The Family Health Guide

New Guidelines for Treating Ear Infections

If your child is rubbing his ear, should you run to the doctor's office to demand antibiotics? Probably not. Your child may simply have fluid in the ear and not the classic ear infection that parents and children dread. The American Academy of Pediatrics (AAP) recently came out with new guidelines for dealing with both conditions, and antibiotics are not the mainstay of treatment in either case.

Middle Ear Fluid (Otitis Media with Effusion)

Over 2 million American children experience fluid in the middle ear each year, often following a cold or an acute ear infection. The condition is also called a silent ear infection because many children have no symptoms. Some children, though, may rub their ear or experience mild pain, sleep disturbances, unexplained clumsiness, muffled hearing, or delays in language and speech development. The condition may be diagnosed during a routine well-child visit with the use of a pneumatic otoscope, which allows the doctor to see how easily the eardrum moves.

The AAP estimates $4 billion are spent in the U.S. for diagnosing and treating fluid in the ear each year. However, the fluid most often disappears of its own accord and does not lead to acute ear infections. Also, antihistamines and antibiotics have little effect on the condition and do not help prevent delays in learning or language and speech development.

According to the recommendations made by the AAP, the only treatment middle ear fluid warrants is watchful waiting. If your child is diagnosed with this condition, the pediatrician will want to reexamine your child in three to six months to be sure the fluid has disappeared. If the fluid persists longer than three months, the physician will recommend your child be tested for hearing and speech development. If the fluid lasts for more than four months and signs of persistent hearing loss are evident, the physician may recommend your child have tubes implanted into the ear to promote drainage.

The AAP indicates that some children may need evaluation of hearing, speech, and language development sooner than others. These include children already at risk for developmental delays or difficulties because of an unrelated condition, such as autism. With these children earlier intervention may be appropriate.

Classic Ear Infection (Acute Otitis Media)

The classic ear infection differs from the silent ear infection because of the sudden onset of significant pain and signs of infection including redness and inflammation. This type of infection is commonly, although not specifically, associated with fever, persistent crying, a runny nose, and perhaps even eye or ear drainage. Often, a pediatrician is unable to diagnose such an infection with certainty because of the difficulty in observing the child's ear. What is really a case of middle ear fluid may be diagnosed as an acute ear infection.

Acute ear infections are the most common infection for which antibiotics are prescribed to children. However, roughly 80 percent of children with acute ear infections get better without antibiotic treatment. In addition, studies show delaying antibiotic treatment with watchful waiting does not increase the likelihood of developing a serious illness. With the new guidelines, the AAP hopes to curb the use of antibiotics when they are not necessary.

If your otherwise healthy child is suffering from an acute ear infection the pediatrician will prescribe acetaminophen or ibuprofen for pain relief, as suggested by the AAP. The doctor may also offer you the option of treating your child's ear infection on your own for two to three days if the symptoms are not severe, then beginning the antibiotic amoxicillin if the infection is not clearing up. The guidelines recommend the prescription of antibiotics if your child is

  • six months or younger and has a diagnosis of certain or suspected acute infection
  • between the ages of six months and two years and has severe symptoms with a diagnosis of certain or suspected acute infection
  • between the ages of two and twelve years and has severe symptoms with a diagnosis of certain acute infection.
The AAP also suggests you help prevent acute ear infections by breastfeeding your infant for at least six months, avoiding "bottle propping," and eliminating your child's exposure to secondhand smoke.

August 2004 Update

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