December 1st, 2008
03:39 PM ET

Will antibiotics help the ache?

By Shahreen Abedin
CNN Medical Senior Producer

I'm typing this blog entry while sitting on an airplane.  Haha, just kidding.  I'm a mom of a now 1-year old who got off a plane a few days ago when I flew home to Dallas for Thanksgiving.  I couldn't imagine tap-tapping on a laptop while also trying to feed and keep the little one calm and happy in that a cramped little airplane seat! 

Along with being near-impossible, it would've been one more thing to push me towards the edge of losing it altogether.  There is just SO much to worry about when flying with baby – are his bottles ready? How do I time lunch and what's he going to eat? Did I bring enough toys that are entertaining enough but won’t disturb others? And oh yeah this is a fun one: Is he going to get sick this time too? 

See, the last two times we flew with the munchkin, he ended up getting an ear infection.  I don’t know if it’s because, like many adults, the re-circulated air in the cabin during cold and flu season, along with the close quarters with so many sniffly, coughing people allowing the virus to cling to trays and seats– just makes him more susceptible to getting a cold?  That stuffiness from his cold (a viral infection) can lead to fluid backing up in a child’s ears, thereby setting the scene for an ear infection, which is bacterial (those infections are usually only treated with antibiotics if they last a few months).

Or is it something else about the experience of flying to a different house, surrounded by different people, sleeping in an unfamiliar bed, etc., that makes his immune system go wonky? 

Nevertheless, I know my kid isn’t alone in his bouts with ear infections.  It’s the most common bacterial illness in children, according to the American Academy of Pediatrics.  Young children are more likely to get these pesky infections because their Eustachian tubes are shorter, narrower, and more horizontal than for the rest of us, so they don’t drain as well.  Every year, over 5 million kids get ear infections, leading to over 30 million doctors’ visits, according to the American Academy of Pediatrics. 

The first time it happened, I saw the telltale ear tugging, usually a sign of pain or discomfort, and then took him to a drug store clinic while I was still in Dallas, where he was prescribed antibiotics by a nurse practitioner.  The second time, we came home and his pediatrician said we could put him on antibiotics or just wait it out and see how he does.  See, the AAP (and I) are both concerned about antibiotic resistance.  Which is why the organization actually now recommends that doctors give parents the option of letting the kid fight the infection on his own for the first two or three days, observing how he does, and then prescribing antibiotics only if the symptoms don’t improve.  The academy says that about 80 percent of cases actually get better even without antibiotics.

On top of that, a study from this February, published in the Archives of Otolaryngology-Head & Neck Surgery, found that antibiotics don't really work to get rid of the fluid that accumulates in the ear due to infections.  When I asked her about this, Dr. Laura Jana, spokesperson for the American Academy of Pediatrics and author of “Heading Home with Your Newborn,” said that yes, for 2 or 3 year olds, the trend is now for doctors to hold off on the antibiotics and let the child fight off the infection naturally.  But for babies under age 1 like mine, because their ability to hear is so intrinsically tied to the critical language skills that they develop during this period, doctors will still give them the amoxicillin to fight off the underlying bacterial infection if there's fluid buildup and inflammation, even if the drugs don’t work for fluid reduction.

For the pain, though, the academy still recommends ibuprofen or acetaminophen.  Dr. Jana also stresses the importance of follow up visits for the little tykes, to make sure that the fluid has indeed finally drained from the ears.

So I’m wondering – how many of you out there have chosen to wait it out and let your baby’s body duke it out alone, and how did that go for you? How many of you, like I was the first time, are more willing to put the baby on antibiotics if it could help, when they're in their first year?  Did you have any problems with antibiotic resistance later on?  And do you also deal with ear infections related to when you travel?  What was your experience?  And what are your most useful tricks for getting your small child to stay healthy and sane on a plane?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (48 Responses)
  1. Terry

    Both my children had ear infections, my oldest seem to get them as soon as we discovered he had allergies, mostly airborne, they would cause him to get stuffed up, his ears would plug, he would end up with excess fluid and get an ear infection. The solution was to treat the allergies, so he wouldn't get so stuffed and to put tubes in his ears to drain the fluid. The tubes were done after finding that he was failing hearing tests. My second child also got ear infections, the tubes in her ears were too small to drain the fluid on their own. Unfortunately, we continued to treat her with antibiotics to the point that she did become resistant, she had tubes put in after she had a perforated ear drum from an infection. They came out on their own, and the infections started again, more atibiotics, then she had permanent tubes put in and her adnoids were removed. Some years after she got a foot infection, it was an injury, but it did not heal partly because of the birth defect she was born with. To make a long story short, we had to use two of the highest types of antibiotics to treat the infection because she was resistant, and were told that she would be in big trouble if they didn't work in the future if she was in this situation again. So be careful using anitbiotics as a qucik fix, it could come back to bite you in the future.

    December 1, 2008 at 17:34 | Report abuse | Reply
  2. Pediatric ENT specialist

    Please read these two articles. There is a great deal of difference between the treatment of Acute Otitis Media (or what describe as a childhood "middle ear infection") and Otitis Media with Effusion, which is the buildup of fluid in the middle ear without the signs and symptoms of an active infection. Confusing the diagnosis and treatment options for both is common and tricky.


    December 1, 2008 at 17:42 | Report abuse | Reply
  3. Greg

    As a child, I went through many an ear infection – usually twice a year or more. My mother would take a spoon of Johnson's Baby Oil and hold a lit match under it until well warmed. Then she would wad up some cotton and dip it in the oil. Placed in the hurting ear there would be some relief. Then placing my head on a towel-wrapped hot water bottle I would go through several pressure build-ups until the ear would abcess. Oh what a tremendous relief! Usually within a few hours. Then she would replace with clean cotton wads until the ear cleared within a couple of days. Sometimes the old ways are better!

    December 2, 2008 at 05:16 | Report abuse | Reply
  4. Heather

    Shahreen, I am no doctor, but I think it might be important for someone in your position to communicate clearly that antibiotic resistant bacteria are not caused by prior antibiotic use in the same person, as your comments seem to imply. ("Did you have any problems with antibiotic resistance later on?")

    Bacteria that are resistant to antibiotics develop when antibiotics are used improperly, it is true. However, they can then be passed from person to person, regardless of any given person's previous use of antibiotics.

    So, not using antibiotics now does not provide any sort of assurance of increased likelihood that your particular child will not later contract an antibiotic resistant strain of bacteria. What it does do is make it less likely in general that resistant strains will develop - if enough people use antibiotics carefully and sparingly, fewer resistant bacteria will develop in the population.

    Avoiding overuse of antibiotics is the right thing to do for society as a whole, so that antibiotic resistant strains are less likely to develop in general. This altruistic reason can be a good reason to avoid using antibiotics - for the good of the many.

    However, avoiding using antibiotics in any given instance for any one particular person will not influence the person's future risk of contracting a drug resistant antibiotic, so this should not be used as a decision factor. One cannot "save" an antibiotic for use later by not taking it now. With good luck, the same person can use amoxicillin 20 times for an ear infection and it will work every time because the strain is susceptible. With bad luck, a person who has never used amoxicillin can take it for the first time and it won't work, because the person happens to be infected with a resistant strain.

    December 2, 2008 at 12:09 | Report abuse | Reply
  5. ACinCincy

    In my case, I had a history of chronic ear infections & impaired hearing as a child (parents were non-smokers). My parents avoide antibiotics, and delayed getting tubes in until I was 5 yrs old, and I now have a ton of scar tissue on and around my eardrum with measurable hearing loss. (I don't notice it unless I'm in a crowde room, then I can't hear the person speaking directly to me, they have to talk in my ear.)

    A friend of mine at work, whose children are now in their mid-20s had a pediatrician advise against treating repeated ear infections with antibiotics or tubes in her youngest son. They eventually cleared up, but he has been left with damage in his ears, similar to mine, which he wasn't even aware of until he was preparing to go on a trip for work (he works with children) and had to have a physical, including a hearing test. He has to be fitted with a hearing aid in order to go on the trip.

    So, when my kids started getting ear infections themselves, we went for the antibiotics right away, which worked. But after multiple infections (10+ in one year for my youngest), we did not hesitate to involve an ENT and go for the tubes. (FYI – Perforated eardrum is something your body usually does on its own anyway if the pressure from fluid buildup gets too great.)

    What a dramatic difference! My (then) 18 month old – who was always an unusually quiet child – had a language explosion; and my (then) 3yr old remarked about how "crunchy" the popsicle was that the nurse gave her after the procedure – in a much quieter voice than we'd ever heard her using. Clearly she had been affected by the fluid buildup.

    Not only was there a dramatic improvement in speech/hearing, but for the next 12-15 months or so (until the tubes fell out), neither one experienced a single ear infection.

    My (then) 18 month old is now 3.5, and is on her second round with tubes.

    My (then) 3 yr old is now 5, and is again experiencing months-long chronic fluid buildup in her ears. Not infected at the present, but it has impacted her hearing, and leaves her highly susceptible to infection in her ears. If it does not resolve in 3-6 months time, we'll do another round of tubes for her as well.

    My take is not to mess around when it comes to eyesight or hearing. Humans are highly adaptable creatures, but once the damage is done, it's done.

    December 2, 2008 at 14:04 | Report abuse | Reply
  6. Sue

    I have flown many times with my child since in the last year she was 6 months old. I was told on take off and landing to make sure she is constantly swallowing during these times to limit the pressure build up in her ears. For this reason, we get her to drink or eat so she is swallowing during take off and landing. A couple of times she was asleep during landing so I hold her almost upright so her ears are draining properly or rather fluid is not accumulating in her ears. I learnt this the hard way on her second flight when she was sleeping on landing and her pediatrician noticed the start of an ear infection a couple of days later. The ear infection was treated with amoxicillin because she was less than 1 year old. My daughter has had no ear infections since but it could be luck rather than good measure. But I'll continue to release the pressure or sit her upright so long as it prevents the ear infection.

    December 2, 2008 at 14:50 | Report abuse | Reply
  7. Kelly

    With the wait and see method, you must take the child back to the doctor to monitor the situation. Between school, work and over-crowded doctor offices, this is not a realistic option for many people. I certainly don't want to see drugs being used when not needed, but articles about antibotic over use never seem to address this part of the problem.

    December 3, 2008 at 15:12 | Report abuse | Reply
  8. rachael

    Through my experience I have learned that it is not always best to wait to treat. My oldest almost lost her hearing due to ear infection. My youngest had an infection and the Dr. said wait and within a day we had a 104 fever from the ear and soon after antibiotics we were better. They were both 2-3. One of the problems for me is that the DR. always wants to prescribe amoxicillian this is a narrow spectrum antibiotic and it does not always work. I usually will wait on most of the infections but I do believe that alot of children are being under treated and suffering longer due to the fear of antibiotic resistance. We need a test to show whether it is viral or bacterial instead of waiting two weeks and then doing antibiotics. I think that would prevent the wrong antibiotics being used and less suffering for children that can be cured with antibiotics and less chance of resistance because you can prescribe the correct antibiotic and not one that does not treat that type.

    December 4, 2008 at 09:19 | Report abuse | Reply
  9. Liz

    Our pediatrician usually will write us the prescription and leave it up to us as parents whether or not to fill it for our son's ear infections. We usually fill it, since all that the wait and see method ever accomplished for us was 3 extra sleepless nights!

    December 4, 2008 at 12:59 | Report abuse | Reply
  10. Sara

    My nephew had tubes put in his ears last year to deal with "hearing loss." In my experience with him, he won't "hear" when you ask him to do a chore in the same room, but had no problem hearing a whisper about treats 3 rooms away! The tubes haven't helped with this at all....

    I also suffered chronic ear infections and chronic sinus issues since birth. I was rated very low normal in hearing tests at school, but found out on my own that I have exceptionally acute hearing in higher ranges, so I question the value of school hearing tests. I had my tonsils and adenoids removed which did not at all affect my ear infections (I grew out of them) or my sinus problems, which I still suffer to this day. The only thing surgery did for me was to make me more petulant and less willing to socialize and talk with my peers. I feel that these elective surgeries are way overdone and can have more harmful effects than realized on children.

    December 9, 2008 at 11:39 | Report abuse | Reply
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