Ear infections are one of the most common reasons little ones end up at the pediatrician — and one of the most repeated. That's partly just biology: a young immune system is still in training, so colds and the ear infections that tag along with them are a normal part of the first years. You can't prevent them all, but the research reviewed by IQWiG points to a few things that genuinely tilt the odds — and a few popular ideas that don't.
What helps
A smoke-free home. Secondhand smoke makes airway and throat infections more likely and takes the edge off a child's immune defenses, so keeping their environment smoke-free is one of the clearest wins.
The pneumococcal vaccine. Vaccinated babies get somewhat fewer ear infections. The protection is real but partial — it only covers one family of bacteria, and plenty of ear infections are caused by other bugs. It also doesn't seem to help once a child is already stuck in a cycle of repeat infections. (In Germany, where the source article was written, it's part of the routine schedule in the first year; most countries have a similar recommendation.)
What might help
Easing up on the pacifier. Heavy pacifier use is linked to a slightly higher risk — the sucking changes pressure in the throat and ears, and pacifiers can pass germs around. No need to ban it; saving it for falling asleep is a reasonable middle ground.
The flu shot. Fewer flu infections may mean fewer ear infections, and vaccinated children in studies needed antibiotics less often. Whether it's routinely recommended for healthy children varies by country, so this one is a conversation with your pediatrician.
Xylitol gum — with a big asterisk. This natural sweetener slows some of the bacteria behind ear infections, and daycare studies did show fewer infections. The catch: it only worked when chewed about five times a day for months, which is a lot to ask of a toddler who shouldn't really be chewing gum anyway.
What doesn't seem to help
Zinc supplements. Zinc matters for immunity, but a normal diet already provides enough. Studies found no preventive benefit for well-nourished children — the exception being children with severe malnutrition.
If infections keep coming back
When enlarged adenoids block airflow to the middle ear, doctors sometimes suggest surgery. The evidence says removing the adenoids on its own probably doesn't prevent new ear infections, while ear tubes (small ventilation tubes placed in the eardrum) may lower the chance of another one, depending on the child's situation. Any surgery has downsides, and there's a comforting fact worth weighing in the decision: ear infections naturally become rarer as children grow.
Sources
The original InformedHealth.org article draws on these studies and reviews:
- Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016; (8): CD007095.
- De Sevaux JL, Venekamp RP, Lutje V et al. Pneumococcal conjugate vaccines for preventing acute otitis media in children. Cochrane Database Syst Rev 2020; (11): CD001480.
- Gulani A, Sachdev HS. Zinc supplements for preventing otitis media. Cochrane Database Syst Rev 2014; (6): CD006639.
- Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2017; (10): CD010089.
- Steele D, Adam GP, Di M et al. Tympanostomy Tubes in Children with Otitis Media. (AHRQ Comparative Effectiveness Reviews; No. 185). 2017.
- Venekamp RP, Mick P, Schilder AG et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018; (5): CD012017.