“Second ear infection in 3 weeks, temp up to 40 on Friday, ended up in care doc. 4 ear infections in 6 months (he’s 1 this month).. time to ask to be referred to ENT?”
#CareCantWait. This story is really showing the cracks of the breakdown in the doctor-patient relationship. The GP shortage means that waiting for appointments means that patients are being seen by out-of-hours GPs. The lack of continuity is disruptive to care. Had the same GP seen your son for the 4th time in 6 months, s/he would definitely be bringing up the discussion about ENT referrals. With long waiting lists (hospital doctor shortage, too), early referral is important more than ever.
For everyone, let’s just recap what we’ve talked about before about ear infections!
Ear infection, or acute otitis media (AOM), remains the most common illness diagnosed in children. 50% of children will have AOM at least once by their first birthday. In AOM, ear pain, which at times can be quite severe, is typically felt deep within the ear. Often, the pain is worse when the child is laying down. Stuffy or runny nose and cough are typical, and often start before the ear pain by several days.
Does your doc always get a good view of the ear? Probably not. An experienced doc just needs to see the tympanic membrane: clues such a bulging membrane, fluid level, change of colour of tympanic membrane, etc. are enough, with other symptoms, to get a good idea what is going on. To see better, a doc sometimes needs to clean out the ear. Perfectly safe and reasonable, but very, very distressing to an unwell child with a sore ear. If s/he can see enough to make the diagnosis, many docs stop there and avoid further distress to an unwell child. It will also make the child fearful/less cooperative the next visit.
In infants and young children, symptoms of an ear infection can include:
●Stuffy or runny nose and cough are typical, and often start before the ear pain by several days.
●Fever
●Pulling on the ear
●Fussiness or irritability
●Decreased activity
●Lack of appetite or difficulty eating
●Vomiting or diarrhoea
●Draining fluid from the outer ear (called otorrhea)
Treatment of an ear infection may include:
●Medicines (paracetamol, ibuprofen) to treat pain and fever
●Antibiotics are routinely given to infants who are younger than 24 months or who have high fever or infection in both ears. Children who are older than 24 months and have mild symptoms may be treated with an antibiotic or often are observed to see if they improve without antibiotics.
If your child is being observed rather than treated with antibiotics: You may be instructed to start the antibiotics if your child’s pain or fever continues or worsens; You may be advised to continue to hold antibiotics/observe if the child is improving. Generally, you are advised that if your child does not improve after 48 hours or gets worse, ring the doc. Make sure that you are perfectly clear on instructions before leaving the surgery. This can be difficult with screeching toddler pulling on you, but it’s important habit to get into. It is very common for mothers to be hesitant or unsure about what to do with that antibiotic prescription 48 hours later.
What doesn’t work for ear infections?
●Decongestants and antihistamines — Cough and cold medicines (which usually include a decongestant or antihistamine) have not been proven to speed healing or reduce complications of ear infections in children. In addition, these treatments have side effects that can be dangerous.
●A wide complementary and alternative medical (CAM) treatments advertised to treat ear infections. These may include homeopathic, naturopathic, chiropractic, and acupuncture treatments. There are few scientific studies of CAM treatments for ear infection, and even fewer studies that show CAM treatments to be effective. As a result, these treatments are not recommended for ear infections in children. Do not allow anyone except your doctor recommend or put something into your child’s ear if they have an ear infection.
Some children develop ear infections frequently. “Recurrent ear infections” are usually defined as three or more infections in six months, or four or more infections within 12 months. In addition to receiving the pneumococcal vaccine, as recommended for all children (#vaccinate!), several interventions can help reduce the risk of recurrent infections. These include avoidance of tobacco smoke, continuing breastfeeding, continuous low dose antibiotics, and/or ENT referral for expert opinion on whether your child would benefit from surgical placement of tubes in the ears
0 Comments