Ear infections tend to strike after a common cold or sinus infection, so take note of that.
Observe the following symptoms:
Your baby pulls, grabs, or tugs at his ears. This could be a sign he’s in pain. (Babies do pull on their ears for all kinds of reasons or for no reason at all. So if your baby seems otherwise fine, he probably doesn’t have an ear infection.)
Diarrhea or vomiting. The bug that causes the ear infection can also affect the gastrointestinal tract.
Reduced appetite. Ear infections can cause gastrointestinal upset. They can also make it painful for your baby to swallow and chew. You may notice your baby pull away from the breast or bottle after he takes the first few sips.
Yellow or whitish fluid draining from the ear. This doesn’t happen to most babies, but it’s a sure sign of infection. It also signals that a small hole has developed in the eardrum. (Don’t worry – this will heal once the infection is treated.)
Unpleasant smell. You may detect a foul odor coming from your child’s ear.
Difficulty sleeping. Lying down can make an ear infection more painful.
How common are ear infections in babies?
Ear infections are the second most commonly diagnosed illness in children in the United States (after the common cold). About half of babies have at least one ear infection by the time they turn 1 year old, and most have had at least one ear infection by their third birthday
What causes ear infections in babies?
An ear infection can be caused by bacteria or a virus. It happens when fluid builds up in the area behind your baby’s eardrum and then becomes infected.
Normally any fluid that enters this area leaves pretty quickly through the eustachian tube, which connects the middle ear to the back of the nose and throat. But if the eustachian tube is blocked – as often happens during colds, sinus infections, even allergies – the fluid gets trapped in the middle ear.
Germs like to grow in dark, warm, wet places, so a fluid-filled middle ear is the perfect breeding ground. As the infection gets worse, the inflammation in and behind the eardrum also tends to worsen, making the condition more painful.
Fever may develop as your baby’s body attempts to fight the infection. The medical term for this condition – a painfully inflamed middle ear, an accumulation of fluid, a red eardrum, and occasionally a fever – is acute otitis media (AOM).
Using a pacifier may increase the risk of middle ear infections in babies and young children. In one study, the incidence of ear infections was 33 percent lower in babies who didn’t use pacifiers.
Babies are particularly susceptible to ear infections because they have short (about 1/2 inch), horizontal eustachian tubes. As children grow to adulthood, their tubes triple in length and become more vertical, so fluid can drain more easily.
When to call the doctor if your baby has an ear infection
Call at the first sign of an ear infection. The doctor will need to look in your baby’s ear with an instrument called an otoscope. An eardrum that’s red, bulging, and possibly draining is probably infected.
The doctor may also check whether the eardrum moves in response to a device called a pneumatic otoscope, which releases a brief puff of air into the ear. If it’s not moving, that’s another indication that fluid is collecting in the middle ear and may be infected.
What’s the treatment for an ear infection in a baby?
Most ear infections clear up on their own, but severe cases need to be treated with antibiotics. The American Academy of Pediatrics (AAP) urges doctors and parents to discuss whether it’s best to take a wait-and-see approach or start antibiotics when symptoms are still relatively mild.
For years, antibiotics were the first line of defense against ear infections, but now doctors are prescribing them more judiciously. Getting too many antibiotics is a concern because it can set children up to be vulnerable to antibiotic-resistant infections.
If your baby is at least 6 months old, your doctor may recommend that you give him infants’ acetaminophen or ibuprofen to relieve pain caused by the infection. (Never give your baby aspirin because it makes him more susceptible to Reye’s syndrome, a rare but potentially fatal disorder.)
Don’t hesitate to call your doctor if your baby seems to be getting worse or hasn’t improved significantly after a few days. If your baby isn’t doing better after 48 to 72 hours, the doctor may want to start antibiotics and have you come back for a follow-up exam. If your baby is taking an antibiotic but doesn’t improve after a few days, the doctor may want to switch the medication or examine your child again.
If your doctor does prescribe antibiotics, make sure to give your child the full course. You may have to follow up with another ear exam a few weeks later so the doctor can determine how well the medication worked.
Ear infections aren’t contagious, but the respiratory infections that often precede and accompany them are. The best way to reduce the spread of germs is to wash your hands (and your child’s hands) often – and always after using the toilet, changing diapers, and before eating or preparing food.