Risk Factors

Acute ear infections account for 15 to 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees the doctor. Furthermore, the rate of acute otitis media has been rising over the past decades.

Gender and Age

Acute Otitis Media (AOM). About two-thirds of children will have a least one attack of AOM by age 3, and a third of these children will have at least 3 episodes. Boys are more likely to have infections than girls .

AOM generally affects children between the ages of 6 and 18 months. The earlier a child has a first ear infection, the more susceptible he or she is to recurrent episodes (for instance, 3 or more episodes within a 6-month period).

As children grow, however, the structures in their ears enlarge and their immune systems become stronger. By 16 months, the risk for recurrent infections is rapidly declining. After age 5, most children have outgrown their susceptibility to any ear infections.

Otitis Media with Effusion. OME is very common in children aged 6 months to 4 years with approximately 90% of children having OME at some point. More than 50% of children experience OME before the age of 1, and more than 60% by age 2.

Specific Risk Factors in Children

Ear infections are more likely to occur in the fall and winter. The following conditions also put children at higher risk for ear infection:

  • Allergies
  • Enrollment in day care
  • Exposure to second-had cigarette smoke
  • Being bottle-fed as infants
  • Having siblings with recurrent ear infections
  • Being in lower socioeconomic groups
  • Obesity. A 2001 study found a link between ear infections and childhood obesity. Eardrum abnormalities increased the more the child weighed, which might explain the association. The researchers also suggested that parents may be confusing their children's fussiness due to the ear infection with hunger and, therefore, overfeeding them.
  • Certain medical disorders, including Down's syndrome, cleft palate, Kartagener's syndrome, and immunosuppressive disorders, such as HIV, increase the risk for ear infections.

Parental Behavior

The behavior of parents can increase a child's risk for otitis media.

  • Parents who smoke pose a significant risk for both otitis media with effusion (OME) and recurrent acute otitis media (AOM) in their children. (Passive smoking does not appear to be a cause of initial ear infections, however.)
  • Pregnant women who drink alcohol put their babies at risk for birth defects that can cause hearing loss and OME, among other problems.
  • Babies who are bottle-fed may have a higher risk for otitis media than breastfed babies. The American Academy of Pediatrics recommends breastfeeding for at least the baby's first 6 months.
  • Several studies have found that the use of pacifiers place children at even higher risk for ear infections. Sucking increases production of saliva, which helps bacteria travel up the Eustachian tubes to the middle ear.