Last month we addressed the question of when to be seen. Over the next couple months, we will assume you have made the decision that your child should be seen, but now the question becomes when to use antibiotics, and when to “wait and see.” This is a hard question at times, because there are many factors that come into play. Factors like the age of your child, symptoms and their severity or duration, and past medical history all help shape the answer to this question. Every child and situation is different, and while we went to school for a long time to learn how to treat patients, there were no specific classes on YOUR child. Because of this, there are no absolute hard and fast rules, but over the next few months, we will have some general guidelines to help you.
Ear infections are one of the more frustrating things for parents of toddlers because unless you happen to have an otoscope lying around at home, you cannot see the eardrum to know what is going on in your child’s ear. Because of this, when an ear infection is suspected (translation = when your child is fussy, cranky, and acts like they have been processed) parents often have to bring their child for a provider to check those ears. Even as a parent, there are times when I have to look in my girls’ ears to see if there is another explanation for their craziness! (Unfortunately, usually my girls are just being crazy…but that we will discuss later when we talk about “Terrible Twos!”) Anyway, I digress…
Believe it our not, some ear infections can heal on their own without antibiotics. So when, you ask, is it necessary to treat an ear infection with antibiotics? To start, anyone under six months of age with an ear infection, or anyone with a bilateral ear infection (or infections on both sides) should be treated. After that, it gets a bit tricky. In 2013, The American Academy of Pediatrics issued a guideline stating that for children ages 6 months to 2 years who had only one ear infected and had only “mild symptoms,” there can be watchful waiting after a discussion with the caregiver and taking into account the patient’s medical history. Now, anyone who has been up all night with a screaming little one with an ear infection is probably laughing at the “mild symptoms” comment. As a general rule, “mild” means no fever over 101.0°F, good pain control with over the counter medications, and no change in eating, sleeping, or drinking patterns. For our older children, the use of antibiotics is similar. If over the age of 2 and your child is otherwise healthy with only mild symptoms, watchful waiting is often best. At the office visit, your provider will go over all the signs and symptoms to look for over the next 2-3 days, and will review with you the risks and benefits of this “watch and wait” approach. If over the age of two, but symptoms have not been well controlled, there is a fever over 102.2°F, or changes in eating, sleeping, or drinking, your child should be treated.
These of course are all just general guidelines and every situation is different. As always, you know your child better than we ever can, so if you have any concerns about your child, please call the office at 804.794.2821 to speak with a nurse or make an appointment. That is, after all, what we are here for!
By Sarah Trezza, PPA