When it comes to ear infections, Heidi Jeens O’Gorman has seen it all. Her now-four-year-old daughter Ellen first began getting them at age four months, making her fussy and hard to feed. “We had zero sleep,” recalls Jeens O’Gorman, a Toronto teacher.

When Ellen was seven or eight months old, “we had our first talk about tubes,” Jeens O’Gorman says, as her baby’s constant ear infections failed to respond to round after round of antibiotics. “They literally never cleared,” says her mother. Even after tubes were surgically inserted through the eardrum to even out air pressure and to allow the ear to drain more effectively, at age 10 months, the infections came back. It was only after a second operation at age two to replace the first tubes that the frequency of infections slowed.

What causes an ear infection in kids?

Ear infections, also known as otitis media, are extremely common in kids aged three months to six years, according to the Canadian Pediatric Society. They happen when viruses or bacteria that cause colds or respiratory infections migrate through the Eustachian tubes (which connect the middle ear to the back of the throat) into the middle ear. Because kids have smaller Eustachian tubes than adults, it’s more likely that these viruses and bacteria will become trapped.

Some kids are more likely to get ear infections:

  • Premature babies
  • Babies who aren’t breastfed
  • Children with allergies
  • Kids who are of First Nations or Inuit descent
  • Children who attend daycare or have siblings in school
  • Kids with cleft palate

But sometimes doctors aren’t sure why a child is predisposed to ear infections. “Ellen was breastfed and she didn’t attend daycare,” says Jeens O’Gorman. “My pediatrician said she had never seen a child with so many ear infections.”

What are the symptoms of an ear infection in a child?

Symptoms may include:

  • Ear pulling – even babies may favour a painful, infected ear by pulling on it
  • Crying and fussiness
  • Fever
  • Lack of appetite
  • Clear, yellow or bloody discharge from the ear
  • Trouble sleeping

Ear infections can be difficult to diagnose in very young kids as their ear canals are so small, says Dr. Marvin Gans, a Toronto pediatrician. If a doctor says there’s no infection but symptoms continue for a day or two, take your child back for another look.

How should you treat an ear infection in a child

It used to be that doctors routinely prescribed antibiotics for ear infections, says Dr. Gans. Not now. “In children over two we try not to use antibiotics,” he says, adding that most ear infections will clear on their own after several days and not require antibiotic treatment.

Instead, Dr. Gans says he often hands a prescription for an antibiotic to parents of older children, with instructions to fill it only if the child complains of severe pain, is in greater distress and it appears the ear infection is worsening.

But in very young children or in those who are showing signs of intense pain, antibiotics are generally given. And for those who have recurring infections such as Ellen’s, who don’t seem to respond to medication, tubes may be recommended. If infections develop while tubes are implanted, antibiotic drops can be placed in the ears.

Dr. Gans says surgery needs to be weighed carefully. He says that as a doctor, “you really have to take a long history” of the child before recommending tubes as they come with some risks, such as going under general anesthesia for the surgical procedure and scarring of the eardrums.

And while recurrent ear infections can negatively affect hearing and may lead to speech and language delays, research has shown that may be a temporary setback. According to Otitis Media in Early Childhood in Relation to Children’s School-Age Language and Academic Skills, published in the official journal of the American Society of Pediatrics, the hearing of kids affected by recurring ear infections does improve over time, allowing them to catch up to their peers from a language standpoint.

Can you prevent ear infections in young children?

While the Canadian Pediatric Society recommends frequent handwashing, keeping vaccinations up-to-date, breastfeeding, avoiding feeding babies while they’re lying down and not smoking around children as precautionary measures, a new Canadian study has come up with an intriguing solution for older children.

In his scientific review, Xylitol for preventing acute otitis media in children up to 12 years of age, Dr. Amir Azarpazhooh, assistant professor at the Faculty of Dentistry, University of Toronto, showed that xylitol, a natural sweetener found in candy and chewing gum, may help prevent ear infections. “Xylitol can inhibit the growth and adherence of microorganisms responsible for the ear infection,” says Dr. Azarpazhooh, who conducted the review to determine alternatives to medication and surgery.

“It was found that xylitol (administered in chewing gum, lozenges or syrup) reduced the occurrence of acute ear infection by 25% among healthy children in daycare centres with no acute upper respiratory infection,” says Dr. Azarpazhooh. “The occurrence of ear infection was reduced by 30% in younger children who received xylitol syrup because they couldn’t chew gum regularly. Healthy older children at these same daycare centres showed a 34% decrease in rates of ear infection if they chewed gum or took lozenges.”

As children mature, their Eustachian tubes grow larger, allowing for easier flow through the ear, and the cycle of infection should end. “We’ve been told she’s growing out of them,” says Jeens O’Gorman. “We’re just keeping our fingers crossed.”

What to do if your child gets ear infections:

  1. Watch and wait. Take your child to the doctor, but be patient. Chances are the infection will clear up on its own.
  2. Schedule a hearing test. Have your child’s hearing tested to prevent missed language milestones.
  3. Get a second opinion. If your doctor prescribes tubes but you’re having serious doubts, talk to another doctor.