Ear infections are down. Here’s probably why

Sometimes as a medical writer and physician, I think I am only telling people what they are doing wrong, but there were two stories out last week about what actions a parent can do to prevent illness in their child: middle ear infections in children are markedly decreasing and we think we know why, and taking fish oil during the third trimester of pregnancy could decrease the chance of asthma in that unborn child. I will address the former today and you’ll find out more about the fish oil in another future post.

A recent study in Pediatrics found that acute middle ear infections had fallen markedly compared to 20 years ago. The rate at 3 months fell by 67 percent, at 6 months by 41 percent and at 1 year by 26 percent.  Major contributions to this decrease were:

  • the prevention of upper respiratory infection by Pneumococcal and Influenza vaccines (and by less exposure to others with colds)
  • increased breastfeeding,
  • decreased exposure to smoking

This study found that the more respiratory infections a child has, the more likely that child is to have a middle ear infection so children in daycare have more ear infection since they are exposed to more colds. Increasing numbers of parents are rejecting immunizations, but children up-to-date on these vaccines get many less serious infections in spite of exposure to other ill children.

Breastfed children, even when exposed to illness, get many less complications especially many less middle ear infections. Breastfed children also are less likely to be obese.  The longer the mother breastfeeds the longer these benefits help the child.

Exposure to smoking (primarily tobacco, but probably also marijuana) is bad for infants in many ways: a much higher rate of Sudden Infant Death Syndrome, much higher rate of lung infections, higher rate of asthma, and markedly increase colds turning into middle ear infections.

Middle ear infection is often over-diagnosed and this study was careful to use strict rules for diagnosing actual ear infections that were probably caused by bacteria. Unfortunately, just having a fever can make the ear drum red, but if there is fluid behind the ear drum and the ear drum is not moving with the child’s breathing then a middle ear infection is likely. 

When an uncomfortable child with cold symptoms comes into the emergency department or has an acute care visit to a doctor’s office, both the parent and the practitioner want to do something to make the poor child better. However, there is generally not much one can do for a common cold.  Over the counter or prescription cold medicines are a multi-billion dollar business, and they do not work well at any age and actually can make children less than 6 years much more irritable.  So parents demand medicine, and all too often doctors over diagnose middle ear infections and then prescribe unnecessary antibiotics. There is even some data that shows that fever reducer/pain medicine such as Tylenol or ibuprofen may short-term make the child feel better, but may prolong the illness by reducing the body’s ability to fight off the infection quickly.

So to minimize your child’s chance of a middle ear infection in the first year of life, make sure they get their immunizations, do not let anyone smoke around them, and breastfeed them as long as you can. Also, minimize the exposure to colds if possible. Eventually, the child will be exposed to people and their illnesses, but the older the child is, the less likely they are to get a middle ear infection on top of the cold.


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