My oldest daughter has recently completed kindergarten and is now beginning to ask about having her ears pierced. We plan on waiting until she is older so that she can care for the ears (mostly) herself, but her periodic questioning has it on my mind with more frequency than before.

Do any of your providers pierce ears? Do you have any recommendations for age, material, etc.?

I realize this can be a more touchy subject, as some parents pierce babies’ ears very young and others wait until high school is nearly over.


Dr. Tony Kovatch (Arcadia) responds:


The issue of piercing the earlobes of girls and boys can be a slippery slope. There are no medical studies on which to base clinical guidelines, and the arguments pro and con are largely emotional. Certain cultures, such as the Hispanic population and Asian Indians, insist on piercing of the ears as a rite of passage from the womb to extra-uterine life. I remember well an encounter with a young Hispanic mother in the clinic where I worked 35 years ago; I chastised the mother for having the piercing performed so early — before receiving tetanus shots. She glared at me half contemptuously and half astonished by my ignorance and responded: “Doctor, where I come from, a baby girl is not properly dressed without earrings.” And she did not mean the clip-on variety.

I admit I am biased. I feel sorry for baby girls with no or little hair — with cue-ball heads in spite of dainty feminine features. Earrings offset this deficiency. I strongly believe that parents have the civil liberty to decide when to perform the procedure, which is beautifying and not disfiguring. Furthermore, I cannot remember seeing a complication in these infants — the parents take immaculate care of the pierced sites, the baby is oblivious to presence of the earrings (and their care becomes routine), and the immune system is not sophisticated yet to reject the foreign bodies.

The situation in older kids is more dicey. Whether the child is 5 or 8 or 10 years old at the time of piercing, there will likely be more anxiety and more pre-occupation with the new body accessory. Foreign body reactions and infections requiring removal of the earrings are far more common, the worst complication being engulfment in the lower pole of the earlobe. These engulfed posts and backings may require general anesthesia in the operating room for humane removal. Fights in older girls and boys can result in through-and-through lacerations of the earlobe, requiring plastic surgery.

Therefore, the decision to have piercing outside the newborn period is best made by the child herself. Many parents view the procedure as a reward for good behavior or as a gift for a special occasion. The providers in my office, the Arcadia Division, as well as most other pediatricians at Pediatric Alliance, refers candidates to a reputable concession, such as the Piercing Pagoda at several local shopping malls. There, the earrings, which must be worn steadily for 6 weeks to maintain the hole, can be immediately purchased. The procedure is largely pain-free and I would bet that any imaginary pain is most often voiced by the older boys, especially the football and hockey players. The quality of the earrings is paramount to prevent reactions. The best materials are 24 carat gold and platinum; sterling silver is acceptable; forget nickel and the other alloys. I personally think the incidence of complications is decreasing as piercings are undertaken at younger and younger ages and the materials are of higher quality.

I think the bottom line is this: Ignore anecdotal advice from negative individuals and follow your own heart — you cannot make a mistake. And remember the song “You’re never fully dressed without a smile.” You’re never fully dressed without a beautiful pair of earrings. As for complications, there are certainly more important things to worry about!