Coughs and colds often bring on ear infections. Paediatrician, Kerry Robinson, looks at treating young children with aching ears

When children get a cold, ear infections can flare up quickly. Usually it's the middle ear, behind the eardrum, that's affected. The main culprit is the Eustachian tube. This connects the middle ear to the back of the nose and throat. Its function is to let air into the middle ear while keeping out debris from the throat. It also lets any fluid that may collect in the middle ear drain to the throat.

In children the Eustachian tube is shorter, wider and more horizontal than in adults. This means debris and bacteria can travel up more easily from the nose and throat to the ear. It also means that any pus or fluid that does collect in the ear cannot drain away so easily to the throat.

So when children get a cold, affecting the nose and throat, an ear infection often follows. When this happens the Eustachian tube swells and closes, trapping infected fluid in the middle ear and creating a breeding ground for germs.

How do I know my child has an ear infection?

• Most ear infections hurt. The pain is often worse at night and you may be woken by a screaming child at 2.00am.
• Young children may just be irritable, cry and refuse to feed.
• There may be a fever. This is more common in younger children.
• Some may pull at their ears. (Don't be fooled by this though. Children often pull at their ears because they are itchy, irritated by soap or shampoo - nothing to do with an infection.)
• Older children may tell you their ears hurt.

Yes. The doctor will look at the eardrum with something called an auroscope. Important things - like the brain - lie so close to the ears that most doctors will want your child to have antibiotics to help clear up the infection as quickly as possible and prevent it spreading.

Does anything else help?

• Painkillers are important. Give your child regular Calpol (do not give aspirin to children).
• Warmth is soothing for some children. Try holding a hot water bottle wrapped in a towel against the ear. Make sure the bottle is warm not hot.
• Over-the-counter decongestants and antihistamines will not help clear up the infection but might help symptoms.

Can ear infections cause further complications?

• Large amounts of fluid can build up behind the eardrum and cause it to burst. You will notice pussy fluid leaking from your child's ear. If this happens the pain usually subsides. The eardrum will usually heal itself.
• In about 10% of children, fluid remains in the middle ear for three months or more. This is called glue ear. It can affect hearing, and consequently the learning of speech and language. In young children speech and language are constantly developing, so it's important to have good hearing.
• Glue ear is not painful so it is important to be aware of your child's hearing after an ear infection. The treatment can involve inserting grommets. These are tiny tubes placed in the eardrum to allow fluid to drain out of the middle ear.
• Mastoiditis - an infection of one of the skull bones called the mastoid and also of the surrounding air space. It is often caused by spread of infection from the cavity of the middle ear. It usually responds to antibiotics but may need surgery.
• Long-term difficulties with hearing.

  Is there anything I can do to prevent my child getting ear infections?

  • Don't smoke around your child. Studies have shown that children of smokers have more colds and ear infections.
  • Breastfeed your baby. Antibodies in breast milk give babies protection in the early months of life when their immune systems are not fully developed.
  • Feed your baby in an upright position and don't let them lie back with a bottle or a breast in their mouth. This prevents milk (a possible source of infection) dribbling into their ears along their Eustachian tubes.
  • Don't put things down your child's ears. Nothing smaller than a finger should go into the ear canal. Be very careful about using cotton buds.
  • The impossible task. Wash things that go in your child's mouth.

  The good news is that as your child gets older he or she should not be so prone to ear infections. This usually happens around the age of five when the ear canal begins to develop its adult shape. So an end is in sight.