What Every Parent Needs To Know About Ear Infections In Children
Common Ear Infection – (Also called Otitis media) in children that usually presents with ear pain, fever, excessive crying or a variation of those.
According to the AAP, otitis media is diagnosed when there is bulging of the tympanic membrane (ear drum) or there is a new onset of drainage of fluid from the ear in a child that has not been diagnosed with otitis externa (inflammation and pain of the hole leading into the ear). Onset of ear pain has to have been recent in the last 48 hours or less. If there is no solid evidence of increased fluid in the middle ear, otitis media should not be the diagnosis.
With regards to other factors that help us diagnose otitis media, they include fever. If the temperature has been above 39 degrees celsius (102.2 F), and the pain is significant, the child is more likely to have otitis media that requires treatment.
Sometimes the symptoms are not as severe but both ears are affected. In such cases I would diagnose otitis media. In milder cases with children between 6 months and 2 years if both ears are involved even if pain is not significant, we would want to treat such children.
During your visit to our clinic with your child, I will ask you several questions relating to how the child is normally. One of the commonly observed patterns in toddlers as well as preschoolers is increased pain (and distress, usually crying) at night. Many parents have tylenol and/or ibuprofen at home and would have given that before they present to the clinic. That is okay. In fact the guidelines recommend giving mild analgesics for pain.
There are some cases where the child has nonsevere pain in one ear. I generally would discuss with the family about observing the child’s symptoms for a few days in these children who are more than 2 years old. However I do discuss this with the parents and it is usually a joint decision. Sometimes there is justification for giving antibiotics as that is the mainstay of treatment apart from pain relief.
In the children that we do decide to observe, the parent(s) or caregivers have to have a reliable means of obtaining the child’s temperature periodically and also ready access to a pharmacy of their choice in the event that we decide to treat with antibiotics.
The antibiotic of choice which is very well tolerated and recommended by the AAP is amoxicillin. This is used if there are no complications, there is no concurrent purulent conjunctivitis and the child has no penicillin allergy. We give high dose for 10 days. It is an oral medication.
With this treatment, we would expect positive improvement in the whole spectrum of symptoms and if we are not seeing improvements within the first 48 to 72 hours despite appropriate compliance, we often re-evaluate the child for either a change of antibiotics or a change of diagnosis (occasionally both the diagnosis and the treatment do change).
I have had parents ask about tympanostomy tubes. These are tubes (super tiny) that are inserted surgically into the ear drums in children that have had recurrent ear infections. Usually up to three separate episodes in a 6 month period or 4 episodes within the preceding year with at least 1 in the preceding 6 month period.
We are always in touch with the appropriate Pediatric ENT surgeons who would evaluate every case we do send to them. The procedures, though, simple could have complications so I would not send any of my patients for tubes unless they actually meet the criteria outlined above.
With that, I turn it over to you. What has been your experience with ear infections in your child? Did they need tubes? Did they get tubes? Comment below.
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Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.
Immunizations after-hours:One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.
