Do Ear Infections in Children Always Need Antibiotics?
As a pediatric nurse practitioner, I see a lot of ear infections. Many parents rush to their pediatrician’s office when their young child has symptoms such as fever, cough, congestion, and irritability. Their main concern is that their child may have an ear infection (aka acute otitis media). This is a valid concern as 5 out of 6 children will have at least 1 ear infection by their 3rd birthday. I often hear something like, “I want to go ahead and get them started on an antibiotic to get the infection cleared up.”
As a parent with 2 children who both had recurrent ear infections, I get it; you want to help your child feel better when you can. However, did you know that 80% of children with an ear infection get better without antibiotic treatment?
Read on to learn more about the watchful waiting approach for ear infections.
Watchful Waiting for Ear Infections
In 2013, the American Academy of Pediatrics updated their guidelines on the management of ear infections. These guidelines outlined parameters of the watchful waiting approach for “nonsevere” ear infections, which involves initial observation of the ear infection as opposed to starting antibiotics right away. With this approach, if the child worsens or fails to improve in 48 to 72 hours, antibiotics will be started. Below are the guidelines in more detail:
- For a nonsevere unilateral ear infection in a child 6 months to 23 months old, the provider will prescribe antibiotics immediately or offer observation with close follow-up.
- For a nonsevere ear infection (unilateral or bilateral) in a child 24 months or older, the provider will prescribe antibiotics or offer observation of the ear infection with close follow-up.
As you can see with these guidelines, the parent has the option of starting the antibiotic immediately or observing their child for worsening signs and symptoms.
What Are Severe Signs And Symptoms Of An Ear Infection?
With these symptoms, regardless of age, antibiotics should be prescribed:
- Moderate or severe ear pain for at least 48 hours
- Fever of 102.2 degrees Fahrenheit or higher
When I suggest watchful waiting for an ear infection, I tell parents to monitor for the above symptoms. I will often go ahead and write a prescription for an antibiotic, but tell the parent not to start it unless their child develops severe symptoms. Parents appreciate this as they may not be able to come back to the office for an ear recheck.
How Can I Help My Child Feel Better During The Observation Period?
During the 48 to 72 hour observation period, I tell the parent to give their child ibuprofen as needed for pain relief as ibuprofen is anti-inflammatory and ear infections are an inflammatory condition. Warm compresses to the ear may also help.
I also recommend that parents try their best to keep their child’s nose clear of mucus since the ears and nose are connected; if we can keep the nose clear, the ears may also drain and help resolve the ear infection. To clear the nose of a young child, saline nose drops and suctioning with an aspirator are very effective.
Why Not Just Give The Antibiotic Immediately?
Ear infections are the most common childhood condition for which antibiotics are prescribed. When I first started practicing, I almost always prescribed an antibiotic for an ear infection regardless of age and symptoms. Why? Because this is what I had been taught by my supervising physicians. However, now that I have a few years of experience, I have started to employ the watchful waiting approach because I’ve seen many of my patients get better without antibiotics. Furthermore, if we continue to use antibiotics when they are not needed, the bacteria that cause ear infections will begin to become resistant to the antibiotics.
