Middle Ear Infection, Wait and See Antibiotic Treatment (Child) 

Your child has an infection of the middle ear. That's the space behind the eardrum. Sometimes the common cold causes this type of infection. Congestion from a cold can block the eustachian tube. This internal passage normally drains fluid from the middle ear. But when the middle ear fills with fluid, bacteria or viruses may grow there, causing an infection.

Not so long ago, healthcare providers used antibiotics to treat almost all cases of middle ear infection. They now know that most people with such an infection will get better without these medicines. 

The reasons for not using antibiotics are:

  • These medicines don't ease pain in the first 24 hours. They also have little effect on pain after that.

  • They may cause diarrhea or other side effects.

  • They don't help with viral infections.

  • They don't treat middle ear fluid.

  • Using them too often may cause bacteria to become resistant. This makes the bacteria harder to treat in the future.

  • Certain ones cost a lot.

Your child's healthcare provider may instead advise a wait and see approach. That means treating your child only with acetaminophen, ibuprofen, or ear drops for the first 2 days. You will wait to see if your child feels better. If your child is not better or is getting worse 2 days after today’s visit, then fill the antibiotic prescription. Start giving your child the medicine as directed by your child's healthcare provider.

Home care

These care tips may help at home:

  • Fluids. Fever increases water loss from the body. For infants younger than age 1, keep up regular formula or breast feedings. Between feedings give an oral rehydration solution. You can find these drinks at grocery and drug stores. No prescription is needed. For children older than 1 year, give plenty of fluids like water, juice, lemon-lime soda, ginger-ale, lemonade, or popsicles. Sports drinks are also OK. Never give your child energy drinks with caffeine in them. If your child is having diarrhea, fluids with sugar in them may make the diarrhea worse.

  • Eating. If your child doesn’t want to eat solid foods, it’s OK for a few days. Just be sure your child drinks lots of fluids. Note how often your child passes urine, such as the number of wet diapers. Also check the color of your child's urine. Light-colored urine means better hydration. A darker urine color means your child may need more fluids.

  • Rest. Keep children with fever at home resting or playing quietly. Your child may return to daycare or school when the fever is gone and he or she is eating well and feeling better.

  • Fever and pain. You may give your child acetaminophen for pain. If your child is older than 6 months, you may give ibuprofen instead. Give these medicines as your child's healthcare provider directs. If your child has chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your child's healthcare provider before using these medicines. Don't give aspirin to anyone younger than age 18 who has a fever. It may cause a potentially life-threatening condition called Reye syndrome.

  • Ear drops. Talk with your child's healthcare provider before giving your child ear drops or other over-the-counter medicines.

  • Antibiotics. Only fill the antibiotic prescription if your child is not better or is getting worse 2 days after today’s visit. Once your child starts taking the medicine, he or she may feel better after the first few days. But make sure your child takes all of the medicine.

Prevention

To reduce the chance of your child getting an ear infection, follow these tips:

  • Breastfeed your child when possible.

  • If you give your child a bottle, don't prop the bottle up.

  • Keep your child away from secondhand smoke.

Follow-up care

Sometimes the infection does not go away after the first antibiotic. A different medicine may be needed. Make an appointment with your child's healthcare provider. He or she will check your child’s ears to be sure the infection has cleared.

Call 911

Call 911 if your child has any of these:

  • Unusual fussiness, drowsiness, or confusion

  • No wet diapers for 8 hours, no tears when crying, or a dry mouth

  • Stiff neck

  • Convulsion (seizure)

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Symptoms get worse or don't start to get better after 2 days of treatment

  • Fever (see Fever and children, below)

  • Headache or neck pain

  • New rash appears

  • Frequent diarrhea or vomiting

  • Fluid or bloody drainage from the ear

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds of digital thermometers. They include ones for the mouth, ear, forehead (temporal), rectum, or armpit. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Use a rectal thermometer with care. It may accidentally poke a hole in the rectum. It may pass on germs from the stool. Follow the product maker’s directions for correct use. If you don’t feel OK using a rectal thermometer, use another type. When you talk to your child’s healthcare provider, tell him or her which type you used.

Below are guidelines to know if your child has a fever. Your child’s healthcare provider may give you different numbers for your child.

A baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

A child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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