Ear infections

Q Why won't my pediatrician call in a prescription to my pharmacy for antibiotics when my child has ear pain on the weekend?

A Without examining your child, a doctor can't really know what's going on. An antibiotic may not be necessary, and may not even help. In fact, it may make matters worse. Even if your child really does have an ear infection, an antibiotic isn't really going to help him quickly on the weekend anyway.

There are only a handful of common causes of ear pain. An "ear infection" is infected fluid behind the eardrum, in the middle ear. Ear infections usually occur after a child has had nasal congestion for a few days. If your child complains of ear pain and hasn't been congested, it probably isn't an ear infection.

"Swimmer's ear" is an infection in the ear canal. This usually, but not always, occurs in children who have been swimming. Swimmer's ears hurt especially when you touch the outside part of the ear. The best treatment is a prescription eardrop.

Rarely, ear pain can be from a tooth or jaw problem, or from something stuck in the ear canal. And sometimes, kids complain of ear pain when there is nothing at all that a doctor can see that is a problem. It's just sensitive in there, and sometimes kids complain of pain for no particular reason.

So what would be the harm in just calling in an antibiotic for any child with ear pain? There is a risk of allergic reactions, which can be serious. But more importantly, overuse of antibiotics when they're not needed will contribute to the development of bacteria that are resistant to infections. Many infections that were once easy to treat are now very difficult to deal with, even with the best antibiotics, because bacteria are learning to outsmart our medicines faster than we can invent new ones. Antibiotics should be used only when necessary.

Let me suggest a "weekend ear pain action plan." Step one: try to alleviate the pain. You can have your child hold a warm heating pad against his ear, or give him a dose of ibuprofen. If the pain subsides with these simple measures--it usually will--the evaluation can certainly wait a few days until your doctor's office reopens. If not, you should be seen at a weekend facility, like an urgent care center. If your child needs prescription medication, have him examined first so you know you're doing the right thing.

As long as your child isn't too sick or uncomfortable, there's no harm in waiting a few days before starting antibiotics for an ear infection. In fact, most ear infections will go away on their own, without antibiotics at all. So waiting a day or two, if your child is reasonably comfortable, is a good way to avoid extra antibiotics that aren't really needed.

Note that this advice is meant for otherwise healthy children older than two who can speak and describe what they're feeling. If your child is younger or has special health needs, you should call your doctor for more specific advice on if you should wait a few days before being seen on the weekend.

COPYRIGHT 2008 Pediatrics for Parents, Inc.
COPYRIGHT 2008 Gale, Cengage Learning