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AAP Sets New Guidelines for Treating Ear Infections in Children

Katlyn Joy |26, February 2013


You wake up to your little one screaming and pulling at his ears. It's an easy guess that the problem is an ear infection. You take the child to the doctor and expect to leave with a prescription for an antibiotic. After all, it's an easy diagnosis, right? Not so fast. The American Academy of Pediatrics, on February 25, 2013, updated their guidelines for treating suspected ear infections in order to reduce unnecessary antibiotic use. Routine use of antibiotics can cause a number of problems including unnecessary side effects such as upset stomachs, the development of allergies to medications, and give rise to the super bugs or infections that are resistant to antibiotic treatment.


Ear infections are one of the most common childhood illnesses and the main reason doctors prescribe antibiotics. Three out of four kids have an ear infection by age 3. The reason is that children's Eustachian tubes are narrower than adults' and so are more difficult to drain of fluids and mucus which accompany viruses and infections. Such infections can cause a high fever and often result in acute pain.

While it may be difficult for a concerned parent, the new guidelines from the AAP recommend a much more conservative approach than previously followed. Now doctors are advised to observe whether the eardrum is at least moderately to severely bulging before diagnosing an ear infection.

Antibiotics are to be prescribed only in cases where children are suffering from a high fever of 102.2 or higher or have had 48 hours of serious pain and swelling. If a child has had moderate or mild symptoms for less than 48 hours, pain relief should be the first course of action.

Symptoms of an ear infection in pre-verbal children include:

  • fussiness,
  • drainage from the ears,
  • sleeplessness,
  • tugging at the ears and
  • a loss of balance (sometimes)
  • hearing problems (sometimes)

According to the AAP, 70 percent of kids who don't get antibiotics will improve within 2 or 3 days and 80 percent within a week or so. If a child doesn't have severe pain and the eardrum is only somewhat pink or red and not bulging, treat the pain and wait and see what the next few days bring. If the child doesn't improve or gets worse, antibiotics can be administered then.

However, if a child has recurrent ear infections, is between the ages of 6 months and 2 years and has a double infection (an infection in both ears) or a child of any age has a ruptured ear drum, antibiotic treatment is needed.

Other ways to prevent ear infection are to keep children away from cigarette smoke and to breastfeed infants for at least the first six months of life, and to get a yearly flu vaccine since reducing the incidence of viruses reduces the risk of ear infection.

The AAP also warned against the practice of preventative or prophylactic administration of antibiotics. This has often been done in cases of children who get repeat ear infections.

Of course parents are reminded that if a doctor prescribes an antibiotic, the directions should be followed closely. Never stop giving the medication even if the symptoms improve and the child feels better. The medicine needs to be given until it is all gone. Saving left over antibiotics to give to a child who is feeling under the weather to prevent an infection is also seriously discouraged as this will also give rise to more resistance to antibiotic treatment in the future. All the medicine must be taken when prescribed in order to completely eradicate the infection. Any bacteria left over will be stronger and more difficult to treat otherwise.

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