New Rules For Treating Children With Ear Infections
Constant crying and irritability. Pain he can’t explain. When your niño has an ear infection, his misery becomes your misery. And it may be hard to tell which treatment is best. Enter the American Academy of Pediatrics’ (AAP) new guidelines for identifying—and more importantly—for how often to treat with antibiotics. Released last week, in a report that will be published in the March 2013 issue of Pediatrics, the children’s group’s new guidelines provides doctors with more clear-cut rules for making the diagnosis and for prescribing antibiotics. You see, ear infections remain the “most common condition for which antibacterial agents are prescribed for children in the United States,” says Dr. Allan S. Lieberthal, MD, a co-author of the study and a doctor at Kaiser Permanente Medical Center in Panorama City, California. A 2010 study conducted by UCLA and Harvard Medical School found that Hispanic children are more likely than white children to visit the emergency room for an ear infection, but are least likely to afford prescriptions, see a specialist or afford insurance.
Previously, the AAP’s guidelines recommended that doctors use antibiotics on children who are two years and younger. But with these new guidelines, they suggest eliminating treatment of antibiotics on children between the ages of six months and 23 months, if the conditions are not severe. Then monitoring the child’s condition with watchful follow-ups. That’s because the research done since the last study in 2004, proved that frequent use of antibiotics—especially since a child might get several infections within the course of a year—exposes a child to its unnecessary side effects, plus might make him/her child resistant to antibiotics in general. So they suggest treating with less potentially harmful solutions like an analgesic. And monitor their reactions. The guidelines also ask doctors to take into account the child’s age and the severity of their ear infection before prescribing antibiotics.
“Antibiotics take 24 to 48 hours before they start to improve signs and symptoms, so if a child has fever or pain, it’s important to place them on [pain-relieving or fever-reducing medications first],” explains Dr. Roya Samuels, a pediatrician based in New Hyde Park, New York.
However, if your child has had three or more ear infections in a six-month period, or four or more infections in a one-year period (with at least one infection occurring in the previous six months), she or he should be referred to an ear, nose and throat specialist. That’s because children with such frequent infections may need to have tubes placed in their ears for better fluid drainage. The new guidelines are helpful to both parents and doctors, says Dr. Samuels. ”The definition is more clear-cut, more precise,” she said. But, she added, “There’s still no gold standard for diagnosis. There are different stages of [ear infections], and making the diagnosis can be tricky.”
For parents, the general symptoms listed below continue to serve as a guideline that lets you know if your child might have an ear infection. So before calling your doctor, check to see about:
- Pain. If your child is old enough to express himself, he can tell you when something hurts. If you have a baby, you’ll only know when they cry and seem irritable—especially during feedings, says the AAP. This is because sucking and swallowing will cause more pressure to the middle ear.
- Loss of appetite. If your child is typically known to clear his plate or bottle with plenty of room for seconds, suddenly doesn’t want any food, check his ear. Loss of an appetite may be due to ear pain.
- Trouble sleeping. Ear pain will cause restlessness, so double check, if your child shows signs of not sleeping throughout the night.
- Fever. If your child develops a temperature between 100°F (normal) to 104°F, contact your physician.
- Ear drainage. During those daily ear wipings, if you notice a foul odor accompanying a yellow or white fluid draining from your child’s ear, call your doctor. It’s not an emergency, as the drainage might mean the infection is leaving, but your child will need to see your pediatrician.
- Trouble hearing. During and after an ear infection, your child may have trouble hearing for several weeks. This occurs because the fluid behind the eardrum gets in the way of sound transmission. This is usually temporary and clears up after the fluid from the middle ear drains away.