Ask The Doctor

Antibiotics and Ear Infections in Children

Dear Dr. Garner,

I have a 6-year-old son, who seems to come down with ear infections at least three times a year. My best friend also has a 6 year old, who gets frequent ear infections.

When I bring my son to the pediatrician, he gets Tylenol or Motrin and that’s all. Every time my friend brings her son to her pediatrician, he gets an antibiotic and Motrin.

Should children with ear infections be getting antibiotics? I remember getting pink liquid antibiotics every time I had an ear infection as a child. What is best?

Looking for Ear Infection

Answers in Astoria


Dear Looking for Answers,

Your question is an important one. First I would like to briefly review the subject of what an ear infection is and why it is most likely children experience these.

An ear infection is a buildup of fluid in the middle ear, which lies behind the eardrum and contains the tiny bones that vibrate to help us hear.

There are tubes that help drain the fluid in the ear, known as Eustachian tubes. In children they are very narrow, and are easily blocked, causing a buildup of fluid in the middle ear. The fluid is a prime sight for germs to grow.

When the fluid builds up, the child feels a lot of pain and may develop a fever or temporary hearing loss.

The doctor can easily make a diagnosis of an ear infection by looking in the ear at the eardrum and seeing if it is bulging from the fluid.

He can also squirt small puffs of air at the eardrum to see if it moves. If it does, it is likely that there is no infection.

Now to your question: Should antibiotics be used to treat the ear infection?

Watchful Waiting Approach

Well, a large organization of pediatricians got together to issue guidelines on this matter a few years back. Their guidelines suggest antibiotics for use in children under age two and for those over age two who have high fever and signs of a severe infection.

For children over age two, they believe that “watchful waiting” is appropriate. This means that the child should be observed for two or three days before starting antibiotic treatment as most ear infections are caused by viruses that aren’t affected by antibiotics.

Each child should be evaluated individually, and each infection evaluated to determine the likelihood for serious infection or complication.

The bottom line is that in the vast majority of cases, in children over age two, antibiotics are not necessary.

I can’t comment on your friend’s son’s case, as I don’t know his medical history or the nature of his infections.

For routine infections, as it seems your son has, your doctor is following the appropriate guidelines.

Reducing Risks

Things that all parents can do to reduce their child’s risk for ear infections are as follows:

  • Have your children vaccinated for the flu to help reduce the risk of contracting it.
  • Prevent common colds by encouraging hand washing and not sharing eating or drinking utensils.
  • Avoid secondhand smoke as this increases the risk.
  • Breastfeed your baby when possible as breast milk contains antibodies that may offer protection from ear infections.
  • If your baby is bottle-fed, hold him or her in an upright position during feedings. Avoid propping a bottle in your baby’s mouth when he or she is lying down.
  • If possible, limit the time your child spends in group child care.

As always, consult with your doctor for your child’s care. Parents must serve as advocates for their children and question their pediatricians about antibiotic usage. This is something your pediatrician should welcome, as too often doctors feel compelled to write antibiotics due to pressure from parents.

Until next week, be well.


Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET-TV, Tuesdays at 8 p.m. on Time Warner Channel 97 and Cablevision Channel 30.

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