Ear infections (Acute Ottitis Media) in babies – what is it and what to do?

Dear Dr. Mo: Following up on your post on parenting, I would like you to tell me more on ear infections in babies – how to recognize them and what could be

Ear infection = nightmare

Ear infection = nightmare

done to mitigate such a difficult state for both a baby and her parents? 

Dear reader: Ear infections are relatively common in babies and small children, especially in those who start their daycare early on (before the age of 3); these are a must-have experience of any parenting adventure.

They can have it several times a year, even up to 6, 7 and 8 etc. Although, if it’s that often, then we say these infections are recurring and a closer medical inspection and surveillance is needed with more aggressive therapy – sometimes even a small surgical intervention but more on this nuisance later.

The most common and unavoidable scenario is that you notice that your baby has a runny nose; she’s somewhat congested, sneezes, coughs a bit maybe but is otherwise fine. A couple days later, suddenly, she’s burning up with fever, her cheeks are red, she may or may not tug on her ear(s) and she’s visibly agitated; her appetite is reduced to basically just milk (if she’s old enough to eat some solid food) and even that may be difficult as sucking action could aggravate the pain in the ear – she’s most likely having what we call an Acute Ottitis Media – a sudden onset of middle ear infection.

You may notice, and I certainly have, a typical situation during feeding: she starts sucking the milk and after a few seconds (or perhaps 10 – 15) she suddenly backs away and starts screaming – this is because sucking and swallowing have become painful as it changes the pressure inside her middle ear, which has become swollen and inflamed.

This is tough enough during the day but wait until you experience it in the evening or during the night – she is hungry and this is making her nervous but she cannot eat because it hurts and she is sleepy, which is also making her nervous but she cannot sleep because she is both hungry and in pain – a combination from hell for both the baby and her parents (and perhaps a few unlucky neighbours).

What you also want to watch for is whether or not her hearing has become diminished – the build up of inflammatory fluids in the middle ear impairs the hearing sensitivity so she may not respond as well to your voice and she may become generally louder. These are all the telltale signs of a problem in the ear.

As not all babies are alike, some may become more quiet than usual, responding to decreased auditory stimulation.

Ok so, since I am not a real expert in parenting (yet) – I am still learning as I go, let me quickly tell you what’s medically happening to the ear that’s causing a baby to turn your life into a nightmare.

How an ear infection happens?

She catches a cold, which congests her totally and as a part of it, it causes her middle ear to swell up. The swelling traps fluid inside the middle ear creating an environment every single bacteria and virus are dreaming about their whole lives – so they seize an opportunity and start to multiply like crazy. Now that the infection has set in, puss builds up (this is basically debris from inflammation containing white blood cells, fragments of bacteria and/or virus, fragments of red blood cells, fluids etc. – think of it as a product of war).

One of the weapons our bodies have in a war against invaders is fever and your baby develops it quickly as her body is fighting an infection, or at least trying to.

Watch for the fever and take it down as it goes beyond 38.5 Centigrade  – any higher than 39 and a baby may get convulsions (frightening seizure-like shaking).
I am sure you know the drill here: combine medication and showers with luke-warm water (not cold but not warm either) as you must bring the fever below 38.5.

One of the reasons these infections happen so easily in children is that the tube in the middle ear (connecting it to the throat) is short and horizontal and still developing – as the child grows up that tube triples in length and becomes more vertical, making it much more difficult for infections from the throat to migrate into the middle ear.

How can you treat your baby’s ear infection?

Acetaminophen is your medication of choice if a baby is 3 months or older (dose it as per her body weight) – if younger and unlucky enough to get an ear infection (or anything else to spike her fever so much) get her to a doctor immediately (or at least call one) to see how to bring the temperature down – but you may certainly shower her asap.

Acetaminophen reduces both fever and pain and this will help her sleep at night – and you want that, believe me.

Keep your baby hydrated well – this is very important; if she can’t suckle feed her milk or water with a small spoon as every little bit counts.

If the temperature is so high (38.5 and higher) don’t mistake it for teething – growing teeth will never cause such a high fever, never.

In any event, I suggest you take her to a doctor.

A doctor may or may not give her antibiotics and with or without them, ear infection should start to get better after 3 – 4 days. More often than not, an antibiotic course will be in order (probably Amoxicilin as the first choice), especially if a baby is younger than 6 months. If she’s older, a watchful waiting may be the first step to see if an infection would improve on its own (because an infection may be viral so no antibiotic is needed or helpful and because the baby’s immune system may be able to control it on its own – particularly as she grows older).

For recurring infections, especially if she’s had 4 or more within 6 months (mine’s had 6, poor thing!), an Ear, Nose and Throat specialist needs to take a good look at her ears and may recommend a quick surgical intervention to place small tubes into (through) the eardrums. These tubes could stay there anywhere from 6 months to a few years and usually fall out on their own or are removed by a surgeon.  Their purpose is to drain the middle ear and keep it ventilated, preventing further fluid build up and recurring ear infections; complications are at 2% chance and are minor and treatable.

This intervention could be very significant as repeated ear infections can leave permanent scarring on the eardrums and even cause them to break leading to a hearing impairment or hearing loss, delays in speech development, further complications much later into the adulthood etc.

At times an Ivy based cough syrup (i.e. Prospan), taken for a few weeks could help clear up the fluids from the middle ear and, providing there haven’t been any additional infections, resolve the problem without the need for tubes.  This is usually given 2.5 ml twice a day for three weeks and then the ears are checked again. This is not usually recommended for children under 2 years old but it is worth a try and if a baby is older than 12 moths, shouldn’t be a problem at all.

A few words on prevention

As inevitable as it may seem, there are a few things you can do to try to prevent your baby getting an ear infection (or at least repeated string of infections):

Give your baby all the vaccination shots, especially Pneumococcal and Hib B; a flu shot is also beneficial and I strongly recommend it.

This is beyond your control but if you can, breast-feed your baby as that milk is full of anti-bodies that can really help her in fighting off the infection.

Sit your baby up to feed her – do not do it in a horizontal position (lying down on her back).

If she uses a soother, give it to her only when it’s time to sleep.

Smoking is harmful to everything and everyone and in this case especially so do not expose your baby to any cigarette smoke.

Keep her out of a daycare if you can, before she turns at least one year and keep her at home if she’s not completely healthy.

Beyond these few things, there’s nothing much you can do – babies do get sick quite often and that’s every parent’s big burden. You signed up for it yourself.

Yours in solidarity,

Dr. Mo

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