with your child's caregiver. For the child who has not been prescribed an antibiotic, the usual decision may be to prescribe one. For the child who is taking an antibiotic and is not getting better, it may be time to switch to a different antibiotic because of concern that the bacteria that is causing the ear infection is one that is resistant to the current medicine.

What happens after an ear infection goes away?

After an ear infection goes away, it takes a while for the middle ear to open up and get back to normal. Until then, the middle ear contains fluid, not air. In most children, this fluid is gone in six weeks, but in about 10 percent of children it will last three months or more.

What are the treatment options for children with chronic fluid in the ear or repeated ear infections?

For children with repeated ear infections or have had fluid in their middle ears for 4 to 6 months, the placement of ear tubes may be considered as a treatment option. The case for ear tubes is more compelling if hearing tests show that the child is having significant hearing problems.

Ear tubes are plastic tubes that are inserted through the eardrums by an ear, nose and throat (ENT) surgeon, usually with a general anesthetic in the hospital. These tubes usually stay in place for about six to 18 months allowing the middle ear to ventilate. The tubes usually fall out by themselves.

The placement of tubes is usually safe and most often they are effective in restoring hearing and reducing the numbers of ear infections. Like any medical treatment, parents ought to discuss with the caregiver the advantages and disadvantages, as well as possible risks and alternative treatments.

What can I do to prevent my child from getting an ear infection?

There are several things parents can do to help reduce the numbers of ear infections in their children:

Breast feed
Children who are bottle-fed get more ear infections than those who are breast-fed. There are several infection-fighting components in breast milk, including antibody proteins and active white blood cells. Also, breast-fed infants are more likely to be fed in a semi-sitting position, so milk doesn't tend to collect around the ear opening in the back of the throat. If you bottle feed, don't prop the bottle. Feed your baby semi-sitting, rather than with him or her lying down. Never prop the bottle on a pillow or let your child feed himself or herself while laying down. This is a matter of safety as well as ear infection prevention.
Keep your home smoke free
Second-hand smoke can increase ear infections in young children by 50 percent. It is an irritant to the upper respiratory passages, paving the way for infection into the middle ears.
Keep up with immunizations
Pneumococcal and the flu vaccines may reduce the occurrence of ear infections.
Prevent colds
Since colds are the most common precursor of ear infections, preventing colds in young children may prevent ear infections. The first line of defense is good hand washing to prevent the spread of viruses, particularly when a family member is ill. Infants and toddlers in a childcare setting with a lot of children are prone to more colds. Choosing a childcare setting with fewer children can be helpful in preventing ear infections.

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Ear Infection, Easing the Pain

Frequently asked questions