It’s two o’clock in the morning, and your 18-month-old wakes up screaming, shaking her head and pulling at her ears. You take her temperature and ﬁnd that its 101.2. You wonder if this could be an ear infection. Good question.The ofﬁcial name is otitis media, and it is an inﬂammation of the middle ear often caused by a viral or bacterial infection. The infection can cause fever, while the buildup of ﬂuid can cause pain and loss of hearing. The whole picture causes parental stress. But like most parenting issues, knowledge is power, and there are some very useful things that parents should know about ear infections and their symptoms.First, symptoms can be very nonspeciﬁc, especially in an infant or toddler who cannot accurately verbalize what’s troubling them. Fevers in children are most often caused by a wide range of viruses, and do not necessarily indicate an ear infection. Fussiness and night wakening are just as nonspeciﬁc. Ear tugging can mean ear pain, teething, a sore throat or even general agitation. With all this overlap in symptoms, we don’t want to jump to conclusions too early.Second, the immediate priority is not to diagnose and treat the ear infection itself, but rather to treat the symptoms. Antibiotics will do nothing to make the child more comfortable in the short run, and it turns out, have little effect on the ultimate outcome in most cases. A fussy child who has fever or is behaving as if they are in pain will beneﬁt much more from a dose of acetaminophen or ibuprofen than they will an antibiotic. The proper dose of one of these medicines also helps move the parent along the decision tree. If the child seems more comfortable 30 to 45 minutes after a dose, then she is unlikely to need urgent care. A visit to the child’s doctor the next day is the best plan of action if she is still having symptoms. When in doubt, call your doctor before seeking emergency treatment.Third, it is important to understand the natural course of an acute ear infection. Eight of 10 children with otitis media will get better on their own, without antibiotics. In addition, bacterial resistance to antibiotics is growing at an alarming rate. That is why the best approach is often watchful waiting once the diagnosis of otitis media has been made. In keeping with current research, a child with mild to moderate symptoms can be treated with pain and fever relief for 48-72 hours. If the symptoms improve within this time frame, as most will, no antibiotics are necessary. There are a few special guidelines for children under 2. For instance, if the ear infection is present in both ears in this younger group, antibiotics are likely to be prescribed at the outset. So if a child this young is having suspicious symptoms, you should see your doctor the next day rather than wait and watch. Remember that if antibiotic treatment is being considered, the diagnosis has to be made by an experienced doctor looking in the ear, and from there the parent and doctor agree on a strategy for followup and treatment — one that may involve rechecks. The goal is to relieve the symptoms promptly, while avoiding unnecessary medications.Finally, an ounce of prevention goes a long way. We know that children who are immunized against pneumococcal infections and inﬂuenza will get fewer ear infections, so make sure your child’s immunizations are up to date. Babies who are breastfed and children who live in households where no one smokes also are likely to have fewer ear infections than children who use bottles or live with smokers. For more information on how to recognize and treat ear infections, visit healthychildren.org. Dr. Maggie Kozel is a pediatrician at Wood River Health Services in Hope Valley. She may be reached at 401-539-2461. Email her questions at firstname.lastname@example.org.