After more than 25 years practicing pediatrics, I can attest to the accuracy of Carina Storrs’ impression of a new study:

Parents of young children are often all too familiar with ear infections. The pain, the fever, the tear-filled nights almost seem like a rite of passage for children in their first two years of life.

But ear infections are not an inevitability of babyhood. A new study suggests that the number of ear infections in infants has decreased over the past couple decades.


Twenty-five years ago, approximately 60% of children had at least one ear infection by their first birthday. A new study published in this month’s issue of Pediatrics finds that even though acute otitis media is still the leading cause of sick visits and antibiotic prescriptions in kids, babies and young children are getting fewer ear infections than before. Lisa Rapaport points to three simple factors that have brought the rate of ear infections in infants down to 46%: higher rates of breastfeeding, vaccinations, and lower rates of maternal cigarette smoking.

Babies in the study were much less likely to get ear infections if they were breastfed and if they received vaccines to protect against flu and against Streptococcus pneumoniae bacteria, which can cause infections of the ears, sinuses, lungs, and blood.

“Parents should make sure their children receive bacterial and flu vaccines as recommended, breastfeed them as recommended, avoid cigarette smoke exposure and exposure to someone with common cold,” said lead study author Dr. Tasnee Chonmaitree of the University of Texas Medical Branch in Galveston.

These measures will help lower the odds of ear infections, even if they can’t always be avoided as a complication of the common cold.


It is really hard to get an ear infection without first having a cold. We know that infants and young children who attend day care, have older siblings, or those whose respiratory defenses are paralyzed by tobacco smoke get more colds. Due to the unique anatomy and function of youngsters’ respiratory tracts, they also get more ear infections, explains Storrs:

Nearly every ear infection in the current study occurred in a baby that had just had the common cold, typically several days earlier. Out of 859 cases of common cold, 21% were followed by an ear infection.

“The common cold starts the process of infection in the nose or area behind the nose, it causes an obstruction, and changes in middle ear pressure, and that allows both viruses and bacteria into the middle ear,” Chonmaitree said.


Breastfeeding provides important antibodies useful for preventing viral infections and bacterial ear infections — protections not available in store-bought infant formulas. In this study, the longer babies were exclusively breastfed, and the longer mothers refrained from using infant formulas, the fewer ear infections they had. Pediatricians, says Rapaport, already know this:

Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.


Two vaccines in particular protected children from ear infections in this study. It can’t be overstated just how important influenza vaccine is in preventing a very dangerous infection in young people. Ear infections are only one of several serious complications of this very common and contagious viral infection that only good handwashing, avoidance of the invisible influenza virus, and flu vaccines can offer. Infants can and should receive their first flu vaccine at six months of age, a second “booster” dose one month later, and then one annually after that.

Pneumococcal conjugate vaccine (Prevnar) was introduced in 2000 to help prevent devastating invasive infections from those ubiquitous nasal colonizers, pneumococcal bacteria. The World Health Organization (WHO) ranks invasive pneumococcal disease, mostly meningitis and pneumonia, as the leading cause of vaccine-preventable death in children worldwide. In 2008 alone, it killed more than 500,000 children under five years of age. But in this country, Prevnar is nothing less than a modern medical miracle; the number of invasive pneumococcal infections, relatively common just a few short years ago, has plummeted here. As a bonus, the vaccine, which is given as a series of four shots at 2-, 4-, 6-, and 12-15 months, has also proven to be effective in preventing ear infections.

Finally, the harm inflicted by those who smoke cigarettes on children has been known for many decades. As more people shake this dreadful addiction and fewer pick up the nasty habit to begin with, rates of ear infections in young children should decrease further.

Want to prevent ear infections in children? Breastfeeding, getting them vaccinated on time, and avoiding their exposure to cigarette smoke will certainly help.