Ear Infections in Babies and Children

Ear infections are one of the most common infections in babies and children, and are especially common in the winter. They can accompany many viral infections that are frequent this time of year. Ear infections also account for a large proportion of antibiotic use in children. It’s very important in this day of antibiotic resistance that your child’s health care provider accurately diagnoses an ear infection and makes sure they are treated appropriately to clear the infection without increasing their resistance to antibiotics.

Signs to Watch For

Most ear infections happen in babies and children before they can speak and tell you what hurts. Watch out for signs of infections to make sure your babies and children get diagnosed and treated early. Common signs and symptoms include:

• Excessive fussiness and crying
• Poor sleep with frequent wakening
• Fevers
• Discharge from ear
• Poor appetite
• Troubles with balance
• Trouble hearing
• Complaints about ear pain (from older children)

Why Do Ear Infections Happen More Often in Babies and Younger Children?

Babies and younger children have smaller eustachian tubes that don’t yet function as well as they do in older children and adults. The eustachian tube is a structure that sits behind the nose in the skull and equalizes the pressure of the ear space. When children have viral infections like an upper respiratory infection, inflammation and congestion allow bacteria to overgrow and infect the ear space. Babies and younger children also do not fight off viruses or bacterial infections well due to their immature immune systems.

What to Do If Your Child Might Have an Ear Infection

Make an appointment with your primary provider as soon as you can. Many other infections and causes can look like an ear infection and need a different treatment.

Make sure your child is treated correctly to allow for improvement and reduce developing resistance to antibiotics. If you can’t make an appointment with your primary provider, an urgent care clinic is appropriate for treatment. Your provider will look at the child’s ear drum or tympanic membrane with an instrument called an otoscope and look for signs of infection like bulging, redness, and dullness.

Treatment for Ear Infections

Typically, the treatment is a 10-day course of an antibiotic, usually amoxicillin. Amoxicillin is used because it is welltolerated, effective, inexpensive, and directly treats ear infections. Most children tolerate amoxicillin well but watch your child for signs of difficulty like rash, excessive diarrhea, or showing poor response. If these do happen, contact your primary provider for further instructions. If your child is allergic to penicillin or amoxicillin, alternative antibiotics can be used to clear the infection.

If amoxicillin is not effective, often the provider will change the antibiotic to Augmentin ES which is a combination of amoxicillin and clavulanic acid. If neither amoxicillin or Augmentin ES is effective, antibiotics can be changed to clindamycin, levofloxacin, or even Rocephin injections.

Typically, children are remarkably improved after 3 days of treatment, but it is very important to complete the full 10-day course of the antibiotic to make sure the infection is cleared and to prevent future antibiotic resistance.

Pain Control for Babies and Children

Tylenol, ibuprofen, or a combination of the two is most important for pain control. Infants with less pain sleep better, feed better, and are much less fussy. Discuss the proper weight-based dosing for each medicine with your primary provider. Topical agents for ears such as lidocaine and benzocaine are not licensed in the U.S. and have been associated with severe reactions in babies and small children. These should be avoided.

Follow up as directed by your primary care provider to make sure the infection is cleared. If your baby or child is not dramatically improved after 3 days of treatment, contact your primary provider.

Boone Clinic and Tiger Pediatric providers are happy to see your baby or child to resolve ear infections or other complications.

BY James Liesen DO, Pediatrician with Tiger Pediatrics