‘Watchful waiting’ proposed for some children’s earaches

Jennifer C. Yates

PITTSBURGH — That familiar tug on his ear or restless night sleep is usually the sign that little Baedden Pollett has another ear infection. The 2 1/2-year-old has had more of them than his parents can count.

Sometimes, his doctor prescribes antibiotics. But in many cases, his parents have waited it out, using Tylenol, warm baths and some extra tender loving care to ease him through it. And he recovers on his own.

More than ever, many parents and doctors these days are taking a “watchful waiting” approach with children older than 2 who have ear infections, the most common childhood illness. Many are foregoing antibiotics because of worries about drug resistance and evidence that most ear infections will heal on their own.

“My experience is that parents are often the driving motive behind not giving antibiotics. Parents are very, very concerned about the use of antibiotics,” said Dr. Richard Rosenfeld, director of pediatric otolaryngology at Long Island College Hospital in Brooklyn and a consultant who helped write national guidelines on antibiotic use for ear infections.

Three out of four children will suffer from ear infections before the age of 3, according to the National Institute on Deafness and Other Communication Disorders. Ear infections occur when viruses or bacteria get inside the ear, usually the result of a cold or other illness. Fluid and mucus can become trapped deep inside the ear.

Antibiotics only work against bacterial infections, though some of the many bacteria that can cause ear infections have grown resistant to certain antibiotics. Doctors have no way of knowing if a virus or a bacteria is causing each individual infection.

Many parents recognize their child’s earache symptoms — fussing, crying, loss of sleep and appetite and a tugging at the ear. Ear infections can result in hearing loss, though doctors say that’s usually temporary.

A visit to the doctor is advised if a child is sick for a few days and suddenly develops a fever, along with those other symptoms like ear-tugging and awaking at night.

“Observing is different than not treating,” Rosenfeld said.

In May 2004, the American Academy of Pediatrics and the American Academy of Family Physicians released the first national guidelines on appropriate diagnosis and treatment for ear infections. Among other things, the authors recommend that pain medication be prescribed for most children and antibiotics used only if the conditions persist or don’t improve.

In an October study in the medical journal The Lancet, researchers found that antibiotics for ear infections are only beneficial to children under the age of 2 with both ears infected. Study leader Dr. Maroeska Rovers, of the University Medical Center Utrecht in the Netherlands, said that researchers found that in most other cases, watchful waiting is OK.

Rovers said that in countries like the Netherlands, watchful waiting has been an accepted practice since about 1990. Critics say the ear infections could develop into something more severe if untreated, but Rovers said studies have not backed that up.

Doctors are the front line in helping educate parents about the best course to take, Rovers said.

“They should not send the parents away by doing nothing, but they should listen carefully to these parents and prescribe sufficient analgesics to treat the pain and the fever in the first few days,” Rovers said. Then, parents should be encouraged to come back in two to three days if things have not gotten better, he said.

At the Children’s Hospital of Pittsburgh, a team of researchers led by Dr. Alejandro Hoberman will lead a government-funded study of about 300 children to further test the watchful waiting vs. antibiotics strategies.

Hoberman, chief of general academic pediatrics at the Pittsburgh hospital, said evidence shows that most infections clear up on their own.

“The key concern is how much longer will it take, and how much pain [and] crying, sleepless nights the child might have,” Hoberman said.

Hoberman said a big part of this is helping doctors with techniques that more accurately diagnose the severity of the ear infections so the most appropriate course of action can be taken.

Doctors can tell if an ear is infected by looking into the ear canal for redness or inflammation. But that observation isn’t always accurate, and in many cases antibiotics are unnecessarily prescribed, he said.

“I think parents are generally more receptive in 2006 and actually consider that antibiotics are not always needed,” Hoberman said.

Baedden’s mom, Denise Pollett, said she and her husband have used many techniques to ease their son’s ear pain, including warm baths twice a day.

She’s also moved him to a different daycare center, hoping he’ll get sick less often. Though ear infections are not contagious, colds are and can lead to ear infections.

“We weren’t that quick to run to the doctor when we knew he was probably getting one,” said Pollett, who lives in the Pittsburgh suburb of Mount Lebanon.

Pollett said more than anything, they wanted to relieve his pain.

“I think sometimes that’s even more important than the antibiotics,” she said.

(Associated Press)