by Heidi Hauser Green
March 05, 2013
When your child seems to be sick, “wait and see” is about the last advice many parents want to hear. It’s hard to see a child’s pain and discomfort, difficult to watch him struggle to overcome the virus du jour.
But since the American Academy of Pediatrics (AAP) last published clinical guidelines for the treatment of ear infections in 2004, the “wait and see” approach has become increasingly common among pediatricians.
While it is true that many ear infections will resolve within about 10 days with or without antibiotics, the treatment of this common childhood malady has been inconsistent. Some doctors have continued to dole out prescriptions for antibiotics at very few symptoms, others have required waiting periods and follow-up office visits before getting out the prescription pads, and still others have found some middle ground. Many parents have expressed frustration, not understanding why their sick child didn’t receive an antibiotic—especially if they needed one after a couple of days.
Fortunately, ear infections have been the focus of several major studies in the past 10 years, adding clarity to our understanding of the problem and its optimal treatment. Now, the AAP has issued a new clinical practice guideline, seeking to provide clarification for health care providers—and parents—about The Diagnosis and Management of Acute Otitis Media.
As explained elsewhere on baby gooroo, middle ear infections are virtually a hallmark feature of early childhood, affecting three out of four children and resulting in millions of doctor visits annually. Fortunately, due to physical changes that occur in the ear, the infections become far less common after about 5 or 6 years of age (although they can occur even in adulthood).
Common symptoms of ear infections include:
Some ear infections are caused by viruses, while others are caused by bacteria. Since only bacteria responds to antibiotics and viruses resolve on their own over time, antibiotic treatment for viral illnesses has been controversial.
At 35 pages in length, the new guideline is an ambitious attempt to provide clarity. Its goals:
It is important to realize—as lead author Dr. Allan S. Lieverthal and his colleagues note more than once—this document is to be used only as a source of guidance, not as a protocol. That is: “[t]he recommendations in this report do not indicate an exclusive course of treatment or serve as a standard of medical care.” Treatment decisions may differ from what’s written here, “taking into account individual circumstances.”
That said, the AAP’s current recommendations for the treatment of ear infections are as follows:
In its new guideline, the AAP also recognizes three steps parents can take to reduce their child’s risk of ear infections:
In the throes of winter, illness can seem to come at a whim. This new release provides the clearest guidance yet for pediatricians and parents alike about how to treat ear infections when they happen—and how to try to prevent them from happening in the first place.
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