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Search Health Information    Ear Infection: Should I Give My Child Antibiotics?

Ear Infection: Should I Give My Child Antibiotics?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Ear Infection: Should I Give My Child Antibiotics?

Get the facts

Your options

  • Wait and see if the ear infection clears up on its own.
  • Give your child antibiotics.

Key points to remember

  • Most ear infections clear up on their own. Antibiotics do not help with ear pain immediately. You can treat pain at home with pain relievers and by putting a warm washcloth or heating pad on your child's ear. Do not allow a child to go to bed with a heating pad. He or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
  • If your child is age 2 or older and has a mild earache, you can wait for up to 48 hours to see if the infection gets better on its own. Talk to your doctor if your child's pain doesn't get better with an over-the-counter pain reliever (such as acetaminophen) or if other symptoms last for more than 48 hours.
  • Doctors usually prescribe antibiotics if a child: 1
    • Is younger than 2 and has an infection in both ears or has more than mild pain or fever.
    • Is very ill from the infection. For example, your child may be dehydrated.
    • Has other health problems, such as cleft palate or repeat infections that could put him or her at risk for serious problems from an ear infection.
    • Has cochlear implants.
  • If your doctor prescribes antibiotics, you may have to wait at least another 48 hours for the medicine to take effect.
  • Antibiotics can have side effects, such as vomiting, diarrhea, and an allergic reaction.
  • Taking antibiotics when they're not needed can make it hard for these medicines to work the next time your child needs them. This can happen because bacteria can build up resistance to the medicine.
FAQs

What is a middle ear infection?

A middle ear infection, also called otitis media, is inflammation or infection of the middle ear. Ear infections often occur along with a cold or other upper respiratory infections . Almost all children have at least one ear infection before age 7.

Most ear infections are caused by bacteria. But viruses also can cause them. The respiratory syncytial virus ( RSV ) and the influenza (flu) virus are the two main viruses that cause ear infections.

Ear infections are most common in young children, because young children have shorter eustachian tubes , which are more easily blocked than those of older children and adults. When the tube is blocked, fluid builds up. This creates a breeding ground for germs.

Pus forms as the body tries to fight the infection. More fluid collects and pushes against the eardrum, causing pain and sometimes a temporary loss of hearing. Fever lasts about 1 to 2 days. Most children have some pain on and off for up to 4 days. Young children may have pain that comes and goes for up to 9 days.

How can you tell if your child has an ear infection?

If your child has an ear infection, he or she may:

  • Have an earache. It may be mild, or it may hurt a lot.
  • Act fussy (babies or young children) or grumpy.
  • Pull at his or her ears.
  • Have trouble sleeping.
  • Have trouble hearing.
  • Have a fever.
  • Not feel like eating.
  • Vomit.

Most parents will know that these symptoms point to an ear infection after their children have had a couple of ear infections. But a visit to the doctor is the only way to know for sure. Your child's doctor can diagnose an infection by looking at your child's ears with a tool called an otoscope.

How well do antibiotics clear up ear infections?

Antibiotics work most of the time to treat ear infections caused by bacteria. But they won't treat ear infections caused by viruses.

No matter what causes the infection, most children 2 years and older won't need antibiotics. Up to 80 out of 100 ear infections get better on their own, while 20 out of 100 don't. 2

How can you treat your child's ear infection at home?

You can help ease your child's pain at home, whether you use antibiotics or wait for the ear infection to get better on its own.

You can:

  • Give your child an over-the-counter pain reliever like acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin). Read and follow all instructions on the label. If you give medicine to your baby, follow your doctor's advice about what amount to give. Do not give aspirin to anyone younger than 20. Aspirin has been linked to Reye syndrome, a serious illness.
  • Put a warm washcloth or heating pad on the ear. Don't let your child go to bed with a heating pad, because he or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
  • Help your child rest by arranging quiet play.
  • Give your child eardrops for pain if your doctor prescribes them.

Why might your doctor recommend antibiotics for an ear infection?

Doctors usually prescribe antibiotics if a child:

  • Is younger than 2, because infections at this age are less likely to go away during watchful waiting. And normal hearing is very important when a young child is learning to talk.
  • Is very ill from the infection. For example, your child may be dehydrated .
  • Has other health problems, such as cleft palate or repeat infections that could put him or her at risk for serious problems from an ear infection.
  • Has cochlear implants. Children who have these hearing devices are at risk for more serious infection.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Give your child antibiotics Give your child antibiotics
  • Your child takes antibiotics for several days. The antibiotic may be a pill or a liquid.
  • Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.
  • You help ease your child's pain at home with:
    • Over-the-counter pain relievers (except for aspirin, which shouldn't be given to anyone younger than 20).
    • A warm washcloth or heating pad on the ear.
    • Rest.
    • Eardrops if your doctor prescribes them.
  • You follow your doctor's advice about bathing, swimming, and other activities.
  • They work most of the time to clear up ear infections.
  • In children under age 2 or who are very sick, antibiotics may prevent problems from the infection, such as trouble with speech development.
  • Side effects may include vomiting, diarrhea, and an allergic reaction.
  • Using antibiotics too often for ear infections can make it hard for the medicines to work the next time your child needs them.
  • These medicines can cost a lot.
Wait and see Wait and see
  • You help ease your child's pain at home with:
    • Over-the-counter pain relievers (except for aspirin, which shouldn't be given to anyone younger than 20.)
    • A warm washcloth or heating pad on the ear.
    • Rest.
    • Eardrops if your doctor prescribes them.
  • You follow your doctor's advice about bathing, swimming, and other activities.
  • Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.
  • Most ear infections get better on their own.
  • You don't have the possible side effects and cost of antibiotics.
  • You reduce the chance that antibiotics won't work in the future because of overuse.
  • If your child isn't better after a couple of days, you can ask your doctor for antibiotics.
  • Some ear infections don't get better on their own.
  • Your child's infection may last a little longer than if he or she took antibiotics.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories from parents whose children had ear infections

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My daughter, Biba, is a wonderfully robust 4-year-old. When she complained of an earache after a cold, we visited our doctor. She told us the ear infection would probably go away on its own, so I decided not to fill the prescription my doctor gave me then. The doctor said to give Biba pain relief medicine for the next few days and if she didn't improve in 2 days that I should fill the prescription and have Biba take the antibiotics. Biba stayed home from school for 1 day, but she felt better the next. Best of all, she didn't have to take antibiotics.

Maureen, age 33

My son, Rashad, has had so many ear infections. He really suffers with them. When the doctor said that I could wait to see if it would clear up, I thought that he would probably need antibiotics anyway, so why wait?

Renee, age 35

I am very concerned about bacteria that are not affected by antibiotics. My friend's child had to take very strong antibiotics to cure his ear infection. When my son, Maury, got an ear infection, I waited to see if he would improve. But he still had an earache after 2 days, so I decided to go ahead and have him take antibiotics.

Briana, age 41

I am a working single mother with three kids. I don't have time to stay home and see if my son, Darrell, will get better. I need the fastest and most certain cure. So I decided he should take the antibiotics now.

Cecelia, age 22

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to give your child antibiotics

Reasons to wait and see

I'm not worried about the risk of side effects from antibiotics.

I'm worried that my child could have side effects from antibiotics.

More important
Equally important
More important

I want to get my child's infection taken care of now.

I'm willing to wait a couple of days for the infection to go away on its own.

More important
Equally important
More important

I'm not concerned that using antibiotics a lot could make them not work in the future.

I'm concerned that antibiotics might not work in the future if my child uses them a lot.

More important
Equally important
More important

I can afford antibiotics.

I don't want to spend money on medicine my child may not need.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using antibiotics

Waiting

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Should all children get antibiotics for an ear infection?

  • Yes Sorry, that's not right. Most ear infections clear up on their own.
  • No You're right. Most ear infections clear up on their own.
  • I'm not sure It may help to go back and read "Get the Facts." Most ear infections clear up on their own.
2.

Do antibiotics relieve ear pain immediately?

  • Yes Sorry, that's not right. Antibiotics do not relieve ear pain immediately. Your child may need to take an over-the-counter medicine for pain.
  • No That's right. Antibiotics do not relieve ear pain immediately. Your child may need to take an over-the-counter medicine for pain.
  • I'm not sure It may help to go back and read "Get the Facts." Antibiotics do not relieve ear pain immediately. Your child may need to take an over-the-counter medicine for pain.
3.

Can antibiotics have bothersome side effects?

  • Yes That's right. Antibiotics can have bothersome side effects, such as vomiting, diarrhea, and an allergic reaction.
  • No No, that's not right. Antibiotics can have bothersome side effects, such as vomiting, diarrhea, and an allergic reaction.
  • I'm not sure It may help to go back and read "Compare Your Options." Antibiotics can have bothersome side effects, such as vomiting, diarrhea, and an allergic reaction.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
Specialist Medical Reviewer Charles M. Myer, III, MD - Otolaryngology

References
Citations
  1. American Academy of Pediatrics and American Academy of Family Physicians (2013). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 131(3): e964–e999.
  2. Damoiseaux RAJM, Rovers MM (2011). AOM in children, search date September 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Ear Infection: Should I Give My Child Antibiotics?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Wait and see if the ear infection clears up on its own.
  • Give your child antibiotics.

Key points to remember

  • Most ear infections clear up on their own. Antibiotics do not help with ear pain immediately. You can treat pain at home with pain relievers and by putting a warm washcloth or heating pad on your child's ear. Do not allow a child to go to bed with a heating pad. He or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
  • If your child is age 2 or older and has a mild earache, you can wait for up to 48 hours to see if the infection gets better on its own. Talk to your doctor if your child's pain doesn't get better with an over-the-counter pain reliever (such as acetaminophen) or if other symptoms last for more than 48 hours.
  • Doctors usually prescribe antibiotics if a child: 1
    • Is younger than 2 and has an infection in both ears or has more than mild pain or fever.
    • Is very ill from the infection. For example, your child may be dehydrated.
    • Has other health problems, such as cleft palate or repeat infections that could put him or her at risk for serious problems from an ear infection.
    • Has cochlear implants.
  • If your doctor prescribes antibiotics, you may have to wait at least another 48 hours for the medicine to take effect.
  • Antibiotics can have side effects, such as vomiting, diarrhea, and an allergic reaction.
  • Taking antibiotics when they're not needed can make it hard for these medicines to work the next time your child needs them. This can happen because bacteria can build up resistance to the medicine.
FAQs

What is a middle ear infection?

A middle ear infection, also called otitis media, is inflammation or infection of the middle ear. Ear infections often occur along with a cold or other upper respiratory infections . Almost all children have at least one ear infection before age 7.

Most ear infections are caused by bacteria. But viruses also can cause them. The respiratory syncytial virus ( RSV ) and the influenza (flu) virus are the two main viruses that cause ear infections.

Ear infections are most common in young children, because young children have shorter eustachian tubes , which are more easily blocked than those of older children and adults. When the tube is blocked, fluid builds up. This creates a breeding ground for germs.

Pus forms as the body tries to fight the infection. More fluid collects and pushes against the eardrum, causing pain and sometimes a temporary loss of hearing. Fever lasts about 1 to 2 days. Most children have some pain on and off for up to 4 days. Young children may have pain that comes and goes for up to 9 days.

How can you tell if your child has an ear infection?

If your child has an ear infection, he or she may:

  • Have an earache. It may be mild, or it may hurt a lot.
  • Act fussy (babies or young children) or grumpy.
  • Pull at his or her ears.
  • Have trouble sleeping.
  • Have trouble hearing.
  • Have a fever.
  • Not feel like eating.
  • Vomit.

Most parents will know that these symptoms point to an ear infection after their children have had a couple of ear infections. But a visit to the doctor is the only way to know for sure. Your child's doctor can diagnose an infection by looking at your child's ears with a tool called an otoscope.

How well do antibiotics clear up ear infections?

Antibiotics work most of the time to treat ear infections caused by bacteria. But they won't treat ear infections caused by viruses.

No matter what causes the infection, most children 2 years and older won't need antibiotics. Up to 80 out of 100 ear infections get better on their own, while 20 out of 100 don't. 2

How can you treat your child's ear infection at home?

You can help ease your child's pain at home, whether you use antibiotics or wait for the ear infection to get better on its own.

You can:

  • Give your child an over-the-counter pain reliever like acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin). Read and follow all instructions on the label. If you give medicine to your baby, follow your doctor's advice about what amount to give. Do not give aspirin to anyone younger than 20. Aspirin has been linked to Reye syndrome, a serious illness.
  • Put a warm washcloth or heating pad on the ear. Don't let your child go to bed with a heating pad, because he or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
  • Help your child rest by arranging quiet play.
  • Give your child eardrops for pain if your doctor prescribes them.

Why might your doctor recommend antibiotics for an ear infection?

Doctors usually prescribe antibiotics if a child:

  • Is younger than 2, because infections at this age are less likely to go away during watchful waiting. And normal hearing is very important when a young child is learning to talk.
  • Is very ill from the infection. For example, your child may be dehydrated .
  • Has other health problems, such as cleft palate or repeat infections that could put him or her at risk for serious problems from an ear infection.
  • Has cochlear implants. Children who have these hearing devices are at risk for more serious infection.

2. Compare your options

  Give your child antibiotics Wait and see
What is usually involved?
  • Your child takes antibiotics for several days. The antibiotic may be a pill or a liquid.
  • Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.
  • You help ease your child's pain at home with:
    • Over-the-counter pain relievers (except for aspirin, which shouldn't be given to anyone younger than 20).
    • A warm washcloth or heating pad on the ear.
    • Rest.
    • Eardrops if your doctor prescribes them.
  • You follow your doctor's advice about bathing, swimming, and other activities.
  • You help ease your child's pain at home with:
    • Over-the-counter pain relievers (except for aspirin, which shouldn't be given to anyone younger than 20.)
    • A warm washcloth or heating pad on the ear.
    • Rest.
    • Eardrops if your doctor prescribes them.
  • You follow your doctor's advice about bathing, swimming, and other activities.
  • Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.
What are the benefits?
  • They work most of the time to clear up ear infections.
  • In children under age 2 or who are very sick, antibiotics may prevent problems from the infection, such as trouble with speech development.
  • Most ear infections get better on their own.
  • You don't have the possible side effects and cost of antibiotics.
  • You reduce the chance that antibiotics won't work in the future because of overuse.
  • If your child isn't better after a couple of days, you can ask your doctor for antibiotics.
What are the risks and side effects?
  • Side effects may include vomiting, diarrhea, and an allergic reaction.
  • Using antibiotics too often for ear infections can make it hard for the medicines to work the next time your child needs them.
  • These medicines can cost a lot.
  • Some ear infections don't get better on their own.
  • Your child's infection may last a little longer than if he or she took antibiotics.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories from parents whose children had ear infections

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My daughter, Biba, is a wonderfully robust 4-year-old. When she complained of an earache after a cold, we visited our doctor. She told us the ear infection would probably go away on its own, so I decided not to fill the prescription my doctor gave me then. The doctor said to give Biba pain relief medicine for the next few days and if she didn't improve in 2 days that I should fill the prescription and have Biba take the antibiotics. Biba stayed home from school for 1 day, but she felt better the next. Best of all, she didn't have to take antibiotics."

— Maureen, age 33

"My son, Rashad, has had so many ear infections. He really suffers with them. When the doctor said that I could wait to see if it would clear up, I thought that he would probably need antibiotics anyway, so why wait?"

— Renee, age 35

"I am very concerned about bacteria that are not affected by antibiotics. My friend's child had to take very strong antibiotics to cure his ear infection. When my son, Maury, got an ear infection, I waited to see if he would improve. But he still had an earache after 2 days, so I decided to go ahead and have him take antibiotics."

— Briana, age 41

"I am a working single mother with three kids. I don't have time to stay home and see if my son, Darrell, will get better. I need the fastest and most certain cure. So I decided he should take the antibiotics now."

— Cecelia, age 22

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to give your child antibiotics

Reasons to wait and see

I'm not worried about the risk of side effects from antibiotics.

I'm worried that my child could have side effects from antibiotics.

             
More important
Equally important
More important

I want to get my child's infection taken care of now.

I'm willing to wait a couple of days for the infection to go away on its own.

             
More important
Equally important
More important

I'm not concerned that using antibiotics a lot could make them not work in the future.

I'm concerned that antibiotics might not work in the future if my child uses them a lot.

             
More important
Equally important
More important

I can afford antibiotics.

I don't want to spend money on medicine my child may not need.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using antibiotics

Waiting

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Should all children get antibiotics for an ear infection?

  • Yes
  • No
  • I'm not sure
You're right. Most ear infections clear up on their own.

2. Do antibiotics relieve ear pain immediately?

  • Yes
  • No
  • I'm not sure
That's right. Antibiotics do not relieve ear pain immediately. Your child may need to take an over-the-counter medicine for pain.

3. Can antibiotics have bothersome side effects?

  • Yes
  • No
  • I'm not sure
That's right. Antibiotics can have bothersome side effects, such as vomiting, diarrhea, and an allergic reaction.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
Specialist Medical Reviewer Charles M. Myer, III, MD - Otolaryngology

References
Citations
  1. American Academy of Pediatrics and American Academy of Family Physicians (2013). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 131(3): e964–e999.
  2. Damoiseaux RAJM, Rovers MM (2011). AOM in children, search date September 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: April 10, 2013

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