Now hear this

It’s a rare parent who doesn’t end up at the pediatrician’s office for an ear infection at some point. Ear infections are the most common childhood diagnosis, affecting three out of four children by the time they are 3 years old.

Ear infections are also the top reason children are prescribed antibiotics in the United States, according to the American Academy of Pediatrics. And therein lies the problem.

In recently released guidelines, the Academy is asking pediatricians to take a more conservative approach to ear infections before whipping out the prescription pad. In some mild cases, ear infections may clear up on their own, making it worthwhile to consider a wait-and-see approach, it says.

As a parent of two toddlers, Rebecca Batisto is skeptical.

“I’ve had a lot of each infections and second only to labor, I’ve never had a worse pain,” says Batisto, whose youngest, 1-year-old Arabella, is already showing a propensity for multiple ear aches. “If my baby has that kind of pain, I want something done … Any parent is going to go the distance to get their child out of pain.”

Ear infections, or acute otitis media, occur when the tubes inside the ear — called the eustachian tubes — get clogged with fluid or mucous and are unable to drain. The buildup may be caused by allergies, colds and sinus infections, excess mucus and saliva produced during teething, tobacco smoke, or other irritants. The result can be significant pain and often a fever.

Like Batista, when a child is howling with pain, all parents want is a solution. But in cases where there is not a high fever or severe bulging of the eardrum, the smart answer may be pain relief with acetaminophen and time. The Academy cited several studies that showed that a majority of children who have a mild problem can fight off the infection on their own with no antibiotics, showing an improvement of symptoms within days.

At issue is the potential overuse of antibiotics and the danger of creating drug-resistant “superbugs” — bacteria that survive the medicine only to evolve and become harder to defeat. But there is also the ever-present possibility of side effects to the child from the medication — problems such as nausea, vomiting, diarrhea, rashes, and more.

Antibiotics like amoxicillin should only be given to kids who are showing severe symptoms — such as significant bulging of the ear drum, infections in both ears, pain and swelling — or those who have a fever higher than 102.2 degrees Fahrenheit, according to the Academy. Of course, your family’s history is also a consideration.

Parents should not be concerned that they’ll be turned away with no medicine if it is needed, says Dr. Keith L. Hassan, medical director for After Hours Pediatrics Urgent Care.

“The AAP does stress the importance of involving the parent in the decision to treat with antibiotics or to observe the child for improvement,” Dr. Hassan says. “A parent can expect their child to be treated if the pain is severe, the child has a high temperature, or if the infection is in both ears and the child is under age 2. They can also expect the child to be treated for an otitis media if the child is under 6 months of age.”

When a wait-and-see approach is taken, parent follow-up is important. If the child worsens or fails to improve in two to three days, antibiotics may be called for, after all, the Academy says.

“They feel this can be accomplished by requiring a second visit for recheck or providing the parents with a prescription for a ‘rescue’ medicine to start in the case of the child not improving or worsening,” Dr. Hassan says.

The bottom line? Parents should always check with their pediatrician in case an ear infection is already advanced. But if it is not, they should be open to allowing a child to heal herself.

KiKi Bochi, an award-winning journalist, reads hundreds of reports monthly to bring readers the latest insights on family health and child development.