All you need to know about ear infections in babies and toddlers

Ear infections are common in babies and toddlers – five out of six will experience at least one before their third birthday, and it is the most common reason parents take their child to a doctor, according to the National Institutes of Health.

Ear infection is caused by inflammation in the middle ear, explains Dr Susan Annandale, a Grotto Bay-based paediatrician. It is mostly triggered by bacteria in fluid that builds up behind the eardrum following a sore throat, cold or upper respiratory infection. They spread through the eustachian tube, which links the back of the nose and throat to the middle ear. 

What to watch out for

Young children are more vulnerable to ear infection than adults as their immune systems are not yet developed, and their eustachian tubes are narrower and more level, making it difficult for fluid to drain. Many will not yet have learned to talk and are unable to tell you their ear hurts, so it is important to watch for signs:

• Redness and swelling behind an ear.

• Discharge from the ear.

• Ear-pulling. “However, this is most commonly caused by teething (the nerve that supplies the jaw runs to the brain together with the nerve that supplies the ear), and actually seldom by middle ear infection,” says Dr Annandale. “If baby pulls an ear and there is no fever, please just observe.”

• A high-pitched cry, great irritation (signs of pain). 

• Not sleeping. 

• Drinking poorly (bottle or breast) – “Sucking aggravates pain in the middle ear,” she says. 

• Preference for an upright position rather than lying down –“Again, it aggravates pain”.

• Running a fever.

• Showing hearing problems (not responding to quiet sounds).

• Showing balance problems (seeming clumsy).

If you notice signs, consult your health provider. And if your little one is in severe pain, has bloody or pus-like discharge from an ear, or is younger than three months with a fever above 38⁰C, or 3 to 12 months old with a fever of 39°C or higher, take them to their nearest emergency department. “Any fever under 3-12 months is cause for concern,” says Dr Annandale.

How to treat ear infections

Treatment will depend on the type and severity of ear infection. If the pain is moderate, your health provider may advise you to wait to see if the infection clears on its own and give over-the-counter pain medication such as paracetamol or ibuprofen. “Never give your child eardrops without consulting your health provider or pharmacist, and never insert anything in their ear, including cotton earbuds, which may damage the eardrum,” she says.

If symptoms are severe, your health provider may prescribe antibiotics. It’s important that these be used exactly as prescribed to prevent your child developing antibiotic resistance, and that they complete the course even if they seem better.

If the ear infection fails to respond or recurs, you may be referred to an ear, nose and throat specialist for further investigation and treatment. This may include the insertion of grommets (tiny tubes) in the eardrum to drain fluid.

Left untreated, ear infections may result in glue ear, where the fluid trapped in the middle ear becomes thick and sticky, making it hard to drain so it builds up. This can cause pain and affect your child’s hearing, delaying speech and language development.

If the infection is severe, the pressure of fluid build-up can cause their ear drum to burst. This brings instant relief as the fluid drains, and the ear drum usually heals by itself. During this time, avoid their ears getting wet in the bath or shower (use small pieces of cottonwood dipped in petroleum jelly). 

How to help prevent ear infections

• Don’t allow your child to sleep or nap with a bottle – hold them upright while feeding, to reduce the risk of fluid entering their ears. If possible, breastfeed, and do so for as long as you can, says Dr Annandale. “Go on to sippy cups after the age of one year.” 

• Keep clear of second-hand smoke – studies suggest children exposed to it are up to three times more likely to develop ear infections.

• Wash your hands often and encourage your child to do the same when old enough, to help protect them against colds and flu.

• Keep them away from children and adults who are sick.

• Vaccinate your child against flu from six months old, preferably before the flu season starts each May, and see they are up to date with their vaccines – especially PCV (pneumococcal conjugate vaccine), given at 6 weeks, 14 weeks and 9 months as part of the Expanded Programme on Immunisation. 

* Baby immunisations are available at Clicks Clinics, visit https://clicks.co.za/clinicBooking

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