Watch, wait and see, may be best option for babes' ear infections

Jun 7 2005

One of the most common and frequent reasons why doctors prescribe antibiotics to young children is for an ear infection.

But new guidelines now suggest that it may be wiser, in many cases, to wait and see if the infection resolves itself without antibiotics.

Studies in the past have shown that this has often been the case.

Increased concerns about the overuse of antibiotics and resistance to them, makes this approach seem very sensible.

Jonathan Finkelstein, associate professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care and his colleagues, conducted a study of 2,000 parents in 16 Massachusetts communities. They asked parents, pediatricians, and family physicians to assess the current use of watchful waiting and to determine the acceptability of this option to parents.

Finkelstein says that the concept of 'watchful waiting', meaning careful observation by pediatricians and parents, was a dramatic shift in treatment for a very common illness in childhood.

Finkelstein, also a staff physician at Children's Hospital Boston, and colleagues, report that a wide range of attitudes among parents and physicians about the watchful waiting method was indicated.

A majority of physicians (63 percent) reported at least occasionally using initial observation, but of those, a scant 6 percent use it frequently.

The findings also indicated that although many parents have concerns about using watchful waiting, only 40 percent would be dissatisfied if their doctor suggested this treatment and 34 percent would be satisfied.

There appeared to be greater acceptance of the technique among parents with more education, with a greater knowledge about antibiotics, or who felt included in medical decisions.

Finkelstein says the study shows there is a range of opinions about the practice, and good communication between parents and doctors is essential to ensure it is used appropriately.

The method was included as a treatment option for selected patients in practice guidelines released by the American Academy of Pediatrics and American Academy of Family Physicians in 2004.

The recommendations involve initial observation of non-severe cases in children 2 years old or older with mild ear pain, without high fever, and for whom the physician believes that prompt follow-up is assured should symptoms worsen.