It’s 4am and I am awakened for the third time to, “Ouch Mommy it hurts, my ear hurts.” With the first and second awakening Audrey immediately fell right back to sleep, but this time she escalates into some screaming and crying. I grab my Ibuprofen and give her a dose along with a warm wash cloth. We cuddle. She falls back to sleep.
Too early the alarm clock rings and I have to wake her up to go to school. We are both exhausted from an interrupted night’s sleep. She is grumpy but she chats my head off on the way to school and claims that her ear feels better. She does not eat nor drink much for breakfast however she seems to be doing okay, so I drop her off after telling her teacher about her pain complaints and I remind them to call me if there are problems.
Sure enough at about 10:30 am daycare calls me. Audrey has been lying down for the past 45 minutes complaining of ear pain and she is very tired. So I go to school to pick her up and because I have the luxury of being a doctor, I check her over and look into her ears. Sure enough her left ear is infected. Not good news but not terrible news because this is only the forth ear infection in her 3 year life, the last one was about 4 months ago. Now I have a dilemma… to treat or not to treat with antibiotics.
I decide to wait for now on the antibiotic treatment and focus instead on treatment of her pain. After all, viruses cause fevers and ear infections more often than bacteria and we do not treat viruses with antibiotics. I review the American Academy of Pediatrics Clinical Practice Guidelines on acute ear infections. Because she is an otherwise healthy child, over the age of 2, who feels bad but is not running a fever over 102.5 F and is drinking fluids, I feel I can give her body a chance to do its thing to fight this infection..
Why wait you might ask? A majority of children will improve within 24 hours by treating symptoms with acetaminophen or ibuprofen whether they receive antibiotics or placebo. If I do not need to give her an antibiotic then that will lessen her risk for side effects from the antibiotic. It will also limit the use of unnecessary antibiotics which we know is related to increasing antibiotic resistance. Furthermore studies have shown that by treating her ear infection with antibiotics I may only reduce her illness by one day if her infection is indeed caused by bacteria.
When do I worry?
- If she has a fever higher than 102.5 F, especially if the fevers do not reduce with Tylenol or Motrin.
- If she is not drinking and not peeing as often
- If her symptoms get worse such as pain or swelling behind her ears.
Because her fevers are responding to treatment and she is drinking fluids I will wait 48-72 hours to see what happens.
I know, I am a doctor but what should you do? Discuss the “what if’s” with your child’s doctor because they know your child’s medical history.
In an otherwise healthy child over the age of 2 years here is what I typically recommend for my patients:
- Treat fevers with acetaminophen or ibuprofen (fever reducers) – I typically treat my children when their temperatures are over 102.5F or if they feel so bad that they are not drinking fluids. Remember, fevers help the body fight off the infection; it is one of your body’s natural defense mechanisms and is not necessarily something to get anxious about.
- Give your child LOTS of fluids, rest, and a little time
- Seek medical attention from your doctor or urgent care if:
- Your child is not drinking fluids well
- Your child’s fever has lasted more than 3 days or is not coming down with the fever reducers
- Your child’s symptoms appear to be getting worse
- Go to the emergency department if:
- Your child is having trouble breathing
- Your child does not urinate for more than six hours while awake
- You are concerned enough and you feel it cannot wait until the morning to call their physician.
Well, I hope to report back that all is well and we did not need a course of antibiotics. Wish us luck and good health!
Follow up: Audrey had fevers for 2 days, ear pain off and on for 3 days, and otherwise did well without antibiotic treatment! Next up for her, her 3 year old well child checkup.