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Baby has an ear infection

WebMD Medical Reference
Medically Reviewed by Dr Rob Hicks

No matter how conscientious parents are, babies are likely to come down with colds during their first year, and colds often lead to ear infections.

Otitis media occurs when a cold infection causes swelling of the baby's Eustachian tube, causing blockage that allows fluid or mucus to collect in the middle ear. This may then become infected with bacteria. Otitis media is particularly common in babies because their immune systems are immature and their Eustachian tubes may not effectively drain fluid from the middle ear.

Acute otitis media often causes pain, fever and a bulging red eardrum. Otitis media with effusion (OME) occurs when the middle ear does not drain properly and fluid is trapped behind the eardrum. A child may not experience pain with OME. Both types of otitis media sometimes clear up without treatment.

Antibiotic balancing act

The most acute symptoms should subside within 24 to 48 hours, and during this time pain can be relieved with age-appropriate paracetamol or ibuprofen and warm compresses. Doctors are now less likely to prescribe antibiotics for milder infections as there is no evidence that antibiotics speed up recovery or lessen the risk of complications. In addition, there is concern about bacteria developing resistance to antibiotics.

However, antibiotics may be prescribed for severe infection or when symptoms are worsening. Make sure to give the antibiotics for the entire prescribed time, or the infection might stick around, and your baby could need an additional course of antibiotics, possibly a different kind.

Those pesky, recurring cases

So, what do you do if your baby has repeated ear infections or ones that do not respond to treatment? If a child has persistent fluid build-up lasting more than a few months, or recurrent and severe ear infections your doctor may suggest other options.

Persistent fluid build-up prevents the eardrum moving back and forth properly and can cause hearing difficulties. Although hearing loss typically is not permanent, it still may be a problem for young children who are just learning language.

When antibiotics are not enough, the most common recommendation is an outpatient surgical procedure in which small tubes, called tympanostomy tubes, or grommets, are inserted through the eardrum to promote drainage. In most cases, this helps reduce the number and severity of infections.

Most tubes fall out by themselves in six to 18 months, as the hole closes. However, in about 1% of cases, the hole may not close on its own, requiring another surgical procedure to patch it.

How to avoid infection in the first place

Nurseries or day-care where children come in contact with lots of other youngsters are often the source of infection.

Day-care with smaller numbers of children may help, according to some experts.

Other measures that reduce ear infection risk:

  • Breastfeeding boosts your baby's immune system and uses a swallowing mechanism that allows less milk to enter the Eustachian tube. Also, breast milk is less irritating to middle-ear tissue.
  • Not letting your baby drink from a bottle while lying down, which may allow small amounts of formula to enter the Eustachian tube and cause blockage.
  • Eliminating exposure to cigarette smoke.

Fortunately there's usually an end in sight. The peak incidence for ear infections is usually around six to 18 months. Because the anatomy of the Eustachian tube gradually becomes more like that of an adult, and infant immune systems mature, children’s ear troubles are often over by the time they reach three years old.

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Reviewed on February 10, 2016

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