How to Prevent Ear Infections in Babies

Ear infections are an unfortunate part of many children’s lives. They wreak havoc on sleep schedules and lead to lots of discomfort and fussiness. But, Andrea White, MD, UnityPoint Health, says there are ways to help prevent ear infection in babies.

Ear Infection Causes

An ear infection is an inflammation of the middle ear space. In young children, congestion and swelling from a cold virus can cause the Eustachian tube to become blocked, leading to fluid buildup and bacteria being trapped in the middle ear. 

“Young children catch an average of 10 to 12 viral colds per year, which can create the right condition for ear infections to start,” Dr. White says.

Doctors look for bulging and redness of the eardrum and for evidence of fluid behind the eardrum to determine if there’s an ear infection. Risk factors for ear infections are also higher in young children and babies due to their anatomy. 

“The Eustachian tubes of children are small in diameter and sit more horizontally in the head compared to adults. This makes it more likely that the Eustachian tube will become plugged, which leads to ear infection,” Dr. White says.

As kids grow, the Eustachian tube changes making ear infection less likely. Kids usually start to outgrow a tendency toward ear infection after their first two-to-three winters. Dr. White says there also appears to be a genetic component associated with the risk for ear infections.  

How to Prevent Ear Infections

While tough, Dr. White says the best way to stop an ear infection is to avoid illness. Here are her six suggestions on how to prevent ear infections in babies:

• Vaccines. The pneumococcal vaccine (Prevnar 13) and the flu vaccine can help prevent ear infections because they prevent illness.
• Hand Washing. Getting the whole family into good hand-washing practices can prevent the spread of illness. It’s especially important before meals and after sneezing, coughing or nose blowing.
• Bottles. If babies are fed a bottle while lying flat, fluid can get into the middle ear space increasing risk of ear infection. Try feeding at a more up-right angle.
• Pacifiers. In studies, pacifier use and thumb sucking is associated with three-times higher risk of ear infection. The study suggests sucking causes the ear canal to become abnormally open, allowing more bacteria in. Try allowing pacifiers only at bedtime or for shorter periods of time.
• Cigarette Smoke. Keep little ones away from second-hand smoke. Exposure can increase the risk of respiratory and ear infections.
• Earwax. Believe it or not, let that earwax be. Ear wax helps protect the ear canal and has antimicrobial properties, which means it fights the growth of microorganisms like bacteria. However, if ear wax gets too thick it might cause trouble hearing for children.

“Water and cold weather are two other common concerns. Water in the ear canal can lead to swimmer’s ear, an infection in the ear canal. However, if a child has intact ear drums, it should not lead to middle ear infection. Likewise, cold air doesn’t directly cause ear infection, but it can cause ear pain. Make sure you cover sensitive little ears with hats to help prevent discomfort,” Dr. White says.

How to Treat Ear Infections

Fever, difficulty sleeping, more crying than usual and tugging at ears are four common ear infection symptoms, but there are others. If you think your child has an ear infection, work with your doctor for the best treatment option. Prescribed antibiotics are one route, but you can also take a wait-and-see approach.

“Per the American Academy of Pediatrics (AAP) guidelines, if a child is over six months of age with no fever and infection in only one ear, pain management through acetaminophen and ibuprofen, along with careful observation and follow up is one option. Antibiotics are given if a fever develops or if pain symptoms or infection are progressing,” she says.

Dr. White says antibiotics are strongly encouraged for children under 6 months of age with a fever of over 102.2 degrees Fahrenheit, infection in both ears and/or persisting pain for over 48 hours. 

“The first line antibiotic for ear infection is amoxicillin. In case of a resistant infection or allergy, other antibiotics like Augmentin or cefdinir may be used,” Dr. White says.

Antibiotics can put your child at risk for allergic reaction, development of antibiotic resistance or negative effects on the healthy bacteria in the body, such as in the gut.

How Many Ear Infections Before a Child May Get Ear Tubes?

Ear tubes are also an option for children who suffer from chronic ear infections. Dr. White says a child is a candidate if they’ve had:

• Three ear infections in the last six months
• Four ear infections in the last year
• Chronic middle ear fluid for three months or longer

Doctor also take into consideration how ear infections are impacting a child’s hearing, balance, development, birth defects of the face or head and chronic ear discomfort. 

“The ear tube procedure involves making a tiny incision in the ear drum, suctioning fluid from the middle ear space and inserting a small plastic tube that looks like a tiny bead. Ear tubes provide another way for air to get to the middle ear space and allows fluid to drain. Ear tubes typically fall out within six to 18 months. Occasionally, they don’t and need to be surgically removed. Also, the hole where the tube was placed sometimes doesn’t heal on its own. If that happen, it’ll be surgically repaired,” Dr. White says.

The procedure requires anesthesia and usually takes less than 15 minutes to complete.
“When the time comes for a discussion about tubes, parents and caregivers are a partner in decision-making together with their pediatrician and ENT surgeon,” Dr. White says.