Ask Dr. Hirsch: Weekly Q&A with Dr. Shari Hirsch, Pediatrician and Lactation Specialist at Lev Pediatric Care

Ask Dr. Hirsch

Weekly Q and A with Dr. Shari Hirsch, Pediatrician and Lactation Specialist at Lev Pediatric Care

This Week’s Question:
“How can I tell if my child has an ear infection, and when are antibiotics really needed?”

Dr. Hirsch’s Answer:
Winter brings cozy sweaters and hot chocolate, but it also brings plenty of runny noses. Along with colds and viruses, ear infections become more common this time of year, leaving many parents wondering if antibiotics are needed.

Why ear infections are more common in winter
Most ear infections develop after a viral illness. Congestion and swelling can block the eustachian tubes, trapping fluid in the middle ear and creating an environment for infection.

Young children are more prone because their eustachian tubes are shorter, their immune systems are still developing, and they are exposed to more viruses at daycare and school.

Signs of an ear infection
Symptoms vary by age. Babies and toddlers may tug at their ears, become fussier, sleep poorly, develop fever, or feed less. Older children may complain of ear pain, pressure, headache, trouble hearing, or fever.

Not all ear pain means infection. Pressure from congestion alone can cause discomfort.

How ear infections are diagnosed
A true ear infection is diagnosed by looking at the eardrum. Pediatricians check for bulging, redness, and fluid. This distinction matters because fluid alone does not always mean infection.

When antibiotics are needed
Antibiotics are sometimes necessary, but not always. They are more likely for young infants, severe symptoms like high fever or significant pain, or if symptoms worsen or do not improve after a few days.

In many mild cases, especially in older children, watchful waiting is safe and effective.

Why antibiotics aren’t always the first step
Antibiotics don’t treat viruses and won’t help ear pain caused by pressure alone. Unnecessary use can cause side effects and contribute to antibiotic resistance. Pain control with acetaminophen or ibuprofen is often the most important first treatment.

When to call your pediatrician
Check in if ear pain lasts more than 24 hours, fever is present, symptoms aren’t improving, fluid is draining from the ear, or your child is under 6 months old. If your child seems more uncomfortable than usual, trust your instincts.

Bottom line
Ear infections are common and stressful, but most are manageable and resolve without complications. The goal isn’t to avoid antibiotics at all costs, but to use them when truly needed. Your pediatrician will help guide that decision.

 ​Dr. Shari Hirsch, MD, specializes in infant feeding, including expert newborn support, lactation guidance, and frenotomy (tongue-tie release). She also offers emotional wellness care, with guidance and medication management for attention, mood, and anxiety support.

Lev Pediatric Care is located at Evergreen Uptown Mall in Pomona. Their hours are Sunday through Thursday, 10:00 am to 7:45 pm, and Friday, 10:00 am to 1:00 pm. Same-day appointments are available. To schedule, call 845-579-5700. They also provide free car service to and from doctor visits.

Have a question for next week’s column? Send it to Lev Pediatric Care, and Dr. Hirsch may feature it in an upcoming Q&A