When two-year-old Isabella began complaining that her ear hurt, mother Natalie Nuys quickly made an appointment with her paediatrician.
“He was kind of abrupt,” says Nuys. “He just gave us antibiotics.” Nuys had heard that new recommendations suggested a wait-and-see approach, so she next took Isabella to a naturopath, who advised waiting three days before filling the prescription.
“Isabella was in a lot of pain,” says Nuys. “It was very hard to just wait and see. We gave her painkillers, which helped, and then by the third day she felt a lot better, and that was it. She hasn’t had an ear infection since and she’s now eight years old.”
The wait-and-see approach to ear infections is currently the recommended approach for most children over six months old. In the past, doctors usually prescribed antibiotics as soon as an ear infection was diagnosed. In some cases, when children had frequent ear infections, they were put on daily doses of antibiotics as a preventive measure. But guidelines now urge a less aggressive approach.
“Not every child needs antibiotics for an ear infection,” says Joan Robinson, a paediatrician at the Stollery Children’s Hospital in Edmonton, and one of the authors of the Canadian Paediatric Society’s statement on managing ear infections (see cps.ca and search “ear infections”). “The child’s body can usually get rid of the infection, and research suggests that fewer than 10 percent actually need the prescription.”
Most ear infections resolve in three days with or without antibiotics, Robinson explains. The difference? With antibiotics, the risk of developing resistant bacteria increases, and the child builds fewer antibodies against repeat infections.
Parents can manage the discomfort by giving over-the-counter medication for pain relief, says Robinson.
When to visit the doctor
A visit to the doctor and antibiotics may be needed if the symptoms haven’t gone after three days or if your child:
• has a fever over 39ºC
• is very irritable and complains of severe pain
• vomits more than once or is unable to drink
• develops new symptoms, such as a stiff neck, rash or joint pains
• becomes very lethargic
• exhibits behaviour or symptoms that worry you
• has other chronic health problems
What if the doctor advises antibiotics immediately? That’s not unusual, Robinson says: “It can be hard to teach old dogs new tricks, and most doctors were trained to treat [ear infections] this way. I think more and more parents are concerned about the overuse of antibiotics, and it’s very reasonable to say to your doctor: ‘Does my child really need antibiotics for this? Could we wait a couple of days?’”
In some cases, there may be a reason for immediate antibiotic use, and your doctor can explain that to you. If not, though, you may be able to avoid unnecessary medications. “And I think that’s a good thing,” says Nuys.
Preventing ear infections
Paediatrician Joan Robinson says you can minimize your child’s risk of ear infections by:
• limiting exposure to other kids with colds, since ear infections are almost invariably connected to colds or influenza
• washing your own and your toddler’s hands frequently
• keeping up-to-date with immunizations, including flu shots
• avoiding pacifiers (several studies have shown that pacifier use increases the risk of ear infection, possibly because the way babies and toddlers suck on a pacifier affects the normal functioning of the Eustachian tubes that go to the ear)
• breastfeeding (which provides antibodies and immune system stimulation to reduce the risk of infection)
• keeping your child away from cigarette smoke