Ear infections in babies
Ear infections are common in babies and small children, but that doesn't make the experience any less unpleasant. Here's everything you need to know about ear infections in babies, including common causes, symptoms and treatments, as well why doctors are being advised not to prescribe antibiotics
What causes ear infections in babies?
Ear infections happen when fluid gets trapped in the middle ear (an air-filled space behind the eardrum) and becomes infected by bacteria or a virus. This is most likely to happen when the eustachian tube (a narrow passageway that connects the throat to the middle ear) becomes blocked. This blockage is usually caused by swelling or congestion from a cold, which is why ear infections often develop after colds.
Why are babies more likely to get ear infections than adults?
Babies' eustachian tubes are shorter and less rigid than adults', meaning that both fluid and germs are more likely to get trapped in the middle ear. As children grow, the eustachian tubes enlarge and start angling down, which improves drainage of the middle ear and reduces the risk of infection.
A child's immune system is still developing, so they will have more trouble fighting off viruses and bacteria compared to an adult.
What are the signs and symptoms of ear infections in babies?
The symptoms of an ear infection usually appear quickly and include:
- Pain inside the ear
- High temperature of 38c or above
- Being sick
- Lack of energy
- Difficulty hearing
- Discharge running out of the ear
- Feeling of pressure or fullness inside the ear
- Itching and irritation in and around the ear
- Scaly skin in and around the ear
A baby with an ear infection may:
- Rub or pull their ear
- Not react to some sounds
- Be irritable or restless
- Be off their food
- Keep losing their balance
How common are ear infections in babies?
Ear infections are most common in infants aged between 15 months and six-years-old, and 25% of children will have experienced one before the age of ten.
Babies with allergies are more likely to get ear infections because the allergies can cause inflammation that obstructs the eustachian tubes so that they can't drain, therefore leading to an infection when germs invade.
Babies who are born with a cleft palate or Down Syndrome are also more likely to get ear infections as their eustachian tubes are less able to function properly.
What is the treatment for ear infections in babies?
Most ear infections are caused by viruses, which can't be treated with antibiotics. They'll normally get better by themselves, usually within about three days, and the most acute symptoms should pass within 24 to 48 hours. Unless your baby’s symptoms persist for more than three days – or they have discharge coming from the ear – you should treat them with age-appropriate ibuprofen or paracetamol (e.g. Calpol).
In a review of children with ear infection symptoms, NICE found that around 60% showed signs of improvement (think fewer tears, fewer screams) within 24 hours of an ear infection diagnosis – without taking any antibiotics. Calpol was proven to be enough to lessen the symptoms and relieve discomfort.
Doctors are now less likely to prescribe antibiotics for milder infections, as there is no evidence that antibiotics speed up recovery or lessen the risk of complications. In addition, there is concern about bacteria developing resistance to antibiotics.
Antibiotics may be prescribed for severe infection or when symptoms are worsening. If your baby is prescribed antibiotics, make sure they complete the course – do not stop taking them early, even if symptoms clear up . If you don't give your baby the full course of antibiotics, the infection might stay and your baby could need an additional course, possibly of a different antibiotic.
The new draft guidelines, encouraging doctors not to prescribe antibiotics for ear infections, have been issued for doctors treating acute otitis media, an infection that occurs in the middle ear.
Professor Gillian Leng, deputy chief executive at NICE, said: “We are all too well aware of the dangers we are facing with antibiotic resistance, so it is vital these medicines are only used when they are effective.
“The evidence shows antibiotics are not needed by most children and young people with middle ear infections. We must make sure the people who need them are given them, but routine prescribing in all cases isn't appropriate.”
When to take your baby to the doctor if they have an ear infection
Although not all ear infections will require you to take your baby to the doctor, you should do so if they have:
- Very high temperature or feel hot and shivery
- Severe earache for more than three days
- Swelling around the ear
- Pus coming from the ear
- Something stuck in the ear
- Hearing loss or a change in hearing
- Other symptoms, like vomiting, a severe sore throat or dizziness
- Regular ear infections
- Long-term medical condition – for example, diabetes or a heart, lung, kidney or neurological disease
- Weakened immune system – for example, because they’re having chemotherapy
How to prevent ear infections in babies
Unfortunately, there's not much you can do to prevent ear infections altogether, particularly inner ear infections caused by colds and flu. However, there are some steps you can take to reduce the risk of your baby getting an ear infection.
To help avoid inner ear infections:
- Make sure your child is up to date with vaccinations
- Keep your child away from smokey environments
- Try not to give your child a dummy after they’re six-months-old
- Never put cotton wool buds or your fingers in your baby's ears
After an ear infection, your child may have a problem hearing for two to six weeks. If the problem lasts for any longer than this, ask your GP for advice.
My little girl, who is nearly three, has suffered from about five ear infections in the last 18 months. Luckily she can now tell me when her ear is hurting, and I can get her to the doctors much earlier on..
I feel much better knowing that there are positive things I can do to help prevent ear infections.
Our GP told me that it is quite safe to use both Junior Nurofen and Calpol at the same time, provided you use the right product for the child's age, stagger the doses and give the right amounts at the right intervals.