What to do when your child has an ear ache

by Kathleen Daly, Ph.D., M.P.H.

December 5, 2005

As many parents know, ear infections are very common in young children. In fact, for preschool children, ear infections are the most common reason for physician visits.

Infections of the middle ear-also called otitis media-develop when bacteria (or viruses) move from the throat to the middle ear via the Eustachian tube and cause infection. Infection produces inflammation, pus, fluid, and discomfort for the child. After the infection is gone, fluid remains for two to four weeks in most children, and in 10 percent of children, up to three months.

Risk Factors

Middle-ear infections are common in infants and young children for several reasons.

• Upper respiratory infections affect the Eustachian tube, decreasing its ability to clear the infection and fluid in the middle ear. The tube angle is shallow in infants and young children so fluid does not easily drain from the middle ear, as it does in older children and adults.
• Additionally, infants do not have well-developed immune systems until about age one, so their bodies have difficulty fighting the bacteria that cause middle-ear infections. Breastfeeding may make up for this lack of immunity because breast milk contains antibodies not present in formula.
• Exposure to other young children, especially in day-care settings, increases an infant's risk of developing middle-ear infections. Exposure to tobacco smoke also can increase an infant's risk.
• Middle-ear infections tend to run in families, but research to identify the genes involved in causing middle-ear infections is just beginning.

Diagnosis and Treatment

In 2004, professional associations of ear-nose-throat specialists, pediatricians, and family practitioners reviewed research about diagnosis and treatment of middle-ear infections. They found that a definitive diagnosis in infants and young children can be difficult. For example, wax in the ear canal that can't be easily removed, inability to test ear drum movement to determine the presence of middle ear fluid, and an uncooperative child may interfere with the examination.

The following recommendations for treatment of acute middle-ear infections apply to children without an underlying disease who have ready access to medical care and can be seen for follow-up if needed.

• Children older than two years with mild ear infections should not receive antibiotics, but can receive pain medication. They should be observed for increased pain, a fever over 102 degrees, or generally worsening condition. If these occur, a physician should be consulted and antibiotics administered.
• Children six months to two years old with a mild ear infection and temperature less than 102 should receive antibiotics if the diagnosis is certain. If not, they should be observed for the symptoms mentioned above.
• Infants younger than six months should receive antibiotics for all ear infections. For children with repeated ear infections or long-lasting fluid, treatment with ear tubes may be recommended.

Middle-ear infections are common, but complex conditions that cause sleepless nights for many parents. Continuing research will provide promising strategies to prevent and treat this disease.

Kathleen Daly, Ph.D., M.P.H., is a senior research associate in the Medical School's Department of Otolaryngology. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.