How to Deal with Your Child's Ear Infections

Host: Dr. Goldsmith, a very common problem amongst children is they wake up in the middle of the night and they have ear pain. What's that all about? Ari Goldsmith: Well, it could be just a child with some poor sleep patterns, it could be an ear infection, it could be teething. It would be hard to tell, just if they are waking up without actually having them examined, but those would probably be the most likely things, some type of dreaming or teething, or obviously an ear infection, which is very painful. Host: If a child goes to the pediatrician, who is obviously under the age of three, and he starts to see a red bulging eardrum with a lot of pain, he will probably treat the kid with antibiotics, is that correct? Ari Goldsmith: Most ear infections are treated by antibiotics, correct. Host: Okay, talking under three now? Ari Goldsmith: Right. Host: What would be your consideration, the drug of choice that you usually use as the first time ear infection? Ari Goldsmith: We always want to try to start with the weakest antibiotic that will work, because this way we don't allow the bacteria to get too smart, and we also make the child better. So the amoxicillin, which is an oldie but a goodie is usually the way to start. If the child is allergic, we would try something else, but again, you want to try as -- you don't want to be using very, very strong antibiotics when not needed, because then you won't have them when you need them. Host: A lot of times people get calls from pharmacies, they see these doses that are very high, why is that? Ari Goldsmith: We are now recommending that actually amoxicillin is used at a higher dose, because it allows the amoxicillin to cover more of the difficult bacteria, but again, we are still using the nice safe drug that we have been using for a very long time. Host: So a 20 pound, one year old, would probably get how much amoxicillin? Ari Goldsmith: 20 pounds is 10 kg, 10 times 90 is 900, so it would be about 450 mg twice a day, which is a hefty dose. Host: Lot of pharmacists get nervous to see those figures, but that is the -- Ari Goldsmith: That's the way to do it. Host: That's a new recommended dosage. There is also a concept where you can see with some of the older kids, what's that all about? Ari Goldsmith: In Europe for many, many years the attitude towards ear infections has been that your body's immune system is able to take care of that, without any antibiotics, and indeed, that's the way they have been doing it. For many years, a lot of studies have shown that it's a very effective way. We have been a little late here in America in starting that up, and now, the new recommendations from the Pediatric Academy; and these are correct recommendations, is in older kids, who are not that sick, we would try a wait and see approach with an your infection. Which means that we would examine the child, confirm it is an ear infection, and then tell the parents that we are going to see what happens over the next 48-72 hours. If the child is able to get better on their own, that's a better way of fighting the infection, and we avoid antibiotics. If the child gets worst despite that wait and see, then we just give them the antibiotic and they get better. Host: So if the kid is not in too much discomfort, yet we do see the classical signs of an ear infection, it's reasonable, in an older child, to wait and see. Less likely in an younger child. Ari Goldsmith: With younger kids we don't like to take chances, because of the complications of ear infections. Host: But it seems kids sometimes, very young, get a lot of ear infections. Is that something I am doing wrong? Ari Goldsmith: You as a parent or you as a pediatrician? Host: As a parent. Ari Goldsmith: No, you are doing nothing wrong. Ear infections are the most common medical problem in kids after respiratory infections, and the most common reason they get antibiotics, and the most common reason they get surgery. So a lot of kids, ear infections are most common from age about six months to 18-24 months, and as long as it's not happening that frequently, the child's quality life is good, we don't get too nervous. Host: If the child keeps getting ear pains, but seems to have a lot of fluid persisting, some kids get tubes, why? Ari Goldsmith: The problem with fluid, as you would imagine, is that if there is fluid in the ear, then the hearing is temporarily blocked, and if the hearing is blocked for a long time during critical time of the child's development, then that could be theoretically effect their speech, language, learning, school performance. So if your child has chronic fluid; it means that its lasting for a certain amount of time, and its effecting the hearing, at some point we would recommend that we drain the fluid with the tubes; not right away, but at some point. Host: How long would the kid have to have this fluid before you as a doctor would consider tubes? Ari Goldsmith: There is no official number, I mean there are recommendations, but in general, four to six months of fluid that's not going away, effecting the hearing, effecting maybe articulation, speech, language, or learning, we would recommend tubes. Host: If you put tubes in, there is something spreads up, because it works in two directions. Is that true? Ari Goldsmith: The initial thinking used to be that, and this is up until recently, that if the child has tubes, they can get their ears wet. You see kids around the pool with ear plugs and headband. The data recently suggested that may not be needed, that kids that have ear tubes can get their ears wet, and most kids will be fine if we try that, but they are getting episodes of drainage more frequently than we are happy with, then we would make them use earplugs. So in general, the best thing with tubes is to leave the child alone, let them forget they have tubes and see what happens. Host: So if a doctor saw the kid ten days after proper treatment, saw some fluid, that doesn't mean you need more inter blocks? Ari Goldsmith: No, thats perfectly normal. You will have fluid up to six to weeks after an ear infection. Less and less fluid as the weeks go by, but the fluid is normal after every ear infection. If I get an infection today, and you looked at my ears in a week or two, I would still have fluid. Host: So in other words, the tubes don't cure the problem, but they have the kid hear better? Ari Goldsmith: They temporarily make the problem better, and hopefully the child outgrows it, and when the tubes come out, hopefully end their problem. Host: Thank You.