Five out of six children will have at least one ear infection by the time they turn three. This high statistic makes ear infections the most common reason why parents seek medical attention…

An ear infection is the inflammation of the middle ear, usually caused by bacteria, and occurs when there is a fluid build-up behind the eardrum. This often happens after your baby has had a sore throat, cold or upper respiratory infection.

According to the National Institute on Deafness and other Communication Disorders (NIDCD), if the upper respiratory infection is bacterial, the same bacteria may spread to the middle ear. However, if the infection is caused by a virus (such as a cold), the bacteria may move into the middle ear as a secondary infection, which will then cause the build-up behind the eardrum.

We all have a canal called the eustachian tube that connects the middle ear to the back of the throat, this helps equalise pressure. The throat and nose provide a moist breeding ground for bacteria and, because your baby’s eustachian tube is short, wide and horizontal, any germs that may be lurking can easily travel through it, which can then be trapped in the middle ear.

There are three main types of ear infections, according to the National Institute on Deafness and other Communication Disorders (NIDCD):

  1. Acute otitis media: This is the most common ear infection. Parts of the middle ear become infected and swollen, resulting in fluid being trapped behind the eardrum. This pressure build-up causes pain in the ear and may be accompanied by a fever.
  2. Otitis media with effusion: According to NIDCD, this can happen when fluid stays trapped behind the eardrum after an ear infection. Your baby may have no symptoms per se, but your doctor will be able to see the fluid behind the eardrum using a specialised instrument.
  3. Chronic otitis media with effusion: This happens if fluid remains trapped for a long period of time, or returns – even with no infection. This can affect your baby’s hearing.

Signs and symptoms of an ear infection

The problem is that most times your baby is too young to be able to voice what is wrong. Symptoms to look out for include:

  • Tugging or pulling his ear
  • Fussiness and crying
  • Trouble sleeping or crying every time you try and put him down for a sleep
  • Fever (particularly in babies and toddlers)
  • Fluid draining from the ear
  • Unusual clumsiness or problems with balance (that hasn’t been there before)
  • Trouble hearing, not turning his head towards noises or not responding to sounds.

When to see the doctor

The good news is that not all ear infections need antibiotics. According to experts, more than half of children will start to feel better in a day or so, and within a week, that number goes up to three-quarters.

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However, if the ear pain is accompanied by the following symptoms, seek medical advice right away:

  • A knot or swelling forming under or behind the ear
  • Sudden high fever
  • If your baby becomes extremely fussy or lethargic
  • If your baby has a seizure
  • Age is also a consideration, so if your baby is under six months, in severe pain or has a high fever, accompanied by grabbing his ear, call your paediatrician.

Your doctor will most likely prescribe antibiotics if your baby or toddler is in moderate to severe pain with a high fever, his condition hasn’t improved within 48 hours, or if there is new fluid present in the ear canal.

Home treatments for ear infections

For minor earaches, try:

  • A warm compress. Place a warm, moist compress, like a damp facecloth over your child’s ear for 10 to 15 minutes
  • Acetaminophen/paracetamol. If your baby is older than six months, an acetaminophen or paracetamol such as Panado, Tylenol or Calpol, may help relieve pain and fever. Use as recommended by healthcare provider.
  • Offer your baby fluids or breastfeed. Swallowing can help open the eustachian tube, which in turn can help drain the trapped fluid.

Can ear infections be prevented?

According to the experts, the best way to prevent ear infections is to reduce the risk factors:

  • Wash your hands (and your toddler’s) frequently, as this can help prevent the spread of germs.
  • Breastfeed if you can as this helps create a natural immunity.
  • Keep an eye on allergens and your baby’s triggers.
  • Boost your older baby and toddler’s immunity by including healthy vegetables and fruit in their diets.
  • Consider the flu vaccine for your baby or toddler.
  • Consider getting the pneumococcal conjugate vaccine as this can help protect against ear infections. According to the American Centers for Disease Control and Prevention, children under the age of two should be vaccinated and studies have shown that those who are vaccinated have fewer ear infections compared to those who don’t. This is particularly recommended for children in daycare.
  • Avoid exposure to second hand cigarette smoke. Studies have shown that those babies who are around smokers have more ear infections than those around non-smokers.
  • Avoid putting your baby down for a nap or for the night with a bottle.
  • Limit exposure to other sick children or adults.

Did you know?

Research is currently being conducted by the NIDCD to find better ways to predict which children are at a higher risk of developing an ear infection. In those babies and toddlers who have recurring ear infections, researchers have identified colonies of antibiotic-resistant bacteria, known as biofilms, present in the middle ears of those children with chronic ear infections. According to the NIDCD, understanding how to target these biofilms could help treat chronic ear infections and help avoid possible surgery.

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