The risk factors for OM have been discussed in detail in the chapter about Risk Factors for OM. To understand how we can try to prevent ETI and OM it is helpful to briefly review the risk factors and look at what can be changed.

The following list of risk factors is in alphabetical order, rather than trying to decide which risk factors are of greater importance, as this is individual for each child….


ETI and ME problems tend to occur in families. Most parents are keen to prevent [or minimise] the problems in their current children and to prevent their next children having the same problems.

If the next child has similar problems to the older sibling, parents are very good at recognising early symptoms and press for early treatment; for the infant’s comfort; their own sleep and sanity and to try to prevent sequelae.

If the opportunity to discuss prevention is available, measures can be taken before the pregnancy. It requires about three months to obtain blood test results and allow time for immunisations if indicated.

If the mother is already pregnant when prevention is discussed, the question of allergies can be discussed and the use of probiotics during pregnancy may be helpful. Restrictions to diet are controversial, but may be indicated in some situations. Immunisations can be given to the mother [soon after the baby is born] to increase antibody levels in the breast milk—to help reduce the incidence of early ear infections. Other general measures are also discussed.

During infancy and childhood there are many issues that may reduce the severity of ETI and ME problems. Prevention of URTIs is important, whenever possible. Contact with smokers, using unflued heaters and swimming in an indoor, heated, public pool are high risk factors for ‘OM prone’ infants and older children. Other issues include management of allergies and intolerances and adequate treatment of bouts of ear infection to ensure that any episode of infection has cleared completely to reduce the possibility of recurrences from inadequately treated OM and MEE.

Follow up is also extremely important to prevent continuing problems and possibly reduce the risk of sequelae. Investigations may be indicated to diagnose iron deficiency or other treatable problems. Immune function testing may be helpful although most immune function abnormalities cannot be treated at this stage. However knowing that the child has an immune function abnormality allows parents and doctors to understand why the infections are occurring, and makes treatment strategies more appropriate. It may also stop parents feeling guilty that they have been doing something that could have caused the problems. Understanding that most children outgrow their immune function problems by about eight years of age is also reassuring for parents.

Meeting the new infant in the first weeks of life and following his progress at regular intervals is helpful to diagnose and treat problems early. Starting seeing the infant early, and following up regularly, also allows early diagnosis in the child who develops middle ear effusions without having any symptoms, although this may produce dilemmas about treatment….

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