Ear Infection in 4 month old
Is it dangerous for a four month old child to have an ear and throat infection? Also the baby is teething.
“Baby with ear and throat infection”
Dear “Baby with ear and throat infection”,
Ear and throat infections are very common in the pediatric population. Ear Infections are so common that they account for 20% of all office visits in the first five years of a child’s life.(1) A child has a 10% chance of developing Otitis Media(a middle ear infection) by 3 months of age and a 62% chance of developing Otitis Media by 1 year old.(l)
Although it is unfortunate, is not unusual or particularly dangerous for a four month old baby to develop an ear infection. As long as your baby is being followed by a Doctor or Nurse Practitioner and is taking an antibiotic as prescribed, your child’s condition should improve. Even though an ear infection itself in a four month old can be successfully treated with an antibiotic it is the complications of an ear infection that I would be more concerned about. Ear pain and dehydration are the two of the complicating factors that you want to try to avoid.
The symptoms of Otitis Media or a middle ear infection include fever, irritability, swollen lymph nodes, ear pain, pulling on the ear, nasal discharge, nasal stuffiness and cough (2) Irritable infants that are in pain many times have difficulty eating and sleeping. If an infant doesn’t ingest the appropriate amount of fluids required in a twenty-four hour period this puts him at risk for dehydration and its complications. This is especially a concern in an infant with an Otitis media who also has a throat infection and is teething. All of these conditions can cause the baby to be very uncomfortable and in pain.
It is very important to address a baby’s pain in order to prevent complications. The pain can be treated with the administration of an analgesic as prescribed by your Doctor. Many Doctor’s and Nurse Practitioners recommend giving Tylenol to infants with pain.(3,4) In particular it is important to control a baby’s pain during feeding so as to ensure that the baby ingests the fluid and calories that are needed. It is a good idea to give the Tylenol 30 minutes before bottle or breastfeeding in order to optimize the amount ingested.
If you find that your baby is having difficulty feeding or has signs of dehydration it would be important to contact his Doctor or Nurse Practitioner. Signs of dehydration in an infant include sunken fontanel (soft spot), dry mucus membranes(inside of the mouth looks dry), sunken appearance of the eyeballs, weak cry, decreased urine output (an infant should urinate at least 6 times in a 24 hour period), listlessness, difficulty waking, sleeping more than normal, weight loss, lack of tear formation, increased heart rate and doughy or dry skin.(5,6) Monitoring for signs early is important because dehydration in an infant can become severe quickly.
Another potential complication of Otitis Media is persistent Middle Ear Effusion or the persistence of fluid in the ear after the infection resolves. Fluid can remain in the ear for 90 days after an acute ear infection resolves. (3) This fluid can interfere with hearing and may affect a child’s learning and language skills. This is a particular concern in children who are developmentally delayed or those with a speech delay.(3)
The symptoms of Middle Ear Effusion include; mild pain, sensation of stuffiness or fullness in the ear, popping or cracking sounds in the ear with chewing or yawning or dizziness. (7) An infant would not be able to tell you that these symptoms exist, therefore a physical examination by your baby’s Doctor or Nurse Practitioner may be necessary in order to make this diagnosis. If a child develops persistent Middle Ear Effusion, he should be monitored on a regualr basis by his Doctor or Nurse Practitioner until it resolves.
An infant with an ear and throat infection should have a diminished fever, decrease in irritability and improvement in eat and sleep patterns within 24 to 48 hours of initiating treatment.(3) If you find that your baby does not show a response to treatment within forty eight hours it would be important to follow up with your baby’s Doctor or Nurse Practitioner. In addition if your baby displays signs of dehydration you should contact your doctor without delay.
Hope your baby feels better soon.
(1)Alper B, Fox G. Acute Otitis Media. The Clinical Advisor. 2005.Apr:78-85.
(2)Kontiodari T, Koivunen P, Niemela M. Symptoms of acute otitis media. Pediatr Infect Dis J. 1998;17:676-679.
(3)Carlson L, Marcy M. Diagnosis and Management of Acute Otitis Media. Summary of the New Clinical Practice Guidelines. Therapeutic Spotlight. 2004.June:4-14.
(4)Berlin L, Pons G, d’Athis P. A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol 1996;10:387-392.
(5)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 787-788.
(6)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:921-922.
(7)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:363.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Parents with Sick Infancts