Ear infection?

How does an ear infection present in a 3-year-old? My son had a few ear infections as an infant, but they were always accompanied by lots of fussiness/crying and a fever.

He started complaining that his ear hurt on Sunday night. No fever, but he insisted he needed to lay down on the couch because it hurt. He continued to complain, so fearing the worst, I gave him Ibuprofen before bed. Slept through the night and did not mention it yesterday morning. However, before bed last night, he again started saying that his ear hurt and that he "needed medicine". On top of a busy weekend and a long day a preschool yesterday, he was a wreck before bed. I went ahead and gave him another dose of Ibuprofen...he still complained for about an hour after going to bed (not really crying, but telling me that his ear still hurt and wanted more medicine). This morning, he asked for more medicine because his ear hurt...but I just distracted him and he did not mention it again. I asked his preschool teacher and she said he did not mention it during the day yesterday either.

So, what do you think?? Due to our work schedules, getting him to the doctor can be challening. Plus, our doctor only prescribed antibiotics the time that his eardrum was actually perforated...

 

If you want to try a home remedy, try putting a small amount of oil in his ear. We used baby oil, but growing up, my mom used to use regular cooking oil. You can warm it up a tiny bit in the microwave and use a dropper to put 2-3 drops in. (Mix it up with your finger to make sure it's not hot just warmed) Have him keep his head tilted to the side for a few mins (laying down works) and then when he sits up the excess will probably just dribble out. It should help with the pain

As for whether it's an ear infection or not, my oldest gets pain in his ears when his sinus's are bugging him, and we're just coming out of some ugly allergy issues here. Sometimes it's not a full blown infection just some sinus drainage causing issues. The oil always helps.

 

Usually an ear infection will have some other symptoms...congestion, cough, etc. Could be sinus pressure, could be wax in the ear bugging him, could even be that he put something in his ear. Try shining a light in the ear canal to see if you can see anything. The warm oil will help if it is wax too. Also could be referred pain from teeth so look in his mouth to see if he's got a cavity or if he's cutting a new molar.

 

Walmart sells cheapy otoscopes which will allow you to look in ears to tell if they are red. There's a guide with photos to let you know what you are seeing. I've used it many times with my girls. My girls rarely actually show ear pain symptoms... they are fussy, sleep is disturbed, and won't eat like normal. They are also congested/runny nosed for a few days prior. Sometimes running low grade fever, but not always.

 

My DD had her first ear infection (as a toddler) on Friday. She has had a cold and it probably went into her ear is what the doctor said. But about 4:30 PM she wanted to lie down and after a while I went in her room and she said her "ear hurt". Something about her face made me RUN to the phone and call the doctor because I knew the doctor would be gone for the weekend at 5PM. luckily we live close and yes her ear was very inflamed and she had an infection! She did not have a fever and I looked in her ear with a light and still nothing. But I always say when in doubt just take them in. The antibiotics worked immediately and helped prevent it from becoming a bigger issue. I would rather take them in then it hitting them hard days later when it's way more inconvenient.

 

Hope he is feeling better - we have only had one ear infection and I if I recall he didnt seem all that sick but really only complained of ear pain and was pulling on it a lot. We ended up just going to the urgent care clinic not ER since our work hours are also hectic.

 

Neither of my kids has had a lot of EIs (thank goodness), but when Amy gets them, there are usually no symptoms other than exactly what you described. (Although it does tend to follow on the heels of a cold, but just when she seems to be getting better.) She will calmly tell me that her ear hurts and that it hurts more when she lies down. One time, I took her to the doctor after a couple of days of this, and it was so inflamed that it was completely blocked. The pain doesn't seem to be excruciating, but it's recurring (and she always points to the same ear when I say "Which one hurts?" :ibiggrin: ).

Our ped did say that the majority of EIs go away without antibiotics -- that said, I refrained from giving them to her one time, and two weeks later she had a worse EI. So I don't even take them to the doctor unless they've been complaining of pain for at least a few days, but at that point I do lean towards abx.

 

One of my boys lost both of his tubes this summer and we have had two ear infections since. His main symptom is still the same... poor sleeping. Which this last time was hard to tell since he was coughing all night. We will be making an appointment with the ENT if he develops another one which I think is very likely.

I am super anal about ear infections. My cousin died from an ear infection two years ago. I thought this was rare until I was talking to a friend. Her uncle had just died from an ear infection. In both cases the ear infection went to the brain. They both waited too long to get antibiotics. Nothing could be done. Again I thought oh this must be rare but my same friend's nephew had an ear infection about 5 years ago as a 1 year old. The doctor wanted to "wait and see". The mom took him in two more times. The last time he was rushed to the hostipal via ambulance. He had developed an infection in his jaw bone from the ear infection. Luckily it had not gone to the brain yet. He had to have antibiotics pumped directly to the site of the infection. Spent 2 weeks in the hospital. So ear infections are no joke. And I will never "wait and see" approach. I'm sure for some this is acceptable as the complications are not common but due to personal experience I prefer to be overzealous.

 

My 3 year old was sick with a fever for a WEEK before I took him in. He was coughing a lot and had a fever. Ear Infection. He had told me that his throat "mouth" hurt, but not his ear. That came out of left field. Hope he is feeling better.

 

Wow, I've never heard of that. My oldest has had a zillion ear infections. As a baby/toddler they were chronic. Almost everytime we went to the Dr. for anything, she'd have an ear infection... most of the time with no pain. She's had her eardrum burst twice (which did hurt a lot), the last time when she was 6 or 7. And most of the time they didn't give us antibiotics because they said the majority of ear infections are viral so antibiotics wouldn't work anyway... and that over prescribing antibiotics for ear infections is one of the reasons for resistance to antibiotics which is also bad. Luckily the rest of my kids have only had a handful of ear infections between them. Scary about the possibility of it going to the brain.

 

My son has had 2 ear infections. The first one was when he was nearly 3 and he didn't once touch his ears, but he was inconsolable and very lethargic, it took the drs here like an hour to figure out it was an ear infection. One on the meds it was fine after a few days. Most important is that ear infections can be very painful for most people, pain relief is what my son hs needed almost every 4-5 hrs for the first 48hrs. Then the pain lessons significantly. they r adopting a more wait and see approach in the US for these issues now because Antibiotics have been widely overprescribed. I think they only wait 1-2 days for the wait And see approach, not a week, so hopefully shouldn't spread the infection to the brain or aywhere else. Always best to c the dr and if things Arent getting better in a day or two then go back again. Better safe than sorry.

 

Yikes! Iv'e never heard of this either. Guess it is better to be safe then sorry. I looked it up and found this.http://en.wikipedia.org/wiki/Brain_abscess

 

If one of mine complains consistently of ear pain for more than a few days, we get it checked. I have seen them get ear infections several times with no fever or other symptoms beyond pain.

As for the brain abscess, I don't think it is all that common considering how many ear infections get treated every year (the actual percentage of ear infections that turn into a brain infection is probably incredibly small), but it does happen occasionally. My oldest daughter has a friend that had an ear infection a couple of years ago that spread to her brain. She is fine now, but she did end up having brain surgery before it was all healed.

 

Tina is right; complications like brain abscess or even mastoiditis (what I am assuming PP means by spreading to jaw bone) are incredibly rare. If there are several occasions of these type of complications within the same family, it makes me wonder if there might be some sort of immune deficiency!

The biggest thing to remember before we all get scared here is that any infection that is spreading or worsening is going to have either constant symptoms or worsening symptoms. Usually, anything that is turning into a serious infection is going to have fever. The AAP guidelines actually outline a protocol for the "watchful waiting" of simple ear infections. This protocol states that in children under 2, observation should only be used if the diagnosis is uncertain. In children over 2, they suggest observation for a period of 48-72 hours in children with 'non-severe illness'. The actual policy statement says: "Observation is an appropriate option only when follow-up can be ensured and antibacterial agents started if symptoms persist or worsen. Nonsevere illness is mild otalgia and fever <39°C in the past 24 hours. Severe illness is moderate to severe otalgia or fever 39°C. A certain diagnosis of AOM meets all 3 criteria: 1) rapid onset, 2) signs of middle ear effusion, and 3) signs and symptoms of middle-ear inflammation." The reason for this is the following data:

Placebo-controlled trials of AOM over the past 30 years have[sup] [/sup]shown consistently that most children do well, without adverse[sup] [/sup]sequelae, even without antibacterial therapy. Between 7 and[sup] [/sup]20 children must be treated with antibacterial agents for 1[sup] [/sup]child to derive benefit.[sup]34–36[/sup] By 24 hours, 61% of children[sup] [/sup]have decreased symptoms whether they receive placebo or antibacterial[sup] [/sup]agents. By 7 days, approximately 75% of children have resolution[sup] [/sup]of symptoms.​

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[font="Arial]So, in a kid who is only complaining intermittently, not having fever, otherwise acting well, it is appropriate to wait and see. If the child starts complaining more, starts having poor sleep or poor appetite, is having pain that doesn't respond to motrin or tylenol or is acting differently than normal (more whiny, etc) it is worth checking things out. Any time a pediatrician sees a child in the office and decides to 'wait and see', they should be telling the parent exactly what symptoms to watch for, when to call, how long to wait and see, etc. I always either had the parent make another appt in 2 days or if it was a reliable parent I would give them a prescription and tell them that if at any time in the next 2 days the child got worse they could fill it and start the antibiotic.[/font]
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[font="Arial]As I said before, ear pain alone without other symptoms could be an ear infection, but it could also be many other things. It could be tooth pain, wax buildup, a foreign body in the ear, a swollen tonsil, etc. Sometimes, kids don't have a good concept of pain and will say hurt for many different sensations (anyone ever have a preschooler who said their tummy hurt because they had to pass gas?). Allergies or a cold can cause that popping sensation in the ears and many kids will interpret this as pain. So, if symptoms are mild, it is definitely appropriate to watch for a few days and see if things get better if your gut feeling is that the child is not seriously ill. I guess the gestalt here is that you need to follow your gut. I have the ability to check ears, lungs, etc at home if I want and there have been many fevers where I don't check these things because if my kid is eating, playing and laughing I am assured that they feel ok.[/font]