Q: Whenever my 2-year-old gets a cold, I worry about his having an ear infection. What symptoms should I look for and when should I take him to the doctor?
A: This is certainly cold season, so we're not surprised you're thinking about ear infections, especially if your son has been troubled by them before. One way to think about it is that the swelling from the virus infection blocks the Eustachian tube, the tunnel from the space behind the eardrum to the back of the throat.
Mucus backs up in the middle ear space and bacteria set up shop there causing more mucus, a feeling of fullness or pressure, pain and often fever. Hearing is sometimes temporarily decreased.
Pain and persistent fever are the most common symptoms suggesting an ear infection in a child with a cold. If your son seems to be recovering from his cold and then gets fever again, an ear infection might well be the cause. A doctor's visit in in order.
Pain is harder to determine in a child too young to tell you something hurts. A child with ear pain may play and eat less than usual. He may hold his ear. He may cry. He may sleep poorly. Of course, some of these symptoms can come from the cold alone.
If your child still seems sick, or seems sick out of proportion to a usual cold, call your doctor. If you miss an ear infection for a few days because your son's symptoms are mild, you will not harm him. But in the end, there is no better way to answer the ear infection question with certainty than to have someone with experience look in your son's ears.
Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.