’Watch and wait’ – a shift in approach to kids’ ear infections

Educating parents and physicians could reduce overuse of antibiotics

The most frequent reason pediatricians prescribe antibiotics to young children is for an ear infection (acute otitis media). With increased concerns about high rates of antibiotic use and resistance, recent guidelines suggest consideration of “watchful waiting” for some ear infections to see if they resolve without antibiotics. Previous studies have shown that many ear infections do resolve on their own.

“Careful observation by pediatricians and parents, sometimes called ’watchful waiting,’ would be a dramatic shift in treatment for a very common illness in childhood,” said Jonathan Finkelstein, associate professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care. Finkelstein and colleagues conducted a study, reported in the June issue of Pediatrics, which indicates a wide range of attitudes among parents and physicians about the watchful waiting method.

Finkelstein, also a staff physician at Children’s Hospital Boston, and colleagues surveyed more than 2,000 parents in 16 Massachusetts communities, asking parents, pediatricians, and family physicians to assess the current use of watchful waiting and to determine the acceptability of this option to parents. 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 indicate 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 was greater acceptance of the technique among parents with more education, with a greater knowledge about antibiotics, or who feel included in medical decisions. “Parents will be hearing more about the option of initially observing ear infections. This study shows there is a range of opinions about this practice,” Finkelstein said, “and good communication between parents and doctors is essential to ensure it is used appropriately.”

This observation 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.