What to do baby ear infection

Ear Infections in Babies and Toddlers

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Ear infections in babies and toddlers are extremely common. In fact, according to the National Institutes of Health, five out of six children will experience an ear infection before their third birthday.

"Many parents are concerned that an ear infection will affect their child's hearing irreversibly—or that an ear infection will go undetected and untreated," says David Tunkel, M.D., Johns Hopkins Medicine pediatric otolaryngologist (ENT). "The good news is that most ear infections go away on their own, and those that don't are typically easy to treat."

Childhood Ear Infections Explained

Ear infections happen when there is inflammation— usually from trapped bacteria—in the middle ear, the part of the ear connects to the back of the nose and throat. The most common type of ear infection is otitis media, which results when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.

If your child has a sore throat, cold, or an upper respiratory infection, bacteria can spread to the middle ear through the eustachian tubes (the channels that connect the middle ear to the throat). In response to the infection, fluid builds up behind the eardrum.

Children are more likely to suffer from ear infections than adults for two reasons:

Their immune systems are underdeveloped and less equipped to fight off infections.
Their eustachian tubes are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear.

"In some cases, fluid remains trapped in the middle ear for a long time, or returns repeatedly, even when there's no infection," Tunkel explains.

Ear Infection Signs and Symptoms

The telltale sign of an ear infection is pain in and around the ear. Young children can develop ear infections before they are old enough to talk. That means parents are often left guessing why their child appears to be suffering. When your child can't say "my ear hurts," the following signs suggest an ear infection could be the culprit:

Tugging or pulling the ear
Crying and irritability
Difficulty sleeping
Fever, especially in younger children
Fluid draining from the ear
Loss of balance
Difficulty hearing or responding to auditory cues

Signs that require immediate attention include high fever, severe pain, or bloody or pus-like discharge from the ears.

Pediatric Otolaryngology

Our pediatric otolaryngologists provide compassionate and comprehensive care for children with common and rare ear, nose, and throat conditions. As part of the Johns Hopkins Children's Center, you have access to all the specialized resources of a children's hospital.

Learn more about Pediatric Otolaryngology

Ear Infection Treatments

Most ear infections go away without treatment. "If your child isn't in severe pain, your doctor may suggest a 'wait-and-see' approach coupled with over-the-counter pain relievers to see if the infection clears on its own," Tunkel says.

The reason: Treating an infection with antibiotics may cause the bacteria causing the infections to become resistant to those antibiotics—and that makes treating future infections more difficult. Equally important, in most cases antibiotics aren't necessary. Otitis media tends to get better without them. While you may be tempted to treat your child's ear infection with homeopathic or natural medicine, Tunkel warns they aren’t well studied.

Your best bet is to work with your child's health care provider to determine the appropriate course of action. In nearly every case, treatment decisions depend on the child’s age, degree of pain and presenting symptoms.

Under 6 months

Babies under six months almost always receive antibiotics. At this age, children are not fully vaccinated. Equally important, there's no research about the safety of skipping antibiotics for babies under 6 months of age — and complications from ear infections can be more severe when they occur in young babies. Bacteria trapped behind the eardrum can spread to other parts of the body and cause serious infections.

6 months to 2 years

For children between the ages of 6 months and 2 years, the American Academy of Pediatrics (AAP) recommends shared decision-making between parents and providers about whether to treat ear infections that are not severe. The best course is often to watch the child for two to three days before prescribing antibiotic treatment. If the child is in pain, or the ear infection is advanced, your child's doctor may suggest immediate antibiotic treatment.

Over 2 years

With children over the age of 2, ear infections that are not severe are likely to clear on their own, without treatment. "In the meantime, you can treat pain with over-the-counter medications, such as ibuprofen or acetaminophen," Tunkel says. If there's no improvement after two to three days, antibiotics may be warranted.

Unfortunately, some children suffer from recurrent ear infections, sometimes up to five or six a year. Kids who get repeated infections may benefit from a surgical procedure where doctors insert small tubes in the eardrums to improve air flow and prevent fluid buildup. "Tubes don't prevent all ear infections, but they make managing them significantly easier," Tunkel explains.

Ear Infection Prevention

There are several steps you can take to reduce your child's risk of developing ear infections, including:

Vaccinate your child: Children who are up-to-date on their vaccines get fewer ear infections than their unvaccinated counterparts. The 13-valent pneumococcal conjugate vaccine (PCV13) protects against 13 types of infection-causing bacteria.
Consider breastfeeding: Breast milk contains antibodies that may help reduce the risk of ear infections and a host of other ailments. Whether you feed milk or formula, make sure your child sits up during feedings to prevent fluid from flowing into the middle ear.
Wash your hands frequently: The best way to protect your child against cold and flu is to keep your hands clean. Wash your hands with soap and water and scrub them clean for a full 20 seconds each time you visit the sink.
Steer clear of sick people: Don't allow your child to spend time with children or adults who are sick.
Avoid secondhand smoke: Studies show that children who are exposed to secondhand smoke are up to three times more likely to develop ear infections than those who don't have those exposures.

Whether your child has ear infections or not, it's important to ensure they're able to hear well. "No child is too young to have a hearing test," Tunkel says. "We use a variety of techniques to test infant hearing and we can identify a hearing problem even in newborns."

Home Remedies for Your Baby’s Ear Infection

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Warm compress

Try placing a warm, moist compress over your child’s ear for about 10 to 15 minutes. This may help reduce pain.

Acetaminophen

If your baby is older than 6 months, acetaminophen (Tylenol) may help relieve pain and fever. Use the medication as recommended by your doctor and the instructions on the pain reliever’s bottle. For best results, try giving your child a dose before bed.

Warm oil

If there is no fluid draining from your child’s ear and a ruptured eardrum isn’t suspected, place a few drops of room temperature or slightly warmed olive oil or sesame oil in the affected ear.

Stay hydrated

Offer your child fluids often. Swallowing can help open the eustachian tube so the trapped fluid can drain.

Elevate your baby’s head

Slightly elevate the crib at the head to improve your baby’s sinus drainage. Do not place pillows under your baby’s head. Instead, place a pillow or two under the mattress.

Homeopathic eardrops

Homeopathic eardrops containing extracts of ingredients such as garlic, mullein, lavender, calendula, and St. John’s wort in olive oil may help relieve inflammation and pain.

Preventing ear infections

Although many ear infections can’t be prevented, there are steps you can take to lessen your baby’s risk.

Breastfeeding

Breastfeed your baby for six to 12 months if possible. Antibodies in your milk can protect your baby from ear infections and a host of other medical conditions.

Avoid secondhand smoke

Protect your baby from exposure to secondhand smoke, which can make ear infections more severe and more frequent.

Proper bottle position

If you bottle feed your baby, hold the infant in a semi-upright position so formula doesn’t flow back into the eustachian tubes. Avoid bottle propping for the same reason.

Healthy environment

When possible, avoid exposing your baby to situations where cold and flu bugs abound. If you or someone in your household is sick, wash your hands often to keep the germs away from your baby.

Vaccinations

Make sure your child’s immunizations are up-to-date, including flu shots (for 6 months and older) and pneumococcal vaccines.

When to call the doctor

The Centers for Disease Control and Prevention (CDC) recommends seeing a doctor if your baby has any of the following symptoms:

fever higher than 100.4°F (38°C) if your baby is under 3 months, and over 102.2°F (39°C) if your baby is older
discharge of blood or pus from the ears

Also, if your baby has been diagnosed with an ear infection and symptoms don’t improve after three to four days, you should return to the doctor.

Ear inflammation in a child: how to prevent complications

Otitis media is one of the most common diseases in childhood. According to international statistics, 98% of children suffer from ear inflammation at least once, 60% experience the disease twice. What is effective prevention and how otitis is treated, said the otorhinolaryngologist of the Morozov Children's Hospital, Candidate of Medical Sciences, holder of the status of "Moscow Doctor" Alexander Mikhailovich Ivanenko. nine0003

Why does otitis occur?

Depending on the location of the inflammatory process, otitis can be external, medial or internal. Otitis externa is caused by microbes and fungi, most often manifested by damage to the skin of the ear canal and boils in the auricle.

Acute otitis media is an acute inflammation of the mucous membrane of the middle ear cavity. It develops against the background of respiratory infections. Ear infection occurs through the auditory tube, when mucus from the nasopharynx enters the middle ear and viruses, bacteria, fungal flora freely penetrate from the nasopharynx through the mouth of the auditory tube into the tympanic cavity. nine0003

Due to anatomical features, the smaller the child, the shorter and wider the auditory tube connecting the ear cavity with the nasopharynx. Therefore, in an infant who spends most of his time lying down, and in a younger child who does not know how to clean his nose, mucus can flow at any time. In adolescent children, the auditory tube is a tortuous narrow tube, so the infection from the nasopharynx to the middle ear is less likely to pass.

Adenoid vegetations also contribute to the development of ear inflammation. This is an overgrowth of the nasopharyngeal tonsil, which is the main focus of bacterial infection in the nasopharynx. nine0003

How does the disease manifest itself?

The main symptom of otitis media is pain in the ear. Children under one year old, as a rule, refuse to eat, because sucking movements cause pain. Babies often touch their ears, rub them, and cry. You can suspect otitis media by pressing on the tragus of the child's auricle.

The key method for diagnosing otitis media is otoscopy - an examination by a doctor of the external auditory canal and eardrum using a special instrument.

How to treat otitis?

If the inflammatory process is at the initial stage, outpatient treatment is carried out. The therapy is selected by a pediatrician or an otorhinolaryngologist depending on the child's condition. Be sure to use vasoconstrictor drops in the nose.

If medical assistance is not provided in a timely manner, the inflammatory process turns into acute catarrhal otitis media, and then into acute purulent otitis media, characterized by the appearance of purulent discharge from the ear. In some cases, with inadequate outflow of contents or its absence, the child in the hospital undergoes paracentesis - an incision in the eardrum. The intervention is performed under anesthesia. Then medical conservative treatment continues. nine0003

Which preventive measures are most effective?

There is an opinion among many parents that otitis media can be prevented by “covering the ears with cotton wool in the street” or “putting a few hats on the child”. Such recommendations will not insure against otitis media.

Due to the fact that ear infection occurs through the auditory tube that communicates with the nasopharynx, it is necessary to carefully care for the nasal cavity if the child has a runny nose. Otherwise, mucus flows from the nasopharynx into the middle ear, which leads to an inflammatory process in the ear. nine0003

In case of excessive growth of the nasopharyngeal tonsil, its removal is recommended.

Otitis ear in a child - symptoms and treatment of otitis 2019.

Otitis media is the medical name for inflammation of the middle ear caused by an infection. The disease is most common in young children, this is due to the peculiarity of the structure of the ENT organs in babies (shorter and wider ear canal than in older children or adults). Acute otitis media is an infection that usually develops due to the accumulation of fluid in the middle ear. Otitis can be caused by viruses or bacteria. Most children with otitis media first develop an acute respiratory viral infection or acute respiratory disease, which then progresses to otitis media, causing inflammation and swelling in the nasal passages and the Eustachian tube. The risk of recurrent middle ear infections is increased in children who:

Attending a nursery or kindergarten
Exposed to cigarette or stove smoke in the home
Have enlarged adenoids that may obstruct the drainage of the Eustachian tube

Symptoms of acute otitis media usually include ear pain and fever. Otitis media with effusion (fluid or pus), also known as adhesive otitis media, occurs when there is fluid in the middle ear after the infection has cleared. This condition usually does not cause pain, but it can cause hearing loss in a child. nine0003

Children with acute otitis media usually get better quickly with anti-inflammatory medication and proper care. Sometimes, if the doctor is sure that the disease is caused by bacteria, the child may be given antibiotics. Children who develop adhesive otitis media and other complications may need additional treatment with physical therapy.

Symptoms of otitis in children

Most children with acute otitis media will complain of ear pain. If the child is still small and does not know how to speak, otitis may be indicated by a long aching cry, the refusal of the child to breastfeed. Other symptoms may include:

Irritability, capriciousness
"forced" position (if the pain is on one side, the child can put his hand to the ear or try to lie on the sore ear)
Lethargy, weakness
sleep disorders
fever
decreased or lack of appetite
vomiting

Because many cases of otitis media are caused by a viral infection, other symptoms associated with the infection, such as runny nose, watery eyes, or cough, can often be present. nine0003

Diagnosis of otitis media

If your child has had an earache for more than 2 days, or if your child is under 2 years old and you suspect that they have an earache, you should urgently seek help from an otolaryngologist, pediatrician, or general practitioner. Delay can threaten the fact that the child will lose his hearing or become completely deaf.

The doctor will examine the child's ears and eardrums with an instrument called an otoscope. In acute otitis media, the eardrum will be inflamed and bulging due to a buildup of fluid in the middle ear. The doctor will take the temperature and examine the child for other infections (such as bronchitis). There are no specific tests to diagnose otitis media. One of the effective diagnostic methods is ENT endoscopy using a flexible ENT endoscope, which is successfully carried out in our medical center by experienced ENT doctors. Such diagnostics are absolutely painless and can be performed according to the doctor's indications in the youngest children, from the age of 9months.

Treatment of otitis media

Your child's treatment will depend on his age and health.

It is generally assumed that children over 6 months of age who have mild otitis media initially receive only anti-inflammatory drugs. If symptoms persist for more than 48 hours or if they worsen, then broad-spectrum antibiotics may be needed. it is extremely important to prevent complications of the disease in any way. The first antibiotic of choice for the treatment of acute otitis media in children is amoxicillin. An alternative antibiotic will be given if the child is allergic to penicillin. Antihistamines and corticosteroids have not been shown to be of any benefit in the treatment of acute otitis media. nine0003

Possible complications

Perforation (rupture) of the eardrum is a common complication of acute otitis media in children. This can lead to leakage of fluid from the ear, while fluid or pus begins to flow from the middle ear cavity, which alleviates the child's condition: pain in the ear decreases due to reduced pressure on the eardrum. By itself, the rupture of the eardrum does not lead to deafness; in the process of treating otitis media, the integrity of the membrane is quickly restored. Treatment is the same as for acute otitis media. The child should not be immersed in water or go to the pool until the eardrum is healed. nine0003

Otitis media sometimes develops after an acute ear infection. This means that there is fluid in the middle ear (otitis media with effusion), which can cause temporary hearing loss. Most children with this complication recover within 3 months without the need for special treatment. In the chronic form of the disease, treatment with a tympanostomy may be required - inserting a small drainage tube into the eardrum to drain fluid and allow air into the middle ear to restore hearing. nine0003

Chronic suppurative otitis media is a middle ear infection with perforation of the tympanic membrane and discharge of fluid from the ear lasting for at least 6 weeks.