It is late at night and your child wakes up with a horrible scream. She is holding her ear, crying and is unable to be consoled. You’ve given her ibuprofen. You’ve given her acetaminophen. These over-the-counter medications help a little, but she is still sobbing, asking you to do something to make it better.
This is a scene that many of us have experienced as parents and the first thing on our minds is to stop our child’s pain. This is natural, normal and appropriate. We would not be caring parents if these thoughts weren’t happening.
At this point we often do one of three things, depending on the timing of the pain and our child’s history:
We call the pediatrician for an appointment that day (or the next morning).
We take our child to urgent care or the emergency room immediately.
We call the doctor’s office and ask them to call in an antibiotic.
These all seem reasonable when we see our child suffering.
But, according to the most up-to-date research, none of these options may be necessary or even appropriate. Antibiotics are not always the answer.As pediatric specialists, Nationwide Children’s Hospital doctors balance the immediate need for antibiotics with the long-term dangers of children building unhealthy tolerances to medications. This forward thinking approach ensures your child will benefit from antibiotics when they’re needed most. Unnecessary antibiotics can also contribute to antibiotic resistance, which means they might be less effective when they are needed.
According to a most recent review of all of the available scientific studies (including children from ages 2 months to 15 years) done in 2015 by Cochrane Reviews, antibiotics have LITTLE or NO effect on ear pain in the first 24 hours. They have a moderate effect on pain in the following several (3-4) days, and may have some impact in avoiding complications later. If your child is over age 2, the likelihood that antibiotics will help is fairly small.
These results appear to make sense. Sometimes, ear pain is not due to a middle ear infection, soantibiotics won’t be helpful at all. There are many times where we assume it is an infection and this is often confirmed when the ear is examined by an experienced provider. But even if it IS an ear infection, and we GIVE an antibiotic, how long can we expect for it to take the patient to improve?
It’s going to be two or three days, maybe longer and the antibiotics may not make any difference at all.
So, what is a good parent to do?
Calm and reassure your child. Your caring does more than anything else.
Provide oral pain medication (acetaminophen or ibuprofen).
Apply local care (heating pad, or warmed rice or potato, “boo-boo bunny”) to the ear.
Upright positioning (less fluid pressure on ear).
Warm oil drops may also help, temporarily.
Wait a day or two, unless worsening—call your child’s doctor for advice.
If your child’s doctor is not available, go to a pediatric-specific urgent care or facility.
The bottom line is that you and your child can make it through the night, or a day, when there is no provider available, without antibiotics. If symptoms persist, seek care, preferably in your child’s medical home or a pediatric-specific urgent care or emergency department.
To find a Nationwide Children's Hospital Primary Care location near you, click here.
Dr. Long is a graduate of West Virginia University School of Medicine and completed his residency at Nationwide Children’s Hospital in Columbus, OH, where he also served as chief resident.
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