Otitis Media, Wait-and-See, No Antibiotics (Child Over 6 Mo)

Home care

These care tips may help at home:

• Fluids. Fever increases water loss from the body. For infants younger than age 1, keep up regular formula or breastfeeding. Between feedings, give an oral rehydration solution. You can find these drinks at grocery and drug stores. For children older than 1 year, give plenty of fluids like water, juice, lemon-lime soda, ginger-ale, lemonade, or ice pops. Sports drinks are also OK. (If your child is having diarrhea, fluids with sugar in them may make the diarrhea worse.) Never give your child energy drinks with caffeine in them.

• Eating. If your child doesn’t want to eat solid foods, it’s OK for a few days. Just be sure your child drinks lots of fluids. Note how often your child passes urine, such as the number of wet diapers. Also check the color of your child's urine. Light-colored urine means better hydration. A darker urine color means your child may need more fluids.

• Rest. If your child has a fever, keep them at home, resting or playing quietly. Your child may return to daycare or school when the fever is gone and they are eating well and feeling better.

• Fever and pain. You may give your child acetaminophen for pain. If your child is older than 6 months, you may give ibuprofen instead. Give these medicines as your child's healthcare provider directs. If your child has chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your child's healthcare provider before using these medicines. Don't give aspirin to anyone younger than age 18 who has a fever. It may cause a life-threatening condition called Reye syndrome.

• Ear drops. Talk with your child's healthcare provider before giving your child ear drops or other over-the-counter medicines.

• Antibiotics. Only fill the antibiotic prescription if your child is not better or is getting worse 2 days after today’s visit. Once your child starts taking the medicine, they may feel better after the first few days. But make sure your child takes all of the medicine.

Prevention

To reduce the chance of your child getting an ear infection, follow these tips:

• Breastfeed your baby if you can.

• If you give your baby a bottle, don't prop up the bottle.

• Keep your child away from secondhand smoke. Don't let people smoke in your home or car, even when your child is not present.

Follow-up care

Sometimes the infection does not go away after the first antibiotic. Your child may need a different medicine. Make an appointment with your child's healthcare provider. They will check your child’s ears to be sure the infection has cleared.

Call 911

Call 911 if:

• Your child is a lot fussier than usual, drowsy, or confused.

• Your child does not pass urine in an 8-hour period (no wet diapers), has no tears when crying, or has a dry mouth.

• Your child has a stiff neck.

• Your child has a seizure.

When to seek medical advice

Call your child's health care provider right away if:

• Symptoms get worse or don't start to get better after 2 days of treatment.

• Your child has a fever of 100.4°F (38°C) or higher, or as directed by your provider (see Fever and children, below).

• Your child is not urinating as often as usual, or their urine is dark.

• Your child has a headache or neck pain.

• A new rash appears.

• Your child has frequent diarrhea or vomiting.

• There is fluid or bloody drainage from the ear.

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider