Spotting and Treating Your Baby’s Ear Infection

“I think she has an ear infection because she’s batting at her right ear,” Celeste said, referring to her 9 month old daughter, Bridget. They were in my office recently, and Bridget had a mild cold. But it was her fussing with her ear that brought Celeste in. Was Celeste correct? Is an infant playing with her ear a sign of an ear infection? The answer is a definite “maybe.”

Common Signs of Ear Infections

Your infant may show one or more of these signs if she has a middle ear infection:1

  • Ear pain, especially when lying down
  • Crying or fussiness more than usual
  • Ear drainage
  • Pulling, playing, or batting at her ear
  • More irritable than usual
  • Difficulty hearing
  • Fever
  • Headache
  • Loss of appetite
  • Trouble with her balance or walking

These symptoms are much more likely to be signs of an ear infection in the presence of an upper respiratory infection or cold.

Though Celeste is right that an infant batting at her ear can be a sign of an ear infection, especially in the setting of a cold, an infant playing or rubbing her ear, especially without other symptoms, is common, and is rarely due to an ear infection.2

In my practice, I find that waking up at night, though not specific, is the most common complaint among infants with ear infections.

Drainage is not always a sign of a middle ear infection. On occasion, the drainage is just soft or liquid wax coming from the ear. If the child is completely well with drainage, that is the usual cause. But more often, the drainage is true pus, and if so, then one cause is a ruptured ear drum from a severe middle ear infection. But in these cases, the cause is obvious: the infant is usually ill and complaining of severe pain or crying as if in pain, then showing relief of pain after the rupture.

Another cause of drainage may be swimmer’s ear, which is an infection of the ear canal and outer ear, not a middle ear infection. This is due to water in the ear, and may be from bathing, not necessarily from swimming. But this type of infection is uncommon in infants.

Treatment: Is it Necessary?

For years, physicians treated all ear infections with antibiotics. But with rising antibiotic resistance, physicians are rethinking that strategy. In 2013, the American Academy of Pediatrics released new guidelines on ear infections, recommending that not all ear infections need to be treated. Many of these infections are caused by viruses, for which antibiotics won’t work, and will resolve on their own.3

Basically, the guideline recommends treating the pain of ear infections with acetaminophen or ibuprofen, watching most ear infections (especially in older children), and treating with an antibiotic if they worsen. The guideline recommends treating with antibiotics the following:3

  • Children 6 months and younger
  • Children 6 months to 12 years with severe symptoms (but can watch and wait for those with non-severe symptoms)
  • Children with underlying conditions that put them at risk for complications (such as Down syndrome, cleft palate, cochlear implants, immunodeficiency, etc.)

The guideline encourages collaborative decision-making between the treating physician and the parents, and rechecking the child should her symptoms get worse. And if symptoms have not improved in 48-72 hours, then antibiotics are recommended. It should be noted that 80% of children with an ear infection get better without antibiotics.4

Prevention

While there is no guarantee that you can prevent all ear infections, there are steps you can take to reduce the chance that your infant will get one. The most important of these is to breastfeed your baby for as long as possible, and preferably for the first 12 months of life. Getting her immunized is another good prevention. Although the pneumococcal vaccine was designed to prevent pneumonia and meningitis in young children, an added benefit is that it helps prevent ear infections, too. And a yearly flu shot will prevent some ear infections, as well. Keeping your infant away from smoke is another helpful preventive measure.4

References:

  1. Mayo Clinic. Ear infection (middle ear).
  2. American Academy of Pediatrics. Ear–Pulling at or rubbing.
  3. Lieberthal AS, et al. Clinical Practice Guideline: The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99.
  4. American Academy of Pediatrics. Middle ear infections.
Ruben Rucoba
Dr. Rucoba has over 25 years of experience as a primary care pediatrician after completing medical school at the University of California, San Francisco. His clinical areas of expertise include caring for children with special health care needs and assisting families with international adoption. He has been a freelance medical writer since 2010, writing for health websites, continuing medical education providers, and various print outlets. He currently works at Wheaton Pediatrics in the suburbs of Chicago, where he lives with his wife and four daughters, including a set of twins.

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