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Canadian Pediatric Society says hold off on antibiotics for ear infections

If your child has a painful ear or a fever, he or she may not really need antibiotics or even benefit from them.


Seems simple enough: Your child gets an ear infection, you see your doctor and your child gets antibiotics and gets better. Simple yes, but not typically necessary it turns out. An updated statement by the Canadian Pediatric Society released last week echoes previous recommendations to use a watchful waiting approach before launching into antibiotic use.

In practical terms, if your child has a painful ear or a fever he or she may not really need antibiotics or even benefit from them. Like many childhood illnesses, most ear infections are caused by viruses, and do not respond to antibiotic treatment. As a pediatrician and mom of three young children, I cannot stress this enough. For many parents this may come as a bit of relief as many young children often fight and refuse medications at the best of times, let alone when they are feeling unwell.

Ear infections are common, especially in children between six months and three years of age. Most ear infections occur when a child has had a cold for a few days; they are not usually serious and are not contagious. Typical symptoms include fever, poor sleep, pulling or tugging the ears and irritability.

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Most children will feel just as well with pain medicine such as ibuprofen or acetaminophen in appropriate doses. This will keep the pain and fever at bay and allow your child to fight the virus that is causing the infection.

Under the new statement from the Canadian Paediatric Society, the following groups of children benefit from a watchful waiting approach. This is where we observe for 24 to 48  hours without the use of antibiotics:

- Children older than six months.

- Children who do not have an immunodeficiency, chronic lung or heart problems, head or neck abnormalities or a history of complicated ear infections (such as a perforated ear drum).

- The illness is not severe (well-controlled fever of less than 39 C and mild ear pain).

- Parents are easily able to recognize signs of worsening illness and have access to medical care.

If after this waiting period your child has persistent fever and ear pain, this is when you should visit your doctor again to have your child reassessed. According to the new guidelines, it is only after this watchful waiting that antibiotics should be introduced.

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Because ear infections are common in young children, there are some simple ways to prevent children from getting them, including:

- Breastfeeding your baby until at least 3 months of age. This has ear infection protection for up to 12 months.

- Avoid bottle-feeding a baby who is lying down.

- Avoid exposing your child to cigarette smoke.

- Refrain from using a pacifier too often.

- Ensure your child is vaccinated with the pneumococcal conjugate (Prevnar) and influenza vaccine at the appropriate age.

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When in doubt please see your doctor. Ear infections are very common and a rite of passage for most children. Luckily, they don't often need treatment.

Dr. Dina Kulik is a pediatrician in Toronto and provides child health information to parents and the public through television, radio, print media and her blog. Follow her on Facebook and Twitter.

Editor's note: The original version of this article stated thatthe Canadian Paediatric Society recommends certain groups of children should be watched for 48 to 72 hours without the use of antibiotics. In fact, the recommendation is to watch for 24 to 48 hours. This version has been corrected.

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