Ear infection (middle ear)

Ear infections are common in children. Get answers to questions that many parents have, such as how to recognize ear infection symptoms, how to relieve ear infection pain, and when to use antibiotics.

What are ear infections?

Ear infections are caused by a virus or bacteria that can affect the middle ear  (as opposed to outer or inner ear infections). They may occur in just one ear or both ears. Ear infections are often a complication of a respiratory tract infection, such as a cold or the flu. Ear infections are therefore more frequent in the fall and winter, although they may occur year round.

Germs are spread through the air in droplets from sneezing and coughing, and through contact with saliva or secretions on objects (e.g., counters, door handles, toys).

Ear infections mostly affect children under the age of 6. Toddlers and infants  are more susceptible to respiratory tract infections, as their immune systems aren't mature yet. Liquid from the inner ear also doesn’t drain as effectively in children as it does in adults, which also makes kids  more prone to ear infections. Young children  also put lots of objects in their mouths, which increases their risk of catching germs, especially in places like daycares.

Other common types of ear infections include swimmer's ear (outer ear infection) and labyrinthitis (inner ear infection). For preschool-aged children, middle ear infections are the most frequent form.

How to tell if your child has an ear infection

If your child has ear infection symptoms, she will:

• Vigorously pull on or rub her ear (or both).
• Have a fever.
• Cry when she drinks, because it hurts to swallow.
• Seem to hear less well.

Often, children with ear infections also show general infection symptoms, such as a loss of appetite, problems sleeping, irritability and crying.

If your child has ear infection symptoms from the list above, you need to see a doctor, who will examine  your child’s ears to check the eardrum. An accurate diagnosis and the right treatment will prevent complications. If the ear swells too much, the eardrum may rupture from the pressure.  In very rare  cases, an ear infection can become chronic and lead to hearing loss if not treated properly or if the ear has malformations.

Does my child need antibiotics?

In 80% of cases, ear infections go away on their own in 48 to 72 hours. Your doctor may recommend that you wait 3 days to see whether your child improves or gets worse before starting a prescription antibiotic. This protocol applies to children over the age of 6 months when the cause of the ear infection is unclear or if their symptoms aren’t serious enough to require immediate antibiotic treatment.

When symptoms are more severe or persist beyond 72 hours, antibiotic treatment is required to prevent complications. Your doctor will prescribe antibiotics for 5 to 10 days. It is very important to administer the full antibiotic prescription, even if your child no longer has pain or fever. Not taking the full course of antibiotics increases the risk of bacterial resistance.

How to relieve the pain of ear infection

Over-the-counter painkillers are good options for managing the pain and fever of ear infections. Doses for children are calculated according to weight and not their age. Talk to your pharmacist for more information on this topic.

• Acetaminophen: 10 to 15 mg/kg/dose every 4 to 6 hours (maximum of 5 doses per day).

• Ibuprofen: 5 to 10 mg/kg/dose with food, every 6 to 8 hours (maximum of 4 doses per day). Do not give ibuprofen to children under the age of 6 months without the consent of your doctor or pharmacist.

Watch out! Never give acetylsalicylic acid (aspirin) to a child under the age of 18.

Applying hot or cold compresses to the ear can relieve pain. Make sure you wrap heating pads or ice packs in a towel before placing them directly on the ear to avoid burns or chilblains.

Are there other ways to get rid of an ear infection?

Some children get repeated ear infections or get them several times a year. A doctor can insert a small tube into the eardrum during a procedure while your child is under anesthesia. This tube keeps liquid from accumulating in the ear, which often solves the problem. This procedure can in fact decrease the number of ear infections by 50% and extend the period without infections in a year by 3 months.

Can ear infections be prevented?

There is no way to completely prevent ear infections. However, some precautions limit the spread of germs: frequent hand washing, sneezing or coughing into your elbow, regularly cleaning surfaces that can become contaminated (e.g., counters, door handles, phones, toys).

The following can also decrease the risk of ear infections:

• Breastfeed exclusively (i.e., only give babies breast milk) up to the age of 6 months.
• Prevent exposure to cigarette smoke.
• When your child has a cold, regularly use a saline solution to clean out the nostrils.
• Get a flu shot and pneumococcal (pneumonia) shot.
• Don’t let your baby have a bottle when she’s lying down.

If you have questions or concerns about your child’s health, don’t hesitate to talk to your pharmacist.