We may call this ‘cold and flu season,’ but throwing kids’ ear infections into the mix would make the description even more accurate.
“Many ear infections in children are secondary to viral infections, and anything that causes a nasal or upper respiratory infection can also cause an ear infection,” says Dr. Joseph Kahn, chairman of the Department of Pediatrics at St. John’s Mercy Children’s Hospital. “Ear infections are certainly more common at this time of year.”
When kids have an upper respiratory or nasal infection, the eustachian tube (a small passage that connects the middle ear to the back of the throat behind the nose) can swell and fill with fluid, trapping and incubating bacteria, he explains. Standard decongestants and cold medicines do little or nothing to prevent the bacterial build-up.
What does help? “Good hydration,” Kahn says. “Kids with colds need to drink plenty of liquids to help thin out mucus secretions. Little kids with nasal congestion may benefit from saline nose drops to maintain open nasal passages and help prevent subsequent ear infections.”
Parents may recall repeated doses of antibiotics when they were children with earaches, but current medical knowledge calls for caution in using antibiotics in order to prevent antibiotic resistance. “Amoxicillin rightly remains the first-line antibiotic of choice, but resistance to this medication has increased,” says Dr. Gene LaBarge, a pediatrician with Docs 4 Kidz. “This fact underscores the importance of judicious use of antibiotics.”
LaBarge increasingly uses an alternate treatment plan for his patients. “Based on more recent American Academy of Pediatrics guidelines, I frequently will encourage the concept of a SNAP, or Safety-Net Antibiotic Prescription,” he says. “If I diagnose a middle-ear infection in a relatively well child, I will discuss with the family the importance of pain control as well as the possibility that the infection will resolve on its own. I will write an antibiotic prescription (SNAP), but I’ll suggest watchful waiting for a day or two before having the SNAP filled.”
Even with preventive efforts and careful treatment, some children suffer from repeated ear infections. These kids may be candidates for surgical ear tube insertion. “A child who has several ear infections within six months should be evaluated,” says Dr. Alan Wild, a SLUCare otolaryngologist (ear, nose and throat specialist).
Wild says there are two typical scenarios that lead to the insertion of tubes, which help drain fluid from the ear and prevent recurrent infections. “First, parents may request that their child have ear tubes after repeated infections,” he says. “The other most common situation occurs when we see an acute infection in which fluid builds up behind the eardrum and doesn’t go away.” Persistent fluid can affect hearing, although children who get tubes for this reason rarely experience any permanent hearing damage.
Waiting two or three days before seeking treatment is generally acceptable, Wild says. However, because other things, such as teething, can mimic ear infections, he advises seeing a physician if ear pain continues. Only a physical exam can confirm whether an infection is present.
Over-the-counter children’s pain relievers can control discomfort, and anesthetic ear drops can be prescribed if needed for additional pain control, Wild adds. Fortunately, most children grow out of recurrent ear infections by the time they’re 4 or 5 years old, so parents can take comfort knowing that this ‘cold, flu and ear infection season’ of childhood won’t last forever.