What causes ear infections?

Why do children get ear infections?

The middle ear normally secretes a small amount of fluid. When a child is healthy, this fluid easily drains through the Eustachian tubes to the back of the nose. However, when a child gets a cold, allergies, or sinus inflammation, the middle ear makes a lot more fluid (just like the nose runs more than usual.) Unfortunately, the Eustachian tubes become swollen and puffy, making it hard for the extra fluid to drain out. The warm, moist fluid builds up in the middle ear, providing an inviting habitat for bacteria to grow. Children do grow out of ear infections eventually -- older children and adults have bigger Eustachian tubes that drain better.

What puts a child at risk for ear infections?

In addition to having a cold and being young, the following are also known to be risk factors for ear infections:

  • Cigarette smoke exposure.
  • Pacifier use. In a 2000 study in Finland, children who used pacifiers over the age of 6 months got 30% more ear infections than children who didn't use pacifiers.
  • Bottle use, especially when lying down.

How are ear infections treated?

Most ear infections will go away without any treatment at all. Studies have shown that four days after symptoms began, 80% of ear infections ended without any antibiotic treatment, compared to 95% of infections which received antibiotics. This means that when antibiotics are given for ear infections, only about one child in seven gets any clear benefit. Since we can't guess beforehand which children will benefit, pediatricians in the United States usually prescribe antibiotics as soon as an ear infection is detected. We will prescribe 10 days of an oral antibiotic (usually a twice-a-day medication.) It is very important to finish all 10 days of the prescription; otherwise, a partially-treated infection can come back worse than before. Antibiotic ear drops may be used to treat mild ear infections, but these are only used if a child has ventilation tubes.

What can I do to help my child's ear pain?

Antibiotics may take 24-36 hours before they start to have a noticeable impact on the infection and your child's ear pain. Even after the ear infection starts to clear up, children still sometimes have some residual ear pain. We recommend the following home treatments to keep your child comfortable:

  • Ibuprofen. This over-the-counter medication, used every 6 hours, can take the edge off your child's ear pain. Check our dosing sheet for how much to give.
  • Warm compresses. Towels or cloths warmed in the dryer, then placed against your child's face and ear, can sometimes be soothing. Even a stuffed animal, warmed against a heating pad, then given to your child to cuddle can be a comforting measure.
  • Analgesic ear drops. These prescription drops can be put directly in the ear, as long as your child doesn't have ventilation tubes in place.

 Hasn't my child had too many ear infections?

Even one ear infection is one too many! Unfortunately, ear infections are pretty common:

  • 44% have at least one ear infection by age 6 months
  • 86% have at least one ear infection by age 1
  • 90% have at least one ear infection by age 3, and 50% of these have had three separate infections by age 3.

 If your child has had 3 ear infections in a six-month period, it might be time to consider ventilation tubes.