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Ear infections
Reviewed by the BabyCenter Medical Advisory Board Last updated: February 2006

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Highlights
How can I tell if my baby has an ear infection? What causes ear infections? When should I call the doctor? How will the doctor treat my baby's ear infection? What can I do to prevent ear infections in the future? My baby gets repeated ear infections. Can ear tubes help? Are ear infections ever serious?

How can I tell if my baby has an ear infection?

The easiest way to tell if your baby has an ear infection (also known as acute otitis media) or any other illness, for that matter is a change in his mood. If he turns fussy, or starts crying more than usual, you should be on the lookout for a problem. If he develops a fever (whether slight or high) you have another big clue. Ear infections tend to strike after a common cold or sinus infection, so keep that in mind too. You may also notice the following symptoms: Your baby pulls, grabs, or tugs at his ears. This may be a sign he's in pain. (However, babies do pull on their ears for all kinds of reasons or for no reason at all, so if your baby seems fine otherwise, he probably doesn't have an ear infection.)

Diarrhea. The bug that causes the ear infection can also affect the gastrointestinal tract.
Dr. P. Marazzi/Photo Researchers, Inc

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.

A 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 on its own once the infection is treated.

A foul odor emanating from the ear.

What causes ear infections?

An ear infection is usually caused by bacteria, but a virus can also be the culprit. 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 commonly happens during colds, sinus infections, even allergy season it traps the fluid in the middle ear. Germs like to grow in dark, warm, wet places, so a fluid-filled middle ear becomes the perfect breeding ground. As the infection worsens, so may the inflammation in and behind the eardrum and, as a result, the pain. Fever may develop as your baby's body attempts to fight the infection. The medical term for this condition an inflammation of the middle ear, with an accumulation of fluid, pain, a red eardrum, and sometimes a fever is acute otitis media (AOM). Pacifier use 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.

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Babies are particularly susceptible to ear infections because their Eustachian tubes are short (about 1/2 inch) and horizontal. As they grow to adulthood, their tubes triple in length and become more vertical, so fluid can drain more easily. Ear infections are one of the most common childhood illnesses. Although there are no statistics on how many babies get them, the American Academy of Pediatrics says most children have at least one ear infection by the time they turn 3.

When should I call the doctor?

Call the doctor at the first sign of an ear infection. She'll ask you to come in so she can take a look in your baby's ear with an instrument called an otoscope. An eardrum that's red, bulging, and possibly draining is probably infected. She may also look to see 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 one more clue that fluid is collecting in the middle ear and may be infected.

How will the doctor treat my baby's ear infection?

Though recent research shows that many ear infections eventually clear up on their own without any treatment, when it comes to babies, doctors will almost always reach for an antibiotic. "With young infants it's usually better to err on the side of caution and prescribe something," says Robert Ruben, an otolaryngologist (ear, nose, and throat doctor) at Montefiore Medical Center in New York. In addition, your doctor may recommend that you give your baby children's acetaminophen or ibuprofen to help relieve any pain caused by the infection. Make sure you give your baby his entire prescription of antibiotics and follow up with an ear re-check a few weeks later so the doctor can gauge whether the medicine did its job. Don't hesitate to call your doctor if your baby seems to be getting worse or hasn't improved significantly after a few days on the antibiotic. She may want to switch the antibiotic or examine your child again.

What can I do to prevent ear infections in the future?

Babies who attend daycare or play groups with other children are more prone to getting ear infections because they're exposed to more germs. That doesn't mean you should keep your baby home all the time. That's not fun or practical and even if you managed to do it, your baby would still catch an illness here or there. Instead, wash your hands (and your baby's hands) often, and try these prevention ideas: Keep your baby up to date on his vaccines. They help prevent certain illnesses that can lead to an ear infection. For example, the Hib vaccine has helped tremendously in reducing the number of ear infections in babies, and the new pneumococcal vaccine can help prevent them as well. If your baby has suffered repeated ear infections, especially after bouts with the flu, you may want to consider an annual flu vaccine, but talk to your doctor first. Only children over 6 months old can get a flu shot.

Breastfeed your baby for a minimum of six months. A recent study from the Centers for Disease Control and Prevention and the Food and Drug Administration, which appeared in the journal Pediatrics, showed that children who are breastfed for the first six months of life are less likely to develop ear infections. In fact, the risk of ear infections was 70 percent greater in formula-fed babies. Practitioners such as Ruben believe that mothers transfer certain immune-building antibodies to their babies through breast milk. However, those antibodies seem to decrease after the six-month mark.

Limit your baby's exposure to tobacco smoke. Even a weekend spent in a house with a smoker can significantly harm a baby and increase his chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your baby to fight off infection.

My baby gets repeated ear infections. Can ear tubes help?

Babies with multiple ear infections which, for many children, is actually one ear infection that lingers on for months despite antibiotic treatment may be good candidates for ear tubes. This procedure, known as tympanostomy, is the most common surgery performed in North America on children under 4, according to a study in the Canadian Medical Association Journal. In the United States alone, doctors perform roughly one million ear-tube insertions each year. During the procedure, which is done under general anesthesia, an otolaryngologist makes a tiny incision in the child's eardrum and inserts a millimeters-long tube into the slit. These tubes act as a vent, letting air in and fluid out so bacteria can't flourish. "It helps the Eustachian tube work better," says Ruben. Your child's doctor may suggest this surgical solution because a baby with persistent fluid in his ears (or otitis media with effusion) is not only a prime candidate for repeated ear infections but also for hearing loss. Babies who have trouble hearing

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may suffer delays in language development. Still, the procedure is considered controversial and there's little consensus among doctors on whether it's really necessary. Studies have shown that some babies who've had recurrent ear infections are a little behind when it comes to school readiness. But somewhere between ages 2 and 5 the connection between chronic ear infections and decreased school readiness disappears, says Joanne E. Roberts, a senior scientist at the Frank Porter Graham Child Development Center at the University of North Carolina in Chapel Hill. Children with chronic ear infections eventually perform on par with their peers who didn't battle ear troubles in the first few years. What should you do? Talk to your doctor and weigh the pros and cons for you and your baby. Unfortunately, there's no definitive answer to the ear tube question yet.

Are ear infections ever serious?

They can be. A severe or untreated infection can rupture your child's eardrum. Ruptures don't happen very often and they generally heal quickly, but it's important to see your child's doctor for a follow-up to make sure that the infection has cleared and that the eardrum is healing well. Repeated ear infections can sometimes lead to hearing loss and scarring. In very rare cases, untreated ear infections can lead to an infection of the skull behind the ear (mastoiditis), or meningitis.

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