Otitis media means that your child has fluid behind his or her ear drum.  There are two kinds of otitis media:

  • Acute Otitis Media (AOM), which means that the fluid is causing pain or fever
  • Otitis Media with Effusion (OME), which means that the fluid is not causing pain

Treating kids’ ear infections used to be pretty straightforward. Your pediatrician simply handed you a prescription for an antibiotic. Maybe your child is now so familiar with “the pink stuff” that he/she can practically measure it into the dispenser alone.  And you probably know a kid who got multiple ear infections that left his ear so clogged with fluid that it wouldn’t drain, so he got ear tubes.  For AOM, today’s treatment is aimed at reducing symptoms.  This means treating pain with ibuprofen (Motrin or Advil) or ear drops such as Auralgan. Antibiotics can sometimes be helpful, but most of the time, AOM goes away without antibiotic treatment.  

          Ear infections are the most common reason pediatricians prescribe antibiotics, and for some children, drugs are a good choice.  But today it’s not a wise idea to be the parent who demands antibiotics every time your child tugs at his ear.  I have to tell you that I was one of these parents.  My oldest son had numerous ear infections, and I couldn’t wait to get to the doctor and grab that prescription!  Although in this day and age, pediatricians are taking the watch and wait approach.  Further, side effects such as diarrhea, stomach pain and rashes affect around 7 % of kids taking antibiotics.  And doctors worry that many forms of bacteria, including the strain that usually causes ear infections, are becoming resistant to antibiotics, making the drugs less effective against more serious infections.  Another reason watchful waiting makes sense is that studies show about 80 percent of ear infections clear up on their own within a week, since the immune system kills invading bacteria or viruses naturally anyway.  In fact, 60 percent of children feel better in just one day.

          Just about a week ago I was watching the ‘Morning Show’ on CBS news, and medical correspondent, Dr. Jennifer Ashton, stated that there’s substantial evidence suggesting that many children with ear infections will get better without antibiotics and with no ill effects.  Ashton said the American Academy of Pediatrics is about to update its guidelines, but essentially the current guidelines say that unless the child is very young or very sick, a doctor should employ “watchful waiting” — monitoring the child’s health.  As a backup, the doctor might prescribe a safety net antibiotic prescription (SNAP) to be filled only if the child has not improved within 48 to 72 hours.

          This approach is becoming more popular, but there are still times when a child could have a much more serious illness such as pneumonia or bacterial meningitis.  In these cases, the child needs an antibiotic immediately.  So the first thing your pediatrician will do is look for telltale ear-infection symptoms: fussiness, crying, fever and tugging at the ear. If he sees a swollen or stiff eardrum, redness and fluid when he looks in your child’s ear, that usually confirms the diagnosis.  If you agree to take a watch-and-wait approach – treat your child’s pain as directed by his/her pediatrician and track the symptoms – there should be improvement over 48 to 72 hours.  Definitely call the doctor if your child doesn’t feel like playing or still has pain or a fever beyond that point.



  1. I am a big fan of the SNAP prescription. OF course, that is only feasible if you have a compliant parent who won’t take it and fill and adminsiter right away without waiting.
    You also need to look at the kid. A kid with a cold and cough, mild fever and not complaining of ear pain with a pink TM is a safe wait and watch bet.
    The kid with a bulging, angry red, TM with intractable pain isn’t a wait and watch scenario.
    I have friends that are all “SEE, I told you abx were evil and unecessary!!!”
    it isn’t always true

  2. a real consideration for parents to keep in mind is the kid’s age; “how red” the tympanic membrane is or how grumpy the child is, isn’t one of the main considerations.

    the current guidelines ( are that we should indeed treat AOM with antibiotics in kids under age 2; over age 2, usually we don’t give a script unless there are complications or considerations beyond your average new onset AOM.

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