In the guidelines, the pediatrics group clearly defines the signs and symptoms that indicate an infection that might need treatment. They also encourage observation with close follow-up instead of antibiotic treatment for many children, including some under the age of 2 years. And, for parents of children with recurrent infections, the new guidelines advise physicians and parents when it's time to see a specialist.
"Between a more accurate diagnosis and the use of observation, we think we can greatly decrease the use of antibiotics," said the lead author of the new guidelines, Dr. Allan Lieberthal, a pediatrician at Kaiser Permanente Panorama City, in Los Angeles, and a clinical professor of pediatrics at the Keck School of Medicine at the University of Southern California.
The last set of guidelines was issued in 2004. Lieberthal said those stimulated a lot of new research, which provided additional evidence for the current American Academy of Pediatrics (AAP) guidelines appearing in the March issue of Pediatrics.
Lieberthal said the biggest change in the new document is the definition of the diagnosis itself.
Pediatrician Dr. Roya Samuels, who has reviewed the new guidelines, agreed. "The definition is more clear-cut, more precise," she said. But, she added, "There's still no gold standard for diagnosis. There are different stages of [ear infections], and making the diagnosis can be tricky."
Previous guidelines recommended giving antibiotics for ear infections in children age 2 and under. The new guidelines suggest that children aged between 6 months and 23 months can be observed with close follow-up as long as they don't have severe symptoms.
Another key component of the new guidelines is pain management. "Antibiotics take 24 to 48 hours before they start to improve signs and symptoms, so if a child has fever or pain, it's important to place them on [pain-relieving or fever-reducing medications]," Samuels said.
The new guidance from the AAP also states that children, even those with recurrent infections, shouldn't be on long-term daily antibiotics to try to prevent infections from occurring.
Children who have three or more ear infections in a six-month period, or four or more infections in a one-year period (with at least one infection occurring in the previous six months), should be referred to an ear, nose and throat specialist. That's because children with such frequent infections may need to have tubes placed in their ears for better fluid drainage.
As parentsit is up to us to use good judgememt. No one likes hearing their child scream in pain. But, according to the doctors we need to watch and wait 2-3 days to see if it clears up on its own.