Ear infections are one of the most common conditions that parents bring their children to the pediatrician for. Unfortunately, parents rarely receive adequate treatment or prevention other than antibiotics for ear infections! I always stress to families that prevention is always the best medicine, and it starts at birth.
Breast is Best
Breastfeeding is absolutely the most effective way to prevent infections and ensure the best possible health for your child. The science shows that children who are breastfed have less ear infections than those on formula. If your child needs to drink any fluids out of a bottle, never let them drink while lying down. This can increase ear infection risk because fluid can collect in the back of the throat near the opening of the middle ear where the infections occur, and encourage bacteria to grow. Pacifier use can also cause problems, as pacifiers can harbor bacteria as well. Ideally, pacifier use should end by around 18 months of age.
The Air in There
The next thing to consider is that children who have allergies get more ear infections. A few ways to help with this is to get a good air purifier for the child’s room that they sleep in, and frequently wash their bedding to eliminate dust mites. Professionally cleaning the air ducts in your house will also remove pollen and dust that has collected and would otherwise affect your child. Any pets that live in the house should be cleaned frequently to cut down on dander and preferably not be allowed to sleep in the child’s room.
Another issue that can cause problems is tobacco smoke. By this time, most of us should know that second-hand smoke could increase chances of cancer and aggravate allergies in those who breathe it. However, a new concern has emerged in the scientific literature, and that’s third-hand smoke. This occurs when someone smokes in the child’s house when that child is not there. The assumption is that if they are not breathing that smoke in, it doesn’t affect the child. However, tobacco smoke can attach to any material including clothing or furniture, and continue to release nicotine and cancer-causing benzo-a-pyrene months after the smoking has occurred! This may also aggravate allergies, so smoking should NEVER occur in the child’s house, and an adult’s clothes should be changed after exposed to smoke. Car upholstery can also act exactly like furniture in the home by releasing these toxins and affecting the child.
How to treat ear infections
Like I mentioned above, breastfeeding is the top priority. The reason is that it will encourage good bacteria to grow in the intestines of the child. These bacteria are responsible for shaping the immune system and 75% of the immune system is located in the intestines, so you can imagine the effects this has on the child’s health! Another way to improve the environment in the intestines and therefore the immune system is by actually giving bacteria that will help develop a healthy immune system. Probiotics are safe to give healthy children of any age. If they are 3 months or younger, the probiotic should primarily have bifidobacterium as its main ingredient. After 3 months, lactobacillus species will be helpful. A minimum of 5- 6 billion cells is an adequate dose, even for babies. The only side effects you might notice is some gas or bloating as their bodies adjust to this new medicine, but this should resolve in a few days.
The new millennium saw a new vaccine come on the market, called Prevnar, which protect kids against a bacteria called pneumococcus. One of the reported benefits was that it prevented ear infections, but the bacteria that this vaccine protects against causes only about 30% of ear infections. Plus, most recurrent ear infections are caused by bacteria or viruses other than pneumococcus, so if a child has three infections in their life this vaccine will prevent only one of them. Therefore, in my opinion, it is not an effective way to prevent ear infections. Now, I should mention here that I DO recommend this vaccine for my patients, since its importance lies in the ability to protect from conditions like meningitis, blood infections, and pneumonia. In fact, 30% of meningitis cases caused by pneumococcus will result in death regardless of whether antibiotics are used to treat it.
For treatment, most pediatricians will use antibiotics to treat ear infections, but viruses cause many ear infections, so antibiotics will have no effect in those cases. Plus, the frequent use of antibiotics will destroy the good bacteria that are already in the gut helping the immune system develop. In Europe, physicians typically wait 5 days before using antibiotics to treat ear infections. Not until recent years has the American Academy of Pediatrics said it is ok to wait 2-3 days before using antibiotics, but many pediatricians still use them as the first treatment option right away.
You may have antihistamines like Zyrtec, Claritin, or Allegra lying around the house and have been tempted to use them for ear infection treatment. This is bad idea! The research shows that antihistamine use during an ear infection will actually prolong the duration of the problem (Chonmaitree, Journal of Pediatrics, Sept 2003). Oral and intranasal steroids have also been shown to NOT help with ear infections.
Ear Tubes? I’m just not a fan of this “treatment”. Here is why its done: Children who have fluid in their middle ears are more prone to infections, since that fluid serves as a great environment for bacteria to grow. The ear tubes are simply a way to allow that fluid to drain out. It is essentially a “release valve”. The problem is, no one takes care of what’s causing the fluid to exist in the first place, so the tubes never address the real cause of the ear infections. The research shows that watchful waiting is okay if you are reluctant to undergo this surgery (Maw, Lancet 1999).
Some physicians will suggest this procedure because it will improve language development in the child. However, studies show that ear tubes do not have a great effect on this, does not improve developmental outcomes, and is not helpful for mild to moderate hearing loss due to middle ear fluid accumulation (Rovers MM, Pediatrics 2000) (Paradise, New England Journal of Medicine, 2001) (Paradise, Pediatric Infectious Disease Journal 2003).
A possible cause of fluid development is an allergic-type reaction to foods that the child eats. I find that taking kids off dairy is one of the most helpful treatments in the prevention of ear infections. This means eliminating milk, yogurt, cheese, etc. Some might argue that cow’s milk is a very important source of vitamin D…however, there are plenty of alternative sources. The American Academy of Pediatrics says that 400 IU of vitamin D is an adequate dose for children, and you would need to drink 32 ounces of cow’s milk to get that much! Drinking this amount could cause iron deficiency in a child, since milk is low in iron and inhibits the body from absorbing iron. There are available vitamin D supplements that provide enough vitamin D without causing this issue, and there are other milks that your child might tolerate better than cow’s milk, such as rice, almond, or soy. All of these are available fortified with vitamin D. The other issue with cow’s milk is that many children don’t tolerate it and react in an allergic fashion (such as producing fluid in the ears, similar to a runny nose), but don’t show any reaction on standard allergy testing done at the allergist or pediatrician. The only way to know if your child will benefit from dairy avoidance is to eliminate it completely from the diet for a few months. Calcium is another nutrient that dairy supplies, but there are plenty of other foods that serve as a great source of calcium. The alternate milks mentioned above are often fortified with the same amount of calcium per ounce that cow’s milk has, and conventional supermarkets supply these now. Most children need 800- 1000mg of calcium per day. As for non-dairy sources of calcium, here’s a list:
Vegetables, per 1 cup
- Bok choy, cooked
- Bean sprouts
- Spinach, cooked
- Collard greens, cooked
- Mustard greens, cooked
- Turnip greens, cooked
Nuts, per 1 cup
- Almonds – 660 mg
- Chestnuts – 600 mg
- Filberts – 450 mg
- Walnuts – 280 mg
- Sesame seeds – 900 mg
- Sunflower seeds – 260 mg
Nut Butters, per 3 tablespoons/50g
- Almond – 135 mg
- Filbert – 95 mg
- Sesame – 215 mg
- Sunflower – 60 mg
- Peanut – 20 mg
Grains, per 1 cup
- Tapioca, dried – 300 mg
- Brown rice, cooked – 20 mg
- Quinoa, cooked – 80 mg
- Corn meal, whole grain – 50 mg
- Rye flour, dark – 40 mg
- Rye flour, light – 20 mg
Beans, per 1 cup
- Garbanzo beans, cooked – 340 mg
- Soybeans, cooked – 450 mg
- Tofu – 400 mg
- blackstrap molasses (1 tbsp) – 130 mg
- carob flour (2 oz.) – 110 mg
- dried figs (3 oz.) – 100 mg
- dried apricots (3 oz.) – 80 mg
Herbal Ear Drops: You can find these drops in most health food stores. They usually have a combination of garlic, mullein, and/or hypericum, and 3-5 drops in the affected ear is a typical dose. These drops can be very helpful to relieve pain and possibly encourages the healing process. An important note here is that if your child has any fluid draining from the ear at all, don’t use the drops until you know that their eardrum has not ruptured. Using these drops on a ruptured eardrum can encourage another infection. But, as long as it is intact, these drops should be safe to use. Warming the drops by putting the bottle in a cup of warm water could make this treatment even more soothing. You may also want to apply a warm compress (or an Onion Poultice, see below) to the affected ear after you use the drops. This can be done several times per day.
Onion Poultice: Ok everyone, don’t laugh. This old folk treatment works GREAT. Parents come back to me praising this therapy: Take an onion, cut it through the middle so you see the rings, put it in the oven at medium temperature for about 20 minutes or the microwave for 20 seconds or until warm to the touch (test it on your wrist first). You can apply this as a warm compress over the ear after using the herbal ear drops. The cut part of the onion lays flat over the ear, and it can be covered with some towels to keep in the heat. That aromatic smell from the onion gets into the ear and provides a soothing feeling. This can be done with each administration of the drops, several times per day.
Xylitol: If your child has recurrent ear infections, this can help. Xylitol is a sugar alcohol that has been recently added to chewing gum for cavity prevention. The reason is that it can decrease the “stickiness” of certain bacteria to the teeth that cause cavities. It also happens to work for other bacteria that can cause ear infections, like Hib and Pneumococcus, because it damages the outer capsule of Pneumococcus and decreases the ability of Hib and Pneumococcus to attach and grow (Tapiainen 2004). The dosing can be up to several teaspoons per day. Xylitol is also found in high levels in plums, strawberries, raspberries, and rowan berries, so snacking on these foods is a great idea. ALWAYS go organic with these! Non- organic berries have some of the highest amounts of pesticides on them, and pesticide consumption has been linked to ADHD (Attention Deficit Hyperactivity Disorder) in recent years (Bouchard, 2010). Note: giving xylitol during an acute infection will most likely NOT help; it should be used as a preventative measure (Tapiainen 2002).
I hope this is helpful to you!
As always, consult with a physician before starting any treatment.