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ear infections in children

Ear infections in children: types, symptoms, prevention and treatment

I came across the word “Mombie” and felt it was very appropriate to use in relation to a baby, toddler or preschooler with an ear infection. “Mombie” (noun). A sleep-deprived mother who feeds on caffeine. Can usually be identified by the dark circles under her eyes, forgetfulness, moodiness, confusion and moments of insanity. Responds to conversation with short grunts and can frequently be found wandering aimlessly because she forgot what she is doing.

When it comes to an ear infection, chances are you, as the parent, have had no sleep, have spent the night in an upright position with your baby lying on your chest and have a severe headache from all the screaming that occurs the minute you try to change the nappy. Basically, the term “Mombie” applies to all sleep-deprived carers.

Types of ear infections in children and babies & what exactly is an ear infection?

Acute Otitis media (AOM)

When your child is diagnosed with an ear infection, it is usually an acute otitis media. Otitis media is the medical term given when there is inflammation in the middle ear. Fluid builds up behind the eardrum and becomes infected with bacteria or virus. This fluid puts pressure on the eardrum and causes a lot of pain.

Otitis media with effusion (OME)

When your child has an ear infection, your doctor will most likely ask you to come back for a follow-up once the treatment is complete. The reason for this is that fluid can remain trapped behind the eardrum. Even if it is not infected, it becomes a perfect host for some nasty little virus or bacteria to find its way back into the ear, or the fluid itself may still block the middle ear, causing pressure and discomfort. This is known as otitis media with effusion.

Chronic otitis media with effusion (COME)

Those little ones who come back time and time again for follow-up and the parents say that this time they hope the ear is clear are most likely suffering chronic otitis media with effusion. The fluid remains behind the eardrum in the middle ear for a long period of time. This fluid is a host for infection, as mentioned above but can also affect hearing.
Imagine that you are washing your hair in the bath. Your head is submerged under the water, and someone asks you a question. You may be able to make out that you are being spoken to, but chances are you won’t know exactly what is being said. This is what a child with fluid behind the eardrum experiences. The knock-on effect will be poor speech and difficulty with hearing.

Signs & symptoms: How do I know if my child has an ear infection?

In my introduction, I alluded to some of the symptoms of ear infections, and when these occur, you will have no doubt that there is something wrong. In truth, though, some ear infections aren’t obvious at all, and your baby may have no symptoms. Parents are often surprised to hear that their child has an ear infection when they are just having a routine check-up because the child hasn’t complained at all.
This doesn’t answer the question above, though, so here are some tell-tale signs:

  • Tugging at the ears
  • Irritability or fussiness
  • Excessive crying
  • Not wanting to feed
  • Crying when lying down
  • Poor sleep
  • Fever (often this is low grade)
  • Fluid or blood coming out of the ear (usually indicates that the ear drum has burst)
  • Loss of balance
  • Difficulty with hearing

What causes an ear infection?

Most often, ear infections will occur when your child has had a cold, respiratory tract infection or throat infection. The bacteria causing these other illnesses spread to the space in the middle ear and cause inflammation and fluid build-up. Even if your child has had a viral infection, the environment creates the perfect place for bacteria to grow and find their way into the middle ear as a secondary infection. The infection causes a fluid build-up behind the eardrum. If the fluid isn’t able to drain or is not treated, the eardrum may actually burst. As a once-off, a burst eardrum is not likely to cause permanent damage, but if it happens repeatedly, the scar tissue may affect your child’s hearing.

Why are babies so prone to ear infections?

Babies are tiny

Anyone can get an ear infection, but in babies, everything is tiny. This goes for the Eustachian tube as well. The Eustachian tube is a tiny pipe that connects the upper part of the throat to the middle ear. Its job is to aerate the middle ear and to drain mucus from the middle ear into the throat.

Build up of mucus

In babies, the tube is small and often more level than in adults. When a child has a cold, and there is a lot of inflammation and mucus in the Eustachian tube, draining the fluid is made more difficult by the size and angle of the tube. This results in a build-up of mucus in the middle ear.

Immature immune systems

Babies and young children are still building up their immune systems. This makes them more likely to pick up an infection, especially if they are around a lot of other children.

A study conducted in January 2022 concluded that otitis media is most often seen in babies between the ages of 6 to 24 months. About 80% of children will get an ear infection at some stage before their third birthday. Between 80 to 90% of children develop otitis media with effusion by the time they go to school.

How does a doctor diagnose an ear infection?

The fact that you are in a doctor’s room with your baby is most likely because your baby has been suffering from some of the symptoms mentioned above. We do, however, often have parents call in to say that their baby just isn’t right. They don’t have a fever but they are behaving out of character. This may be a sign that the child has an ear infection, at which point they may want to come in or observe for a day, keeping in mind that ears may be the culprit.
The doctor will examine the baby’s ears using an otoscope. This instrument shines light into the ear and allows the doctor to see the eardrum. If the eardrum is red and bulging, your baby has an ear infection.
A pneumatic otoscope blows a puff of air into the ear canal. If the eardrum is normal, it will move back and forth. Fluid behind the ear drum prevents this movement.
Some doctors may also take a reading of the pressure in the ear using Tympanometry. This machine prints out a reading of the pressures it has measured. A flat tracing indicates no movement in the ear, whereas a nice wave shows that there is no fluid preventing movement of the eardrum.

What is the treatment for an ear infection in a baby or child?

As with many medical conditions, the question is often, how do we treat ear infections? Since otitis media may resolve on its own, you may want to wait a day or so before treating it if your child is not in pain. Your doctor will want to be sure that you are able to observe your baby very closely. This does pose a dilemma, and for this reason, the American Academy of Paediatrics has drawn up treatment protocols to guide practitioners on whether antibiotics are necessary or if a wait-and-see approach would be safe. I have included the table for you, as the parents, to make an informed decision.

What is the treatment for an ear infection in a baby or child?
Via My American Nurse

Antibiotic treatment

If the child fits the criteria for anti-biotic treatment, then a course of 10 days is usually recommended. It is really important for the baby to finish the entire course of the antibiotic to ensure that there is no regrowth of the bacteria or resistance to the antibiotic.

Surgery

If your baby gets recurrent ear infections, your doctor may refer you to an ENT surgeon for grommets. This is a minor surgical procedure. Tiny tubes are placed in the eardrum to allow for air to move freely in and out of the middle ear and to prevent fluid from building up behind the eardrum. If the grommets fail to stop the infections, the ENT may suggest removing the adenoids. These are small lumps of tissue above the roof of the mouth. They form part of our immune system, and their job is to trap viruses and bacteria from entering the Eustachian tubes. If the adenoids are swollen and infected themselves, they may need to be removed to prevent infection from being passed along to the middle ear.

Is there anything I can do to protect my child and prevent ear infections?

Unfortunately, colds are part and parcel of growing up, but there are certainly steps you can take to help prevent ear infections. These include:

Flu vaccine

This can be given every year from the age of 6 months

Pneumococcal vaccine

This vaccine is usually given from 6 weeks of age. It is usually given in a series of 3. It protects children from the bugs which cause ear infections and is especially important for a baby in daycare.

Breastfeeding

Breastfeeding is a very effective way to boost a baby’s immune system. If you are able to feed your baby, it has been shown to protect your baby from infection.

Avoid exposing your child to cigarette smoke

Smoke results in a lot of inflammation of the airways and definitely increases a child’s risk for ear infections.

Never allow your baby to go to bed with a bottle

Once asleep, they tend to hold the fluid in their mouths. This tracts along the Eustachian tubes and into the middle ear. Sleeping with a bottle is a major cause of ear infections in babies.

Avoid sick people

Get strict about having your baby around sick people. You need to protect your baby from unnecessary illnesses, especially in the first 6 months of life. It’s ok to say no to visitors and outings if someone is unwell and you have a little one to take care of.

Conclusion

If you are a parent, then chances are you have experienced a child with an ear infection. An acute otitis media, one that comes on suddenly, causes terrible pain and results in a lot of distress for both you and your baby, is likely to resolve within two to three days. In babies, where the ear infection persists or goes untreated, complications can occur. A baby may develop a hole in the eardrum (perforation), hearing loss or mastoiditis. Hearing loss will affect your child’s speech and affect development. We all want a good night’s sleep, a happy baby and certainly a child that grows up without any permanent damage to the vital sense of hearing. Watch for signs of an ear infection, and don’t be afraid to ask for help if you are unsure. Ear infections can be sneaky and catch you off guard if they are silent and rumbling along behind the eardrum and not causing any apparent distress.

References

https://emedicine.medscape.com/article/994656-guidelines
https://www.ncbi.nlm.nih.gov/books/NBK470332/
https://emedicine.medscape.com/article/874348-overview
https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media

 

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