Otitis Media, Wait-and-See Antibiotic Treatment (Child Over 6 Months)

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 antibiotics 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. Keep giving the medicine until it's gone, even if your child feels better.

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 breastfeeding. 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 ice pops. 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 they are 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, they 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 up the bottle.

  • Keep your child away from secondhand smoke. Don't let people smoke in your home or car, even when your child is not present.

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. They 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 of 100.4°F (38°C) or higher, or as directed by your healthcare provider (see Fever and children, below)

  • Infrequent wet diapers or dark urine

  • 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 and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

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

Fever readings for 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

Fever readings for 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 in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • 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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