Dear Dr. Garner,
I have a dilemma. I have a six-year-old boy, who seems to come down with ear infections at least three times a year. My best friend also has a six year old, who also gets his fair share of ear infections.
I hope you won’t feel uncomfortable answering this question, but here goes.
Every time my friend brings her son to the pediatrician for an ear infection, he gets an antibiotic and Motrin.
Every time I bring my son to our pediatrician he gets Tylenol or Motrin and that’s all.
Should children with ear infections be getting antibiotics? I remember always getting pink liquid antibiotics every time I had an ear infection as a child.
What is best for my son? Should I look for a new pediatrician?
Looking for Ear Infection
Answers in Astoria
Dear Looking,
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 loss of hearing.
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 for the $64,000 question: Should antibiotics be used to treat the ear infection?
Well, a large organization of pediatricians recently has gotten together to issue guidelines on this matter. 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.
Watchful Waiting Approach
For children over age two, they believe that “watchful waiting” is appropriate. This means that the child should be observed for two to three days before starting antibiotic treatment as most ear infections are caused by viruses which are not affected by antibiotics.
There is a need for clinical decision making, and medicine is not merely a cookbook. 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 cannot comment on your friend’s case as I do not know the medical history for your friend’s son, or the nature of his infections.
For routine infections, as it seems your son has, your doctor is following the appropriate guidelines.
I believe that all parents should be questioning their doctors about antibiotic use. Due to overuse of antibiotics in the past, we are now facing new bacteria that are resistant to antibiotics.
There was just a new study published last week which found that due to widespread antibiotic use, normal bacteria which live in our body and help us in many different functions, such as digestion, have been wiped out. This is leading to an increase in weight gain due to difficulty digesting food, as well as immune system problems, asthma and general allergies.
Ways to Reduce Risk
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. 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 doctors 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.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.