Dear NP

Dear NP,

“I have an 18-month-old who continually gets ear infections. Can you explain what causes some children to be more prone to ear infections than others? Is there anything I can do to help prevent these ear infections from recurring?”

Dear Reader,

There is nothing worse than seeing your child in pain and feeling helpless. Some children seem to be particularly prone to ear infections.

The onset of an ear infection generally occurs rapidly, resulting in a variety of symptoms. Children may seem fussy, pull at their ears, have trouble sleeping, eat less, run fevers, complain of ear pain, have difficulty with their balance or have drainage from the ear.

Ear infections are caused when a virus or bacteria affects the fluid behind the eardrum in the middle ear space. The infection is usually a result of another illness such as a cold, flu or allergy that causes congestion and swelling of the nose, throat and eustachian tubes.

When the eustachian tubes (narrow tubes that run from the middle to ear to the back of the throat and nasal passages) become swollen, or blocked fluids build up and won’t drain properly from the middle ear space. This fluid can then become infected, causing the symptoms of an ear infection.

In children, the shape and angle of the eustachian tubes are narrower and more horizontal. The tubes are more likely to get clogged because they do not drain as well as adult eustachian tubes. As children grow and the eustachian tube changes, many children will “outgrow” ear infections.

Some risk factors seem to increase the frequency of ear infections. These include age between six months and two years, group child care settings, bottle-fed babies, children with seasonal allergies and children exposed to secondhand smoke.

Recurrent ear infections can lead to long-term complications, so you are right to want to prevent infections when possible and treat any infections promptly. Complications of recurrent ear infections include hearing loss, speech or developmental delays, the spread of infection to nearby tissues of the head and skull and rupture of the eardrum.

You can try the following strategies to prevent ear infections:

Avoid exposure to secondhand smoke. Make sure no one inside your home smokes and stay in smoke-free environments.

Breastfeed your baby for at least six months. Breastfed babies experience fewer ear infections. Breast milk contains antibodies that protect against ear infections. If you do bottle feed, don’t prop bottles or allow your baby to lie down while drinking. Avoid giving bottles when your baby is in their crib.

If your child seems to suffer from seasonal allergies, talk to your health care provider about treatment options. Treating allergies prevents the inflammation that can set your child up for an ear infection.

If you suspect your child may have an ear infection, it’s time to call your healthcare provider for a visit. Some ear infections will require an antibiotic to resolve, while others can be treated with observation and treatment targeting the pain.

Over-the-counter fever and pain reducers such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) will help keep your child comfortable. A cold or warm compress placed over the ear, depending on your child’s preference, can help reduce discomfort. Keep your child well hydrated by offering plenty of fluids.

Elevate your child’s head while they sleep to reduce pressure in the ears. In some cases, your healthcare provider may recommend an evaluation by an ear, nose and throat (ENT) specialist.

Following the suggestions above, you may be able to decrease the frequency of your child’s ear infections. Always seek the recommendations of your healthcare provider if you have any concerns.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]