An indication that there’s something wrong with a baby’s ear is when the baby is fussier than usual and cries while pulling their ear. More often than not, an ear infection is to be blamed for this unexplained change in your baby’s mood.
In fact, according to the National Institute on Deafness and Other Communication Disorders, 5 out of 6 children will have an ear infection before their 3rd birthday in the USA.
Ear infections are some of the most commonly reported complaints at the pediatrician’s office, and they are not to be taken lightly. At this tender age, babies rely heavily on sounds and hearing in order to learn to speak.
Thus, prolonged periods of muffled hearing due to severe or recurrent ear infections can lead to delayed speech development and loss of hearing in babies.
Causes of Middle Ear Infection in Babies
Otitis media, commonly known as ear infection, is characterized by painful swelling and infection of the middle ear (located just behind the eardrum).
- An ear infection can be caused by bacteria or a virus. It happens when fluid builds up in the area behind your child’s eardrum and then the ear becomes infected.
- These infections often spring from a common cold or an allergic flare-up that causes the inflammation or blockage of the eustachian tube. Because this tube connects the middle ear to the back of the throat and nose, it is tasked with the responsibility of draining any fluids that enter this area. However, in the wake of a cold, sinus infection, or an allergy-induced tube blockage, the ear secretions get trapped behind the eardrum, causing pain and pressure. This is further compounded by the fact that children have shorter, narrower, and increasingly horizontal eustachian tubes than adults. Subsequently, this fluid retention further welcomes bacteria and viruses to flourish in the dark, warm, and moist confines of the middle ear, causing an infection.
- Some other reasons for the eustachian tubes to become swollen or blocked are a sinus infection, excess mucus, infected or overgrown adenoids, and exposure to tobacco smoke.
- Because babies have underdeveloped immune systems, they become easy targets for these infection-causing pathogens.
- Using a pacifier may increase the risk of middle ear infections in babies and toddlers.
Symptoms of Middle Ear Infection in Babies
Aside from pain, other common symptoms of an ear infection amongst babies are.
- Fever of 38 C (100.4 F) or above
- Decrease in energy
- Difficulty hearing
- Pus-like discharge draining out of the child’s ear only with otitis externa or ruptured TM (tympanic membrane)
- A feeling of pressure or fullness inside the ear
- Unpleasant odor from the ear
Young children and infants with an ear infection may also:
- Rub or tug at their ear.
- Be unresponsive to certain sounds.
- Be unusually irritable or restless.
- Have loss of appetite.
- Have loss of balance; sometimes, an ear infection can also cause dizziness in babies, which can make them prone to falls and accidents.
Risk Factors for Middle Ear Infection in Babies
Babies who are bottle-fed while lying on their back run the risk of milk entering the eustachian tube, causing inflammation. Some other risk factors for acute ear infections in babies include:
- Changes in altitude or climate.
- A family history of ear infections.
- Use of pacifier at an early age. Pacifier use should be stopped or limited after 6 months of age to reduce the risk of ear infection.
- Children below the age of 5 as they have shorter eustachian tubes.
- Children who attend daycare, because they are more susceptible to contracting common cold infections.
- Children with active allergies.
- Exposure to cigarette smoke can end up inflaming the eustachian tube, making ear infections more likely.
- Children who were not breastfed tend to be bereft of certain antibodies that help fight infections.
- Children with cleft palates usually have swollen eustachian tubes.
- Breastfeed your baby for at least 6–12 months, because the mother’s milk is well endowed with disease-fighting antibodies.
- Keep your baby away from secondhand smoke of any kind.
- Offer your child fluids often as swallowing can help open the eustachian tube so the trapped fluid can drain.
- If you bottle feed your baby, hold the infant in a semi-upright position so the formula doesn’t flow back into the eustachian tubes.
- As soon as your baby reaches the age when he is capable of holding the bottle on his own, swap the bottle with a cup. Teach your baby to drink fluids from a regular cup, although not the “sippy cup.”
- Avoid exposing your baby to situations where cold and flu bugs abound.
- Make sure your child is up to date with vaccinations, including flu shots and pneumococcal vaccines.
When to See a Doctor
As soon as you suspect that your baby is suffering from an ear infection, book an appointment with your pediatrician. The doctor will take a closer look inside your child’s ear with an otoscope. The doctor will confirm if the discomfort is arising from an infection or some other condition. If the eardrum appears red or swollen or oozing with discharge, chances are it’s an infection.
While the eardrum usually heals within a couple of weeks, in some cases, it can cause permanent damage to the child’s hearing.
It is important to consult with your doctor when you first notice signs of possible infection, to see if your child requires treatment.
Occasionally, an acute middle ear infection without timely or appropriate treatment can spiral into graver concerns:
- The eardrum might rupture on account of increased or unabated pressure, causing blood and fluid to drain out of the ear. According to the Children’s National Health System, approximately 5 percent to 10 percent of children with an ear infection will experience a ruptured eardrum.
- The adjoining bone around the ear might get infected.
- Meningitis or infection of the tissue adjoining the brain is always a risk.
- Recurrent infections can lead to the formation of abnormal skin-like tissue, called a cholesteatoma, in the middle ear and possibly through the eardrum, causing irreparable hearing damage or deafness.
Treating Middle Ear Infection in Babies
The American Academy of Pediatrics recommends pediatricians prescribe antibiotics for children 6 months of age and older with evidence of an ear infection with severe symptoms such as ear pain and fever. If symptoms are less severe, then observation may be warranted before the use of antibiotics.
To treat an ear infection in babies under 6 months, most doctors prescribe antibiotics right away.
To reduce the pain and prevent the infection from spreading, there are also some simple yet effective remedies that you can try.
Here are the top few home remedies for ear infection in babies.
1. Apply Warm Compresses
Placing a warm, moist washcloth over the affected ear may lessen the pain that babies experience as a result of an ear infection.
The warm heat will reduce the pain and even prevent the pathogens from multiplying.
- Dip a clean washcloth in lukewarm water, wring out the excess water, and place the washcloth on the pain-stricken ear of your baby for 5 minutes. Wait for 10 minutes, and then repeat the process as needed.
- Another option is to heat 1 cup of salt on the stove or in the microwave, put the warm salt on a piece of cloth, and tie the cloth properly. Place the compress on the affected ear for 10 minutes at a time. Use as needed.
2. Try Cold Compresses
Just like warm compress, you can also reduce ear pain in babies due to ear infection with a cold compress. The cold temperature will numb the nerves around the ears temporarily, providing short-term relief from the pain to your little one.
- Soak a washcloth in cool water and wring out the excess water.
- Put the washcloth over the ear that’s bothering your child.
- Do this for up to 20 minutes at a time.
- Repeat as needed.
3. Breastfeed Your Baby
Breast milk contains many substances that protect your baby from a variety of diseases, and ear infection is just one of them. Breastfed children are less prone to bacterial or viral infections; breast milk even helps speed up the healing process of any kind of ear infection.
A 2016 study published by the University of Texas Medical Branch at Galveston demonstrated that breastfeeding led to a decline in the rate of ear infections among babies under the age of 1. The study also attributed considerable credit to the use of vaccinations and lower smoking rates for this favorable drop in the incidence of ear infections among infants.
- Try to breastfeed your baby for 6 to 12 months if possible.
4. Put Garlic Oil
Garlic has antimicrobial and anti-inflammatory properties; hence, it is considered a good remedy for ear infections.
A 2001 study published in the Archives of Pediatrics and Adolescent Medicine reports that that naturopathic eardrop containing garlic, among other ingredients, was just as effective as over-the-counter anesthetic eardrops in managing ear infection-induced pain.
- Take two crushed garlic cloves.
- Soak them in 1 tablespoon of warm olive or sesame oil for 30 minutes.
- Strain the garlic out.
- Put a drop of the oil into each of the ear canals using a dropper.
- Repeat twice daily.
5. Use Olive Oil
If your child’s ear infection hasn’t escalated to the level that he has a ruptured eardrum or discharge is oozing out of the ear, only then is this olive oil remedy recommended.
Olive oil works as an ear canal lubricant that can loosen troublesome ear wax and provide soothing relief.
Sometimes, an ear infection can be traced back to some fungal or bacterial growth that gets attached to the wax in the ear, leading to blockages in the eustachian tube. This obstruction can easily be dealt with by the use of olive oil.
A 2013 study published in Practice Nursing reports that regular olive oil lubrication increased the ear canal contents. However, olive oil sprayed into the ears immediately before removing wax enabled total wax removal.
Further research is needed to provide improved evidence for ear care.
Giving further legitimacy to olive oil as an ear infection remedy is a 2003 study published in Pediatrics, which found that herbal ear drops containing olive oil helped to reduce pain from an ear infection in children.
- Warm some olive oil slightly.
- Put a few drops of the warm oil into the infected ear.
- You may put a piece of cotton in the ear as needed so that the oil doesn’t leak out.
6. Prevent Exposure to Secondhand Smoke
Exposure to secondhand smoke is one of the reasons behind ear infections in children.
Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This leads to swelling and obstruction, which interfere with pressure equalization in the middle ear, leading to pain, fluid retention, and infection.
A 2012 study published in the International Journal of Pediatric Otorhinolaryngology reports that childhood exposure to environmental tobacco smoke (ETS) is high among an ENT clinic population of Hungarian children.
Such exposure correlates with acute otitis media (AOM) episodes, ENT operations, and conductive hearing loss.
Hence, try to quit smoking and protect your baby from exposure to secondhand smoke, which can make ear infections more severe and more frequent.
7. Keep Your Child Up-to-Date with Vaccines
Keeping your child up-to-date with vaccines can help prevent ear infection.
A 2016 study published by the University of Texas Medical Branch at Galveston reports that use of vaccinations can help lower ear infection in children.
Another 2017 study published in Cochrane Database of Systematic Reviews reports that, because antibiotic treatment increases the risk of antibiotic resistance, influenza vaccines might be an effective way of reducing this risk by preventing the development of acute otitis media.
Talk with your child’s doctor about the vaccines that protect against pneumonia and meningitis and get your baby immunized on time.
8. Check Your Baby’s Sleeping Position
Your child’s sleeping position can either aggravate or reduce ear pain. For instance, lying down flat can sometimes worsen the feeling of pressure and pain in the infected ear.
Hence, when suffering from an ear infection, you need to make sure that your baby is sleeping in the right position. Slightly elevate the crib at the head to improve your baby’s sinus drainage. Do not place pillows directly under your baby’s head. Instead, place a pillow or two under the mattress.
9. Chiropractic Treatment
This is another effective treatment to deal with pain due to ear infections in babies.
The nerves in the upper portion of the neck affect the health and functioning of the inner ear and surrounding tissues. In some babies, spinal misalignments can interfere with proper neurological control and regulation, making them more susceptible to an infection.
In such a case, making an appointment with a seasoned chiropractor can help a lot. They help locate and correct areas of spinal misalignment by using very little pressure, leading to more normal nervous system functioning.
A study published in the Journal of Manipulative and Physiological Therapeutics indicates that the addition of chiropractic care to limited medical care may decrease the symptoms of ear infections in young children.
Expert Answers (Q&A)
Answered by Dr. Jen Trachtenberg, MD (Pediatrician)
How long does it typically take for children to recover from an ear infection?
Most ear infections, about 80%, clear up on their own without any antibiotics. In general it can take about 7-14 days however, residual fluid build up behind the eardrum can last even a few months.
Can ear infection in babies lead to deafness? If so, then can this deafness be reversed?
Ear infections most often cause temporary hearing loss due to the fluid and pus build up inside the middle ear area. When an ear infection resolves and the fluid is gone, the hearing returns.
Only in extremely severe cases of untreated infection can there be potential for damage to the structures in the middle ear leading to permanent hearing loss.
What are the most common complications associated with an untreated case of ear infection in babies?
Rare complications with severe untreated cases can cause mastoiditis (infection of the mastoid bone) and meningitis. However, most common complication with middle ear infection is temporary hearing loss which in young infants and toddlers can affect speech and language.
Will putting a drop of breast milk in the baby’s ear help clear the infection?
There is no scientific evidence that dropping droplets of breast milk in baby’s ear will help clear up an ear infection particularly because the infection is in the middle ear on the other side of the tympanic membrane. However, breastfeeding does decrease the risk of ear infections in babies.
What are the obvious signs of a worsening case of a middle ear infection?
Signs of worsening ear infection or one that is not resolving on its own in babies can be increased fever, very irritable or cranky, poor balance, vomiting, not eating, dehydration, not sleeping, or not responding to sound or noises.
Are there any safe and effective methods available to drain the infected fluid from the ear?
There is no safe way at home to drain the fluid from behind the tympanic membrane of the middle ear. If required, an ENT surgeon can perform a procedure to place myringotomy tubes for drainage and pressure balance in chronic cases of ear infections.
Please provide some additional tips or inputs regarding pediatric cases of middle ear infection.
Most cases of ear infections are viral and can resolve on their own with just pain medication as needed. However, antibiotics are given if the child is less than 24 months, has severe pain, fever or infection in both ears.
Children who are older and with mild symptoms can be monitored, given pain management with close follow up to check if it is resolving or if antibiotics are needed after 24-48 hrs. Some important points to remember include:
- Prevention is key
- Breastfeeding reduces incidence of ear infections
- Avoid smoking or second hand smoke near a baby
- Make sure immunizations are up to date, for example the pneumococcal vaccine has drastically reduced instances of ear infections in infants
About Jen Trachtenberg, MD: Dr. Trachtenberg is a board-certified pediatrician, nationally renowned parenting expert, author, spokesperson for the American Academy of Pediatrics and an Assistant Clinical Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai. She has a successful private practice in New York City for over 22 years.
Dr. Jen’s mission is to maximize the inherent potential in every child. She is the creator of Pediatrician in Your Pocket, the only science-based, mom-tested, no-judgment, video guide for new parents.
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