Before a toddler can speak, some ailments are easier to identify than others. Your baby doesn’t need to have any sort of vocabulary for you to tell there’s a diaper rash developing. Your toddler doesn’t need to be particularly articulate when you can see a bleeding graze on their knee after they fell down those garden steps (after you told them to stay away from the garden steps). These maladies are easy to see. However, it’s the internal things that can get parents worried. The ouchies on the inside, those stomach aches, fractured bones, swallowed-something-I-shouldn’t-have incidents that a young child can’t tell you about – those are the concerning ones.

Ear infections are one of the most common infections in children. Different sources will give you a range of statistics about how high the prevalence is, but to give you an idea –about 60% of children will have had at least one ear infection by age 4. Though this ubiquitous malady is fortunately not life-threatening, it’s not a pleasant experience for our little ones. If your child is pre-verbal, it’s also one of those “inside ouchies”, those illnesses that can be difficult to identify.


The Low-Down on Ear Infections in Children

Ear infections are particularly common in our little ones for a couple of reasons. One is that their immune systems are still under development, so are not as well-versed in fighting off various infections. Little ears also have horizontal Eustachian tubes, rather than slanted ones. The Eustachian tubes are channels between the middle ear and the throat. As these tubes are horizontal, fluid doesn’t drain from the ear as efficiently as in an adult’s.

Most instances of ear infections are a result of bacteria. They’re often associated with some sort of upper respiratory tract infection, such as a cold. The bacteria responsible for the cold can migrate to the middle ear, causing an infection there, which is termed acute otitis media. As a byproduct of the infection, fluid will often accumulate behind the eardrum. This can interfere with both hearing and balance.


How Can I Tell if My Child Has an Ear Infection?

If your child is too young to have the words to tell you that their ear hurts, there are still a few signs you can look out for that might alert you to an ear infection:

  • Pulling at their ear
  • Difficulty sleeping
  • Being particularly fussy or upset, being more clingy than usual
  • Trouble with hearing and responding to sounds
  • Poor appetite
  • Fever, particularly in younger children and infants
  • Poor balance and unusual clumsiness

Not all (or any) of these signs might be present in a child with an ear infection. And if your child is exhibiting any of these signs, there are other possible explanations. However, if you can’t for the life of you figure out why your toddler won’t sleep, won’t eat, and keeps tripping down those garden steps, perhaps a visit to your ENT doctor might be in order.


How is an Ear Infection Diagnosed and Treated?

Your child’s doctor will first take a history of signs you’ve noticed and any events leading up to your child becoming particularly fussy. For example, knowing that your child had a cold recently can heighten suspicion for an ear infection.

To prove the diagnosis, the doctor may use an otoscope to look directly at your child’s eardrum. An otoscope is an instrument with a light that allows a good view down the ear canal. If the eardrum is bulging and red and just looks angry, it’s a good indication that there’s an ear infection going on.

Other tests may also be used to support the diagnosis of an ear infection. A pneumatic otoscope blows a puff of air at the eardrum to see how well it moves. If the middle ear is full of fluid from otitis media, the eardrum won’t move very well. In cases where there’s still doubt about the diagnosis, tympanometry can be used to deliver different degrees of pressure to the eardrum, assessing its movement in response to the changes in pressure.

In many cases, it’s okay to just monitor your child with an ear infection and provide supportive therapy (like lots of cuddles). Some ear infections can improve without the use of antibiotics. If your doctor thinks antibiotics are necessary, your child will most likely be given high-dose amoxicillin for a course dependent on their age; the younger they are, the longer the course. It should only take a few days for your child to become less fussy. However, if they’re teething or you gave them the blue cup when they wanted the red cup (even though they asked for the blue cup), expect the fussiness to continue.


Tips on Preventing Ear Infections

Though there’s no guaranteed method of avoiding an ear infection in your child entirely, there are some steps you can take to reduce the risk.

  • Avoid giving your baby the bottle while they’re lying horizontally. This increases the risk of liquid getting through the Eustachian tube and into the ear.
  • Do what you can to reduce your child’s risk of catching a cold. This may be the elusive holy grail of parenting young children, but avoiding upper respiratory tract infections can remove one of the more common causative factors for otitis media. As best you can, keep your child’s hands clean, keep them away from other sick children, and keep up to date with their flu vaccinations.
  • Keep your children clear of cigarette smoke. Research has shown that secondhand smoke can increase the risk of an ear infection by up to three times compared to children not exposed to passive smoking.
  • Manage allergies. If there’s an overproduction of mucous due to allergies like hay fever, this can plug up your child’s Eustachian tube and increase the chance of an ear infection.

An ear infection is no fun for anyone, least of all for the smallest members of the family. If you suspect your child is suffering from an ear infection, a trip to your family physician can help to provide a diagnosis and some reassurance.