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Pain, Pain, Go Away

New guidelines on treating ear infections urges less reliance on antibiotics

© Dayna More | Dreamstime.com

It’s a rare parent who doesn’t end up at the pediatrician’s office at least once for an ear infection, an ailment that effects three out of four children by age 3.

It’s also the top reason children are prescribed antibiotics, according to the American Academy of Pediatrics (AAP).

And therein lies the problem.

In recently released guidelines, the academy is asking pediatricians to take a more conservative approach to ear infections before whipping out the prescription pad. In some mild cases, an ear infection may clear up on its own.

As a parent of two toddlers, Rebecca Batisto is skeptical. “I’ve had a lot of ear infections and second only to labor, I’ve never had worse pain,” says Batisto, whose 1-year-old daughter, Arabella, is already showing a propensity for earaches.         

“If my baby has that kind of pain, I want something done.”

Ear infections, or acute otitis media, occur when the Eustachian tubes get clogged with fluid and are unable to drain. The buildup may be caused by allergies, colds and sinus infections, excess mucus and saliva produced during teething, tobacco smoke, or other irritants. The result can be significant pain and often a fever.

Like Batista, when a child is howling with pain, most parents just want a solution. But in cases where there is not a high fever or severe bulging of the eardrum, the smart answer may be pain relief with acetaminophen and time. The AAP cited several studies that showed a majority of children who have a mild problem can fight off infection with no antibiotics, showing an improvement of symptoms within days.

At issue is the potential overuse of antibiotics and the danger of creating drug-resistant “superbugs” — bacteria that survive the medicine only to evolve and become harder to defeat. There is also the ever-present possibility of side effects from the medication, such as nausea, vomiting, diarrhea, rashes, and more.

Antibiotics like amoxicillin should only be given to kids who are showing moderate to severe symptoms, such as significant bulging of the ear drum, infections in both ears, pain and swelling, or those who have a fever higher than 102.2 degrees.  

“The AAP does stress the importance of involving the parent in the decision to treat with antibiotics or to observe the child for improvement,” says Dr. Keith L. Hassan. “A parent can expect their child to be treated if the pain is severe, if the child has a high temperature, or if the infection is in both ears and the child is under age 2.”

When a wait-and-see approach is taken, parent follow-up is important. If the child worsens or fails to improve in two to three days, antibiotics may be called for, after all. “This can be accomplished by requiring a second visit for recheck or providing the parents with a prescription for a ‘rescue’ medicine to start in the case of the child not improving or worsening,” Hassan says.

The bottom line? Pay a visit to the pediatrician’s office in case an ear infection is already advanced. If not, be open to allowing your child to heal on his own.

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