How should I counsel parents about the expected course and management of acute otitis media in their children?

Advise parents that the usual course of acute otitis media is about 3 days, but can be up to 1 week. Most children get better within 3 days without antibiotics, and a watchful waiting approach is recommended if symptoms are mild. ¹

Recommend regular doses of paracetamol or ibuprofen for pain relief, appropriate for the child's age and weight. There is no evidence to support the use of decongestants or antihistamines for symptom management. ¹

Explain that if symptoms do not improve within 3 days or worsen, an antibiotic may be prescribed or a back-up prescription offered, and they should seek medical advice if symptoms worsen rapidly or the child becomes very unwell. Antibiotics are reserved for cases where symptoms persist beyond 3 days or worsen, or if the child is systemically unwell. ¹

Advise that children and young people under 18 who are not prescribed antibiotics and do not have eardrum perforation or otorrhoea can be treated with ear drops containing an anaesthetic and analgesic, which may reduce antibiotic use. ¹

Children do not need restrictions from usual activities, but swimming should be avoided if there is evidence of tympanic membrane perforation, and air travel may worsen ear pain. Children can return to school or daycare once they are afebrile and the ear pain has resolved. ¹