Ear Infections in Young Children on the Decline

For generations, it was a painful and routine ritual for many babies and young children—as well as their parents. Ear infections: It meant a trip with the feverish toddler to the pediatrician and an examination of the screaming child’s inflamed ear. Then came the prescription for the pink-liquid antibiotic, amoxicillin, to treat otitis media, or middle ear infection, and the hope that the child would recover quickly and remain ear infection-free for awhile.

Kids with repeated or chronic infections, facing hearing loss and speech delays, frequently underwent a minor procedure to place ear tubes though the eardrums to prevent fluid buildup and allow air into the middle ear.

Today, while ear infections aren’t totally a thing of the past, they are less common and antibiotic treatment less routine. “Yes, we are seeing an improvement in bacterial-type ear infections,” said Tatiana Ivan, M.D., a family medicine physician for Baptist Health Primary Care Family Medicine Center at West Kendall Baptist Hospital.

Study: Rates of Infection Decreasing

In a study published in the March issue of the journal Pediatrics, researchers followed 367 babies in their first year of life. They found that 6 percent had an ear infection by three months old, 23 percent by 6 months and 46 percent by a year. In the 1980s and 1990s, higher rates of ear infections were recorded: 18 percent of babies had an ear infection by 3 months, 30-39 percent by six months and 60-62 percent by a year.

In the recent study, the babies who got ear infections also had twice as many colds, revealing the connection between viruses and ear infections. Breast-feeding babies had fewer colds and ear infections than babies who were not breast-feeding, a finding that was consistent with many previous studies.

In addition to breast-feeding, researchers have pinpointed several other factors leading to the decline in ear infections:

• New and better vaccines;
• A lower smoking rate among parents;
• And tighter criteria for diagnosing an ear infection.

In 2000, the first routine childhood vaccine for Streptococcus pneumoniaiae, or pneumococcus, became available. Pneumococcus can cause serious infections like pneumonia and meningitis and is also one of the types of bacteria that cause ear infections.  A 2014 JAMA Pediatrics study found, from 2004 to 2011, a decline in medical visits for ear infections among children up to age, with a sharp drop in 2010-11, the same year the pneumococcal vaccine was improved to cover more bacterial serotypes.

Overprescribing of Antibiotics

In light of concerns over overprescribing antibiotics and their effects on the child’s microbiome (the bacteria living on and inside the body), the American Academy of Pediatrics revised its evidence-based clinical practice guidelines in 2013 to tighten the criteria for diagnosing otitis media. The child’s eardrum must be clearly bulging, not just pink or red, before antibiotics are considered an appropriate treatment. And the guidelines suggest a wait-and-see approach for older children with bulging eardrums who do not have significant pain or high fever.

The new guidelines reflect an emphasis on maintaining healthier microbiomes, which support healthy immune systems, and avoiding breeding resistant bacteria.

Dr. Ivan said the Family Residency program at West Kendall Baptist Hospital takes the recommendations very seriously.

“There are clear guidelines about diagnosis and who should get antibiotics and who should be watched for 48 to 72 hours,” she said.

Typically, parents bring their young kids in with fever and cold symptoms. “What we try to do is make sure there is no bacterial infection,” Dr. Ivan said. “If you get a cold, you can get a lot of inflammation in the mucus membranes and then the inner ear can’t drain. This puts the child at risk for a bacterial infection because the fluid is just sitting there.”

Dr. Ivan said communicating with parents and educating them about evidence-based treatments are key to developing a trusting relationship with the family.

“I’m finding that more and more parents respond really well to education,” she said. “They want to keep their kids safe. We spend time with them so they are comfortable at the end of the visit and they end up with a positive understanding of the disease process. Sometimes it’s safer to help with the pain and discomfort, providing comfort measures” rather than antibiotics.