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Reducing Your Risk of Middle Ear Infections

You may not be able to prevent ear infections entirely, but there are things you can do in your daily life and in caring for your children that may reduce the risk.

To reduce your children’s risk of ear infections:

  • Avoid exposure to cigarette smoke or smoke from wood-burning stoves.
  • Consider breastfeeding your infant for at least the first 6 months.
  • If you bottlefeed your baby, keep your baby’s head upright as much as possible.
  • Reduce exposure to environmental factors that might trigger allergic reactions.
  • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
  • If your child has a history of ear infections, talk to the doctor about surgery.
  • Try to avoid using a pacifier or use one only when your child goes to sleep.
  • Make sure that your child receives all recommended immunizations.
  • Use good hand washing techniques and other practices to avoid spreading germs.
  • If your child snores, ask the doctor to check for enlarged adenoids.
  • What should you do about daycare?

Cigarette smoke and smoke from wood-burning stoves irritate the mucous membranes and can make it easier for respiratory infections to travel to the middle ear. Try to quit smoking, but if you are unsuccessful, be sure that your children are not in the same room or car as a smoking adult. Try to avoid using a wood stove to heat your home. If you must use this form of heat, try to keep children away from the smoke.

Breast milk contains substances that are beneficial for your baby’s immune system and may help your child resist ear infections. In addition, breast milk is less likely than formula to trigger an allergic reaction that could increase the risk of ear infection.

Never lay your baby down flat in bed with a bottle. In this position, fluid is more likely to fill the eustachian tubes. Try to hold your baby in an upright position or use one of the newer angled bottles.

The mucous membranes of children with allergies or asthma are more likely to become swollen, which reduces fluid drainage from the eustachian tubes. In some children, allergies are associated with prolonged or recurrent ear infections. In these children, exposure to environmental allergens, such as pet dander, increases mucus production and may lead to ear infections. If your child is allergic to a pet, try to find the animal a new home. If other environmental allergies are confirmed by your child's doctor, use foam pillows instead of feather or down, and try to wash bedding frequently in hot water. Avoid carpets in the bedroom if possible, and get rid of stuffed animals or keep them in a closet.

If your child has recurrent problems with fluid and infection in the ears, the doctor may recommend long-term antibiotics to prevent an infection. Long-term antibiotics are usually prescribed for a period longer than 6 weeks.

If your child has a history of ear infections, talk to the doctor about a surgical procedure called a myringotomy. During a myringotomy, tympanostomy tubes can be inserted into the middle ear to help prevent the accumulation of fluid.

Children who use pacifiers continuously are more likely to develop ear infections than those who use them only when going to sleep. Avoid using a pacifier or try to wean your child from the pacifier by the time he or she is 1 year old. If you are unsuccessful, set rules for when the pacifier can be used. Wash the pacifier and/or replace it frequently, especially after a cold, sore throat, or other respiratory infection.

Keeping your child up-to-date on immunizations can reduce the risk of illness. For example, the pneumococcal vaccine is effective in preventing some types of middle ear infections caused by pneumococcal infection. Evidence is still unclear about whether it can reduce the overall number of middle ear infections.

Your child should also receive a yearly flu shot, especially if he or she has asthma or other chronic health conditions or if he or she attends daycare.

Wash your hands frequently, and teach your children to do the same, especially after blowing their noses. If your child chews on toys, keep those toys separate and wash them thoroughly before they are played with again. Teach your children to cover their mouths with a disposable tissue when they cough or sneeze and to throw the tissue away immediately.

The adenoids are tonsil-like structures located in the back of the nose, invisible to normal methods of examination of either the nose or throat. When adenoids are large, children tend to mouth-breathe, and they may snore at night. Many children with enlarged adenoids have a nasal sounding voice because of obstruction. The eustachian tubes open into the nose close to the adenoids, and their opening may be blocked when adenoids are enlarged. Blocked eustachian tubes are among the causes of chronic middle ear infection. In some cases, the doctor may recommend that your child have his adenoids removed. While this surgery has not been shown to stop middle ear infections from occurring, it can help to get rid of fluid build-up in the ear.

For most families today, there are few, if any, alternatives to group care. Daycare has some health risks, but it may also have significant and lasting health benefits. Children who go to daycare in the first year or 2 of life are more likely to develop ear infections because they catch more frequent viral infections from other kids. However, daycare may have health benefits, as well. Children in daycare may be less likely to eventually develop asthma and other allergic conditions—especially if their mothers do not have asthma.

Revision Information

  • About antibiotic use and resistance. Centers for Disease Control and Prevention website. Available at: Accessed April 17, 2015. Accessed September 21, 2015.

  • Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at: Updated May 17, 2016. Accessed October 4, 2016.

  • Ear infections in children. National Institute on Deafness and Other Communication Disorders website. Available at: Published March 2013. Accessed September 21, 2015.

  • Middle ear infections. American Academy of Pediatrics Healthy Children website. Available at: Updated August 20, 2015. Accessed September 21, 2015.

  • 7/21/2009 DynaMed Plus Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123:e1103-1110.

  • 3/26/2010 DynaMed Plus Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance Van Den Aardweg M, Schilder A, Herkert E, Boonacker C, Rovers M. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev. 2010;(1):CD007810.

  • 12/16/2011 DynaMed Plus Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095.

  • 3/31/2014 DynaMed Plus Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance Vernacchio L, Corwin MJ, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics. 2014 Feb;133(2):289-295.