Your little one is cranky, tugging on her ear, and running a fever. Is it an ear infection? Will your child need antibiotics?
The answers to these questions aren’t as straightforward as you might think. Ear pain — even when accompanied with fever — isn’t always an infection. And not every infection will need antibiotics. Too much exposure to antibiotics can lead to resistance, not to mention the potential of side effects associated with unnecessary antibiotic use. But all too often, say experts, doctors rush to diagnose an ear infection and parents rush to ask for a prescription of antibiotics. To clarify some of the confusion and to help with better diagnosing and treating of this common childhood ailment, the American Academy of Pediatrics has updated their guidelines on ear infections. The guidelines will appear in the March issue of Pediatrics.
Previous guidelines recommended giving antibiotics for ear infections in children age two and under. The new recommendations suggest that doctors use “watchful waiting” — observation and close follow-up — for children under two with a not-so-severe infection in one ear instead of rushing to treat with antibiotics. Numerous studies have shown that 70 percent of children with ear infections get better without antibiotics. If pain relievers alone don’t do the trick after 48 to 72 hours, then antibiotics — preferably amoxicillin (assuming no allergy to penicillin) — can be given. Toddlers under two should get a 10-day course of antibiotics, preschoolers ages 2 to 5 should take antibiotics for seven days, and kids older than 6 should get a five- to seven-day course.
The criteria for what an infection actually is have also changed. While the old guidelines, written in 2004, focused on how fast symptoms appeared and whether there was fluid and/or inflammation in the ear, the new guidelines emphasize the difference between an acute ear infection — which can benefit from antibiotics — and just inflammation of the middle ear, which shouldn’t be treated with antibiotics. Now doctors are urged not to diagnose ear pain as an infection unless they see bulging of the eardrum and fluid in the ear.
Got a child who keeps on getting infections? The new recommendations say that even kids with recurrent infections shouldn't be on long-term daily antibiotics to try to prevent infections from occurring. Instead, they should be seen by a specialist to determine if tubes might be needed.
Will these new guidelines cut down on the diagnoses of ear infections? Hard to say, especially because it depends on how closely doctors follow them. But the authors of the guidelines hope that between a more accurate diagnosis and the use of observation, there will be less antibiotics use. And that will be a good thing.
Does your child suffer from ear infections? Share below in the comments section!