Ear Infections

Ear infections are the number one reason children visit their physicians due to illness, following the common cold. According to the Centers for Disease Control and Prevention (CDC), ear infections in children account for more than 30 million physician office visits per year. More than 85 percent of three-year-old children have experienced at least one ear infection.

Causes

Ear infections are caused by trapped viruses or bacteria and swelling developing behind the eardrum (tympanic membrane) when the child has an upper respiratory infection. The eustachian tube opens into the middle ear, behind the eardrum. In children, this eustachian tube is smaller and more horizontal than that of an adult, and these factors cause the tube to become closed when swollen. The fluid is trapped in the middle ear because the eustachian tube is closed. Viruses and bacteria then multiply in this trapped area, resulting in an infected eardrum.

Symptoms

The main symptoms of an ear infection include behavioral changes, crying, tugging at the ear, fever, and irritability. Some children may complain of a sore throat from referral pain from the ear; others have diarrhea and vomiting. All of this is caused by the inflammation and fluid buildup that causes pressure on the tympanic membrane. The pain associated with ear infections usually only lasts about six hours, but these other symptoms may persist. Also, the child with an ear infection nearly always has a runny nose, which is associated with the swollen eustachian tube. The ear infection itself is not contagious, but the virus causing the runny nose can be passed on to each person who comes in contact with the child or items the child has touched.

Treatment

Most ear infections are viral in nature and are caused by the viral upper respiratory infections so common among young children. Antibiotics will not cure viral ear infections, but can be used to combat bacterial infections. However, in many cases the initial problem of the upper respiratory infection and related swollen eustachian tube continues even after antibiotic treatment, and the ear infection itself does not get better. This is not the "fault" of the antibiotic, but of the ear canal itself.

Antibiotics can now be given either one time per day or twice per day, so it is possible and preferable that the parent give the medicine at home. This is important because first, it helps the child see their parent as someone who is helping them to feel better. It also is less burdensome for childcare program staff. Once the child is being treated by a physician and doing well enough to interact in most if not all activities, he or she does not need to be excluded from childcare programs.

Prevention

A number of research studies have shown that breast-feeding decreases ear infections in infants. Bottle feeding, especially when given to a child lying down on his back, actually can increase the incidence of ear infections. Recent studies also suggest that pacifiers may contribute to acute ear infections. Passive smoking, or exposure to "second hand smoke" from cigarettes also increases the incidence of ear infection. A new vaccine called Prevnar, which is recommended by the American Academy of Pediatrics, immunizes the child against S. pneumoniae bacteria, which cause 40 percent of bacterial ear infections in children under the age of two. The new vaccine also protects against meningitis and pneumonia in children. Childcare providers may suggest to parents that their young children receive this vaccine. The annual flu vaccine also can decrease ear infections by reducing the incidence of upper respiratory infections due to the flu.

Good hand washing by staff, children, and parents, along with vaccines, breast feeding, avoiding cigarette smoke, and decreasing the use of pacifiers helps prevent ear infections.

The American Academy of Pediatrics' fact sheet on ear infections includes the following information: There are several risk factors for developing childhood ear infection, including:

Age. Infants and young children are more likely to get ear infections. The size and shape of their eustachian tubes make it easier for fluid to build up. Ear infections occur most often in children between three months and three years of age. Also, the younger a child is at the time of the first ear infection, the greater the chance he or she will have repeated infections.

Sex. Although researchers are not sure why, boys have more ear infections than girls.

Heredity. Ear infections can run in families. Children are more likely to have repeated middle-ear infections if a parent or sibling also had repeated ear infections.

Colds/Allergies. Colds often lead to ear infections. Children in group childcare settings have a higher chance of passing their colds to each other because they are exposed to more germs and viruses from the other children. Allergies that cause stuffy noses can also lead to ear infections.

Tobacco smoke. Children who breathe in someone else's tobacco smoke have a higher risk of developing health problems, including ear infections.

Bottle-feeding. Babies who are bottle-fed, especially while they are lying down, get more ear infections than breastfed babies. If you a child is bottle fed, hold his or her head above the stomach level during feedings. This keeps the eustachian tubes from getting blocked.

By Jim Poole, MD, FAAP
Early Childhood, Adoption & Care Committee
American Academy of Pediatrics

Internet Resources

American Academy of Pediatrics; www.aap.org/healthtopics/earinfections.cfm

Centers for Disease Control and Prevention; www.cdc.gov/ncidod/diseases/submenus/sub_ear_infection.htm

Kid's Health; www.kidshealth.org/parent/infections/ear/otitis_media.html

Kid's Health: www.kidshealth.org/parent/medical/ears/ear_infections.html

National Institute on Deafness and other Communication Disorders; www.nidcd.nih.gov/health/hearing/index.asp

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