You know the signs all too well: the cranky mood, the cold symptoms (runny nose and low-grade fever), the tugging on the ear, the loss of appetite and the difficulty sleeping. Yup, now that your child is a toddler, you've probably seen an ear infection or two (at least), and you can spot one from a mile away.
But what do you do when your tot keeps getting ear infection after ear infection? How can you treat them and end your tortured tot's pain? The answers below may help.
What exactly is an ear infection?
There are several types of ear infections, but the most common — technically called acute otitis media — usually develops along with a cold or other upper-respiratory infection, when the lining of the eustachian tube (the tube that connects the middle ear to the nose and the back of the throat) swells and gets blocked up. The blockage causes fluid to accumulate in the middle ear behind the eardrum, which then becomes a breeding ground for germs.
The pain and temporary hearing loss your toddler sometimes experiences is due to the blocked fluid putting pressure on the eardrum; the fever your child often develops is due to the infection in the middle ear that his little body is fighting. Note that your tot could have excess fluid in the middle ear without that fluid becoming infected.
Ear infections are one of the most common illnesses among children in the U.S., and young kids are much more prone to them than older kids and adults. Not only are the tubes in children's ears shorter and smaller, but the way they're angled makes it easier for fluid to get trapped and build up. Most kids have at least one ear infection by the time they turn 2.
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How many ear infections are too many?
One or two ear infections a year is fairly normal — never fun to handle, but normal nonetheless. However, if your child has three episodes in six months or four in a year (with at least one in the past six months), then you've got a case of recurrent ear infections.
It's also possible for your child to suffer from fluid that doesn't clear or an ear infection that doesn't resolve — different conditions that also require treatment.
What causes chronic ear infections?
No one knows exactly why one child gets more ear infections than another — or why one child's ear infections may linger — but the following factors can raise the risk.
- Day care. Kids in day care are exposed to more germs and bugs than kids who don't go to day care.
- Living with a smoker. Research shows children who grow up around smoke have greater incidences of ear infections. High levels of pollution can also increase the risk of ear infections.
- Family history of ear infections. If relatives got them frequently, your child may get them frequently too.
- Allergies. They can cause the upper airways and eustachian tubes to become inflamed or irritated.
- Siblings. Having one or more siblings means more germs brought into the household.
- Living in areas with long winters. Kids in these regions often get more upper-respiratory infections, which usually precede ear infections.
- Gender. Boys tend to get more ear infections than girls, though experts don't know the reason.
- Age. Children younger than 18 months are more prone to ear infections than older kids because babies' and young toddlers' immune systems are less developed and their eustachian tubes are smaller.
- Premature birth. Children who were born prematurely tend to have more ear infections than other kids.
- Bottle propping. Even if your baby can hold a bottle herself, you'll still want to feed it to her. Besides creating a choking risk, bottle propping can also increase the likelihood of ear infections because liquid can enter the eustachian tube.
- Missing vaccinations. Getting the flu shot and pneumococcal vaccine can help prevent some ear infections.[1]
- Other underlying health problems. They may compromise a child's immunity and make him more susceptible to ear infections. Genetic conditions associated with certain anatomical differences — Down syndrome, for example — can also increase the risk.
What's the treatment for an ear infection?
In recent years, doctors have cut back on using antibiotics to treat every ear infection. One reason is that ear infections that are caused by viruses (as opposed to bacteria) would not respond to antibiotics anyway.
Also, it turns out that most ear infections clear up without these meds after two or three days, and giving your child too many antibiotics can put him at risk for becoming resistant to these potent drugs when they're really needed. Plus, the overuse of antibiotics contributes to the creation of superbugs in our communities that are resistant to treatment.
What most pediatricians do now is take a wait-and-see approach with ear infections — which means they hold off on giving antibiotics at the first sign of an ear infection to see if it gets better on its own. Pediatricians often suggest acetaminophen or ibuprofen for pain relief. (Ibuprofen isn't approved for babies younger than six months.)
Sometimes, though, antibiotics are needed — especially when the infection is severe — so talk with your doctor about what's best for your toddler.
How are chronic ear infections treated?
Different doctors have different standards for deciding how to treat chronic ear infections, and every case is unique. Usually, the first line of treatment when a toddler has an earache is still watchful waiting or antibiotics.
If antibiotics don't do the trick, and the earache lingers or keeps coming back, doctors often suggest surgically draining fluid from the ear and inserting ear tubes to ventilate the area and normalize pressure in the middle ear.[2] This procedure is done by an ENT (ear, nose and throat specialist).
After about 12 months, the tubes usually fall out on their own. The tubes are supposed to provide a temporary solution until your child outgrows his tendency to develop ear infections.
Your doctor may also suggest removing your child's adenoids. Adenoids are lymph tissue located at the back of the nose in the upper part of the throat, and they can block the eustachian tube. But in light of recent research, the American Academy of Pediatrics does not advise taking out the adenoids to treat chronic ear infections.[3] If your doctor still recommends this procedure, discuss the pros and cons of the treatment and consider getting a second opinion.
What can I do for my toddler now?
Do what you can for your child's pain and tears. In addition to giving him lots of TLC, you can give him pain relievers, or your doctor may prescribe pain-relieving ear drops.
You may also want to talk with your doctor about getting your child's hearing tested; chronic ear infections or chronic fluid buildup in the ear can cause hearing problems, which may in turn cause speech delays if left untreated.
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