Ear pulling may not be sign of infection

Ear infections are common in young children, and during cold and flu season these infections happen even more. Parents worry that an infection gone undiagnosed could result in undue pain or hearing problems for their infant, so they often bring their baby in to get his ears checked at the first sign of a possible infection. Sometimes, though, parents misinterpret normal behaviors as signs of ear pain and medicate at home or make extra visits to the doctor’s office for assessment when things are just fine.

It can be tricky, but here are some guidelines to know when your youngster is likely to be suffering from an infection and therefore it’s worth giving pain medication or making a trip to the doctor’s office — and when it’s not.

Yes: It’s days into a cold

Ear infections typically accompany colds. You need to have some sort of runny nose or significant mucus production (even really bad nasal allergy symptoms can do it) to set the stage for an ear infection. Fluid and mucus needs to collect behind the ear drum before bacteria can invade it and start to grow. Ear infections won’t typically happen until around the 5th day of a cold as a result. The first few days of a cold your baby will be very fussy and may even be pulling on his ears, but not enough time has passed for the fluid to collect and bacteria to grow in the fluid to result in infection. The fussiness in the early days of the illness is most likely from the other early cold symptoms like head fullness, sore throat, body aches, and fever that can accompany any virus. Babies will pull on their ears during this time because they can’t “pop” their ears like we can by opening our mouths wide or plugging our noses and forcing air to open up the passageway. Babies then try pulling on their ear to “pop” it, we think. In these early days of a cold, even though babies are fussy, sleeping poorly, and pulling on their ears, they rarely have an ear infection.

Yes: Improving symptoms nosedive

By the third or fourth day of a cold, though, babies have settled in and are used to the cold they have. Their symptoms are leveling off and they are less fussy. They aren’t well yet, of course, but if they take a nose dive after this point and get much fussier, start sleeping poorly, or if a fever returns, an ear infection may indeed be the reason. Ear pulling alone, though, if nothing else is worsening wouldn’t be enough of a reason in my book to make a trip to the doctor’s office. If your baby is still sleeping well, eating OK, and weathering the cold but is just fooling around with his ears, even if he has an infection he is likely to get over it on his own. I’d stay home.

No: Developmental fussiness

The other scenario I see often is a child who isn’t sick at all but is between 4 and 12 months of age and is somewhat fussier than normal according to the parents, may not be sleeping quite as well as usual and is poking or pulling at her ears. Sometimes parents have even been giving acetaminophen or ibuprofen regularly for days at a time to see if that helps. Other times parents will have chalked the behavior up to “teething” (even though no teeth are erupting) and come in to make sure that the baby’s ears are fine. I can virtually guarantee I won’t find an ear infection in this scenario. Once in a blue moon I will and when I do, I question more closely and almost always find that the parent had downplayed a mild cold the child had the week before.

Babies between 4 and 12 months go through phases of developmental fussiness. It’s normal. It’s not due to teething pain typically and by medicating daily, you run the risk of causing withdrawal headaches when the medication wears off, prolonging the fussiness cycle. Pulling on their ears and sleep disruptions are also common at this time, so unless there is an illness too, my advice is to not reinforce the night wakings and to ignore the ear poking. Once your baby hits the next developmental milestone, the fussiness will improve and you’ll be good to go.

No: Vacation worries

The final scenario I see with regard to ear pulling is the family who is planning to go out of town and wants me to check the baby’s ears to be sure all is well before they fly since he’s been pulling on them. I think this one is born out of  a worry that needs to be dispelled: flying with an ear infection isn’t dangerous. In the case of a child with no symptoms of an ear infection other than fooling around with his ear, the chance that he has an ear infection is tiny. I’d skip the office visit and head off on the trip confident that all is well.