Teething usually begins at four to five months of age but can start as early as three months. Since it can take anywhere
from three hours to three weeks for teeth to break through, the symptoms can sometimes be misdiagnosed and one of the most common misdiagnoses is inner-ear infection or Acute Otitis Media.
A teething child’s gums become inflamed and cause excessive drooling, which can cause irritation to the Eustachian tubes; thus, irritating the inner ear. As a result, the child will usually be fussy and tugging on their ears, which are symptoms of an ear infection. Consequently, most parents will take their child to the pediatrician’s office where the misuse of the otoscope or a crying infant may cause a false-positive finding.
In 2004, the American Academy of Pediatrics (AAP) released the results of a study stating that Acute Otitis Media (AOM) is the most commonly diagnosed and misdiagnosed disease in childhood and is a primary factor in increased antibiotic resistance. Since there are such diverse diagnostic criteria and varying opinions regarding the use of antibiotic treatment, it is an acknowledged fact that antibiotics are being overly prescribed.
Accurate diagnosis of AOM requires recognizing the difference between a normal ear, an inflamed ear due to
teething, an infected ear that requires treatment with antibiotics and Otitis Media with Effusion (OME), which is
an asymptomatic disease with persistent middle ear effusion that does not require antibiotics.
In February of 2013, the AAP updated its guidelines for treating AOM. Compared to the previous guidelines, these
highlighted more stringent criteria to use in making an accurate diagnosis, which will enable clinicians to prescribe
antibiotics most effectively. These new guidelines included recommendations for treatment or observation alone (a wait and watch approach) based on the child’s age and the severity of their symptoms.
The results of the 2004 study stated, “Each course of antibiotics given to a child can make future infections more
difficult to treat. The result is an increase in the use of a larger range of – and generally more expensive – antibiotics.
In addition, the benefit of antibiotics for Acute Otitis Media is small on average and must be balanced against potential harm of therapy. About 15% of children who take antibiotics suffer from diarrhea or vomiting and up to 5% have allergic reactions, which can be serious or life threatening.”
On a more alarming note was the AAP’s warning regarding a child developing an antibiotic-resistant bacterium, which can be passed to siblings, other family members, neighbors, and other children in daycare or school settings.