Ear Infections: What Every Parent Should Know

Dr. Natasha Burgert

Ear infections are one of the most common reasons children visit my pediatric practice. Recently, there have been changes to the way ear infections are diagnosed and treated. Current evidence-based guidelines stress the importance of pain management during early infection and offer practical ways to prevent antibiotic resistance.

Here are some things every parent should know about ear infections:

There are no absolute "signs" that a child has an ear infection. Kids can pull on their ears for a variety of reasons, from teething to self-soothing. Not all ear infections cause fever. And, not all ear pain is from bacterial infection. For this reason, it's common for parents to have a few ear pain "false alarms" that lead to a doctor's visit without a diagnosis. Only after a child gets an ear infection a few times will the symptoms become more apparent.

[Read: Does My Child Have Strep Throat?]

Ear pain is not an emergency. Pain management is the primary goal for ear pain until your child's doctor is available for an appointment. A doctor who knows your child and family will be a better diagnostician and has a much higher chance to get the therapy correct. If you must visit an urgent care center or emergency room, be sure that the clinician is well-versed in children's health care.

Ear infections happen on a spectrum. This means the physical exam findings can change as the infection progresses. Many families get upset if an ear infection isn't diagnosed in the initial doctor's visit. But it may not be possible to detect an infection until more time lapses. It is always best to have a definite diagnosis rather than early, unnecessary treatment.

Not all ear infections need to be treated with antibiotics. Antibiotic treatment can safely be delayed in certain circumstances. Specifically, children 6 months or older with unilateral (one-sided) infections and minimal symptoms may be offered pain medication like acetaminophen (Tylenol) or ibuprofen for 48 hours to see if the ear infection resolves on its own. If pain or symptoms worsen or persist after 48 hours, then antibiotics may be started. The key is close follow-up with your child's doctor.

Antibiotics do not decrease pain. This is especially true in children under the age of 2 years. Even if your child is started on antibiotics, expect to continue over-the-counter pain medication for the first few days of treatment. Pain early in treatment does not indicate the antibiotic is not working.

[Read: 12 Things You Should Know About Stomach Flu in Children.]

The best antibiotic is chosen based on your child's medical history. It's essential for a clinician to prescribe the correct antibiotic for optimal treatment. Correct antibiotic selection also decreases the development of antibiotic resistance. If the doctor is unaware of your child's full medical history, however, the antibiotic decision can be difficult. Ideally, all of your visits for ear pain will be at your child's medical home. If that's not possible, be sure to gather paperwork from other providers to add to your child's primary medical record. If your child's doctor isn't aware of previous antibiotics the child has taken, it will increase the chances your child will be prescribed the wrong antibiotic.

Children 6 and older may have a shorter duration of treatment. Current recommendations suggest the duration of antibiotic therapy for ear infections can change based on a child's age. Babies 6 months to 2 years of age should be treated for 10 days. Preschoolers ages 2 to 5 years old can be treated for seven days. Kids over the age of 6 years only need five days of treatment.

Know when your child should be referred to a specialist. Referral to an ear, nose and throat doctor for tympanostomy tubes, or ear tubes, should occur after three infections in six months. Keep in mind that some infections may take multiple rounds of antibiotics to cure. For this reason, the number of individual infections is more important than the number of times a child is on antibiotics. For children with a strong family history of ear infection, kids with Down syndrome or certain anatomic characteristics, or those with immune deficiencies, referral to an ENT may occur more quickly.

Vaccines help prevent ear infections. Germs like pneumococcus, haemophilus influenzae and the influenza virus are commonly known to cause meningitis, pneumonia, and life-threatening infections. However, these are some of the same germs that cause ear infections, too. Vaccines help protect your child from all sorts of illnesses, so vaccinate on time and on schedule.

[See: 10 Things Pediatricians Advise That Parents Ignore -- and Really Shouldn't.]

Nearly every child will have at least one ear infection during childhood. Current experience and scientific review are allowing clinicians to treat this common infection with more precision. Advocate for following these updated guidelines when visiting your child's doctor for ear pain.

Natasha Burgert, M.D., FAAP has been contributing to the U.S. News For Parents blog since 2018. After receiving her medical degree from the University of Nebraska Medical Center, she completed her pediatric residency at Cincinnati Children's Hospital Medical Center. She now calls Kansas City, Missouri, home, working as an innovative general pediatrician, while serving as a national spokesperson for the American Academy of Pediatrics and a member of the AAP's Counsel of Communications and Media.

Her work with patients has been featured in outlets such as The New York Times, The Wall Street Journal and Parents magazine. She has also been on NBC Nightly News, CBS This Morning and other local news programs. She is a regular contributor to NBC News' Parent Toolkit and her local NPR affiliate and has been quoted in numerous print and digital articles. She's also been the keynote speak at various health marketing, vaccine advocacy, and physician-led organizations.

If she is not in clinic, you will find her regularly sharing evidence-based child health on KCKidsDoc.com, Instagram, Twitter and Facebook.