Kids and Health Care: Ear Infections
Younger children get ear infections. Sometimes, the infections are related to drinking from baby bottles -- they occur a lot in toddlers who are still drinking bottles at night. In other cases, the ear infections are related to rapid growth and the intricate tubing that's part of the inner ear.
Whatever the cause, ear infections are the most common reason that pediatricians prescribe antibiotics for children. There were an estimated 16 million office visits and more than 13 million antibiotic prescriptions written for ear infections in 2000. Those antibiotics can break a fever fast...but they're not necessarily the best response for the child.
In March 2004, two influential doctors' groups published guidelines aimed at limiting use of antibiotics for ear infections in children. The guidelines stated that about 80 percent of children with ear infections get better without antibiotics -- and that pain relief should be the top priority.
The guidelines encouraged doctors to try pain relief and observation in otherwise healthy children with relatively mild ear infections, if they could be assured of adequate follow-up. In such cases, antibiotics could be started if symptoms didn't improve in two or three days.
The rationale behind addressing pain first is that about 60 percent of kids feel better after a day, and antibiotics don't relieve pain in the first 24 hours anyway. This wait-and-see approach requires patience and may lead to a second office visit that may be inconvenient and expensive.
Because some ear infections can lead to complications, the guidelines say antibiotics should be prescribed to children younger than sixth months who have diagnosed or suspected middle ear infections; kids six months to two years with suspected or confirmed infections and severe symptoms; and kids two to 12 with confirmed infections and symptoms.
If antibiotics are used, the guidelines -- a joint effort of the American Academy of Pediatrics and the American Academy of Family Physicians -- say amoxicillin should be prescribed for most children.
The guidelines focused on a specific type of ear infection known as acute otitis media. It's the most common infection for which antibiotics are prescribed. And the doctors' groups acknowledged that initial treatment with antibiotics may be appropriate for children younger than two and those who are very sick or have a high fever with their ear infections.
While use of antibiotics for childhood ear infections has long been routine in the U.S., in European countries common practice is observation and pain relief first -- which may help stop the rise in antibiotic-resistant germs created by overuse of the drugs.
Why do American doctors prescribe -- and American children consume -- more antibiotics than their European counterparts? Some experts point out that the doctors are so frightened by potential malpractice claims that they medicate just about any illness or discomfort that they see. Patients are satisfied and feel justified when a doctor prescribes drugs; the doctors can show they took the patient's complaints seriously...if anyone questions their actions later.
Some doctors suggest surgery for children with chronic otitis media. This kind of surgery involves the insertion of tubes into the eardrum and is one of the most common operations performed on children. It is usually performed in an outpatient clinic. Tubes are usually placed in both ears. They ventilate the middle ear and help equalize air pressure.
Tubes also drain fluid from the middle ear and improve hearing. Hearing loss is common in children who have built-up fluid behind their eardrums. Children who have ear infections often develop fluid behind their eardrum and hearing loss. Hearing loss is of greatest concern in children age 2 and younger because normal hearing at this age is critical in developing basic speech and language skills.
The decision to resort to surgery is made on a case-by-case basis and has been a debated topic among doctors for decades. Surgery to remove the adenoids (adenoidectomy) or to remove the adenoids and tonsils (adenotonsillectomy), are also controversial operations, which may be done if swelling of this tissue is thought to be blocking the eustachian tube. A large study over a 14-year period found only limited and short-term benefits from either surgery. For this reason, the experts recommend adenoidectomy or adenotonsillectomy only after tubes have failed to prevent recurrent ear infections. If you're considering these kinds of operations for your children, it's a good idea to get a few opinions from various doctors first.
