New ear infection guidelines for children

ear infection pediatricEar infections seem to almost be a rite of passage for babies and young children. What used to always result in a prescription for antibiotics is now being treated more cautiously, as outlined in the new ear infection guidelines published by the American Academy of Pediatrics.

The new guidelines call for a wait and see approach for children unless they have a fever of 102.2 or higher, significant pain, ruptured eardrum with drainage, or infection in both ears. Those patients will still receive antibiotics right away.

Children with an ear infection that does not meet those criteria should be treated for the pain, but not with antibiotics.  A red eardrum without purulent middle ear fluid, or pus, is not sufficient to warrant antibiotic treatment.

For years, we’ve been over-prescribing antibiotics, which has helped to lead to the development of antibiotic-resistant bacteria. Since many episodes of middle ear fluid will clear up on their own, we just need to manage the child’s pain with acetaminophen or ibuprofen. If the symptoms do not improve or get worse after 48 to 72 hours, then we’ll start antibiotics.

Children with frequent ear infections should not be prescribed prophylactic antibiotics to prevent ear infections. For those patients, we consider using tubes that ventilate the middle ear and prevent the accumulation of fluids. Even if a child with tubes has some drainage, it’s important to not automatically prescribe antibiotics. We treat those children with time, acetaminophen or ibuprofen, and antibiotic ear drops.

Of course, prevention is the first step.  Here are a few things you can do to help prevent your child from getting ear infections:

  • Research has shown that breastfeeding lowers your child’s chances of getting ear infections.
  • Keep your infant upright while taking a bottle.
  • Keep your child in a smoke-free environment.

For parents, the new guidelines should not affect when you take your child to the doctor. Even if they are not in great pain or running a high fever, children can still have an ear infection that requires antibiotics. Only through a doctor’s exam can the best course of treatment be planned. If in doubt, call your doctor’s office to help determine if you need to bring your child in.


mott blog - charles koopmann thumbCharles Koopmann, MD, is a pediatric otolaryngologist at C.S. Mott Children’s Hospital at the University of Michigan.  His areas of special interest include sleep Apnea, endoscopic sinus surgery, airway problems, pediatric voice problems, pediatric ear and hearing problems, and medical ethics questions.



best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.