What's New 

Author: Jane Kilian, M.D.
Clinic: Como/Roseville Clinic

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The American Academy of Family Physicians (AAFP) and the American Academy of Pediatricians (AAP) recently issued new guidelines for treating ear infections (otitis media) in children ages 6 months to 12 years. The guidelines stress the importance of treating the symptoms of the infection (pain, fever) but avoiding antibiotics in many, but not all, cases. Parents may be surprised by this change in policy. Information and education help us accept new ideas, so that is the purpose of this month's article.

 

     So, why the new guidelines? Research shows that many cases of otitis media will heal on their own. There are certain bacteria that commonly cause the infections, but without sticking a needle past the ear drum to collect fluid, doctors can only treat based on (common organisms). This means using what is called a (broad spectrum) antibiotic - one designed to kill several organisms. Overuse of antibiotics causes drug resistance - eventually the drugs don't work. Essentially, if you take antibiotics when you don't really need them, they might not work when you do need them.

 

     Ears are complicated and delicate systems of bones, canals, and fluid. They are connected to the nose and throat. Otitis media often begins with a cold, which causes increased fluid and swelling in the head, including in the ear tubes. Trapped fluid causes increased pressure (pain) and the fluid can become infected. Sometimes the eardrums can even rupture, in which case you will see pus, and or blood, draining from the ear. It looks dramatic, but eardrums actually heal quite well on their own.

 

     Middle ear infections affect almost all children at least once. The most common age range is 4 months to 4 years. Most children stop having ear infections by the time they are school age. However, adults can get ear infections too. Infants may pull at the infected ear – but don't be fooled - they often do this as they discover their ears. Other symptoms include pain, fever, irritability, sleeping problems, decreased appetite, and occasionally vomiting. If you think your child might have an ear infection, see your doctor. Together you can decide if your child needs antibiotics or if time is a better treatment.

 

     If you and your doctor decide not to use antibiotics, you can still provide care to make you or your child more comfortable. Pain relief can be accomplished by alternating acetaminophen (Tyienol, etc.) with ibuprofen (Advil). Give one or the other every four hours. Do not use aspirin for children as it can cause a fatal disease called Reye's Syndrome. Warm compresses applied to the ears is soothing. There are prescription ear drops available to lessen the pain. Your child may need to stay home from day care or school. Stay home with her.

 

 Do fun, but quiet activities: cuddle, read, nap together, make a special lunch (there is just something about sandwiches cut into 4 triangles, or cut into shapes with a cookie cutter, that makes a plain lunch seen like a treat). A little extra attention goes a long way toward relieving symptoms.

 

     You can help prevent ear infections in your child. Breast feeding for at least 4 months passes immunities to your infant. Don't let your baby drink from a bottle while lying down - this can force fluid into the ear canals. The Prevnar (pneumococcal) vaccine reduces risk of ear infections. Second hand smoke greatly increases the risk of infections as well as asthma. If possible, choose a small day care setting to avoid exposure to infections. If you smoke, you must go outside to smoke. Simply moving to another room isn't good enough. If you want to quit (hooray for you) talk to your doctor. Stay happy and healthy.