Because of that, they are also, perhaps, the most over-diagnosed.
At KinderMender, we frequently see infants age 1 and younger, who have exhibited extreme fussiness, particularly at night, combined with the classic telltale signs of pulling and pawing at their ears. Parents often make the inductive leap to ear infection.
But that’s not always the case.
An experienced provider should be able to make the call, however, even before the exam. After all, ear examinations are incredibly difficult and subjective, especially with infants. Doctors must peer into the tiny, frequently wax-filled ear canal of a squirming child, which makes an accurate visual diagnosis a challenge, at best. Even among experts, there tend to be different interpretations regarding the appearance of a bulging ear drum.
Not to mention, redness and congestion do not necessarily mean infection. Consider this: A runny nose can have multiple causes – allergies, sinus infections, and the common cold, among others – and they may all present in the exact same way. The same holds true for ear pain.
Before diagnosing a bacterial infection, physicians must consider the following factors:
- Is there a preceding respiratory illness? You have to have a cold, first, before you can have an ear infection – it’s that simple. Acute otitis media, or “middle ear” infections, are different than swimmer’s ear or external ear infections. They are caused when the common cold and the resulting congestion leads to fluid buildup behind the eardrum, which leads to a breeding ground for bacteria, which leads to infection. But it does not happen overnight. Which prompts the question…
- What is the timeline? How long has your baby been feeling this way? An ear infection does not come on suddenly, but is the culminating event in a series of unpleasant stages.
- Are there other potential causes for this irritation? In infants, the sensation of ear pain can often stem from a sore throat, which itself tends to manifest in babies as excessive drooling. While drooling is largely attributed to teething, a sore throat will greatly affect its sheer volume. Shared sensory nerves in the back of the throat, near the ears, causes referred pain, and generally results in start-and-stop feedings, fussiness, and general malaise.
In older children, pain can be related to fluid in the ear that is also not caused by an infection. Serous otitis media, which differs from acute, occurs after an infection has been vanquished, but fluid – or effusion – remains trapped behind the eardrum. Because physicians can only see the fluid, not the bacteria floating throughout, it can be difficult to distinguish if this effusion is related to the earlier infection, or is something different altogether, and the picture can quickly become convoluted.
So, what to do?
The dirty little secret of many infections is that most would simply get better on their own. After all, antibiotics have their own set of side effects, which can include gastrointestinal upset, rash, and a growing resistance to pharmaceuticals, which medical science has already seen in regards to Methicillin-resistant Staphylococcus aureus.
Options must be weighed, all hinging on one crucial consideration: How will the child benefit from an antibiotic?
To make this determination, physicians should consider the following:
- Duration of symptoms: If the pain has lingered for more than 2-3 days; increased in severity; or is causing toxicity – signs and symptoms such as fever, fatigue, and an overall “ill” feeling – antibiotics can provide necessary relief.
- Age of the child: Children younger than 2 years of age are more likely to benefit from antibiotic treatment, as older children have larger drainage passages and heightened natural defenses.
- Concurrent medical conditions: Children with severe allergies are predisposed to ear infections, because their degree of congestion is higher. Children with developmental disorders, such as Down syndrome, or birth defects such as cleft palate, are also at higher risk.
If you believe your child may have an ear infection – you could be mistaken. And that’s okay. It certainly doesn’t mean you shouldn’t be concerned. The bottom line, when considering the use of antibiotics, should be the prevention of any undue suffering, both by children or infants and their families. KinderMender can help. Call and speak to one of our pediatric specialists today.