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
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.
- six months or younger and has a diagnosis of certain or suspected
- 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.
August 2004 Update
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