This article looks at when antibiotics might be needed to treat an ear infection in a baby, and how to treat the symptoms at home while the baby's natural defenses fight the infection.
Are antibiotics necessary?
Many babies with ear infections will not require antibiotics.
Treatment for an ear infection in a baby will depend on the type and severity. Doctors may prescribe antibiotic ear drops for some infections, such as acute otitis externa (AOE), but in many cases, the baby's immune system will fight the infection on its own. Other infections, such as otitis media with effusion (OME), will usually clear up on their own without any antibiotics.
As OME and mild AOE do not usually require treatment, doctors tend to recommend a period of "watchful waiting" before prescribing antibiotics. This is because antibiotics can cause side effects.
According to the American Academy of Pediatrics (AAP), antibiotics cause diarrhea and vomiting in around 15 percent of children. Up to 5 percent may also have an allergic reaction, which can be serious or life-threatening in some children.
Within the first 24 hours, around 60 percent of children feel better. That figure rises to between 80 and 90 percent of children within a few days.
If there is no improvement or the infection gets worse during this time, a doctor may prescribe antibiotics.
Home and natural remedies
Doctors usually advise caregivers to watch their child for 2 to 3 days to give the baby's immune system the chance to fight off the infection without the need for antibiotics.
During this time, doctors will probably recommend that caregivers treat the symptoms of the infection at home. Remedies may include:
- Over-the-counter medication. In babies of 6 months or older, caregivers may consider giving the child acetaminophen to relieve pain or fever. Speak to a doctor before giving any medication to babies under 3 months of age.
- Warm compress. Holding a warm compress to the child's ear may also help ease the pain.
- Fluids. Giving the child plenty of fluids to drink encourages swallowing, which can help drain the middle ear and relieve painful pressure.
What are ear infections?
Ear infections, which can affect the ear canal or the middle ear, are common in babies. According to a study in Pediatrics, 23 percent of babies in the United States will experience at least one ear infection by the time they are 12 months old. That figure rises to more than half by the age of 3 years.
Ear infections tend to start either with an unhealthful bacterial growth or a viral infection, such as a common cold.
There most common types of ear infections in babies are:
- Acute otitis externa (AOE). Also known as swimmer's ear, AOE refers to an infection in the ear canal.
- Otitis media. An infection in the middle ear can cause inflammation, leading to a fluid buildup behind the eardrum. Sometimes, the narrow passageways that connect the middle ear to the back of the nose, called the Eustachian tubes, can swell.
- Otitis media with effusion (OME). This infection occurs when fluid builds up in the middle ear but does not usually cause pain or fever.
- Acute otitis media (AOM). This refers to a fluid buildup in the ear, which typically results from a bacterial infection.
Babies and children are more prone to ear infections as their Eustachian passages are shorter and narrower that than those of adults. This not only makes it easier for bacteria to reach the middle ear, but it means fluid is more easily trapped.
Because babies and children do not have a fully-developed immune system, it can be harder for them to fight off infections. However, a baby's natural defenses are usually enough to fight off an ear infection.
A reduced appetite can signal an ear infection.
One of the main signs that a baby has an ear infection is the baby tugging or pulling at their ear. However, the AAP points out that this action may be a self-soothing reflex in many young children or may simply be the baby exploring itself.
Other symptoms to look out for include:
- crying more than usual, particularly when lying down
- vomiting or diarrhea
- reduced appetite
- difficulty sleeping or hearing
- fever or a headache
- yellow or white fluid coming from the ears
- an unpleasant smell coming from the ears
It is not always possible to prevent ear infections in babies, but there are some steps caregivers can take to make them less likely:
Avoid exposure to smoke
Second-hand cigarette and tobacco smoke can increase the likelihood of ear infections occurring.
Practice good hygiene
Preventing the spread of germs wherever possible can help reduce the risk of ear infection.
Breast-feeding helps protect babies against infection by building up their immune system.
The pneumococcal vaccination protects against Streptococcus pneumoniae, which is a common bacterial cause of AOM. According to the National Institutes of Health, studies have shown that children who have had this vaccination experience fewer ear infections.
The annual flu vaccination, which is available for babies aged 6 months and over, can also help prevent ear infections that develop after flu.
Breast milk contains substances that help build a baby's immune system. This means that breast-fed babies are less likely to suffer bacterial or viral infections, including ear infections.
The Centers for Disease Control and Prevention (CDC) recommend exclusive breast-feeding for the first six months and then mixed feeding until the child reaches at least 1 year to protect against infections.
Avoid foreign objects
Putting things in the baby's ear, such as cotton swabs, can result in cuts and bruises in the ear canal that can get infected.
When to call a doctor
Caregivers should seek medical attention if the baby has either:
- a fever of 102.2°F (39°C) or higher
- discharge or fluid coming from the ear
If the symptoms get worse, or last for more than 2 or 3 days, seek medical advice.
Caregivers should also speak to a healthcare professional if the child has symptoms of OME for more than 1 month or is experiencing hearing loss.