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Despite a recent drop in ear infection rates, they’re still the second-most common illness in babies. Here’s how to prevent, spot and treat an ear infection in your little one.

Good news for new parents: Your baby’s ears are probably healthier than yours were in infancy. According to a study published this spring in Pediatrics, around 60 percent of babies born in the 1980s and 1990s had an ear infection before age 1, compared to 46 percent of babies now.

Doctors attribute the decline to vaccines—specifically, the pneumococcal conjugate vaccine, because pneumococcal bacteria are a major cause of ear infections, and the flu shot, because ear infections often occur after a viral illness like the flu. Other factors include higher rates of breastfeeding and less exposure to secondhand smoke.

But even with the recent drop-off in ear drama, nearly half of babies will still get hit with an ear infection before their first birthday, making them the second-most commonly diagnosed childhood illness after the common cold. In addition to stabbing pain and aching discomfort—things no parent wants their child to experience—persistent ear infections can lead to long-term hearing problems and speech and language delays.

The problem: Babies can’t tell you if they’re experiencing ear pain, so ear infections can be tough to spot in infants. Pay extra attention to non-verbal cues that your child is experiencing ear pain after a cold or flu bug, because congestion that lingers after a respiratory illness can trap fluids in the ear and make infection more likely.

Which non-verbal cues should caregivers watch for? A baby pulling and tugging his ear is one. GeneraWhich non-verbal cues should caregivers watch for? A baby pulling and tugging his ear is one. General fussiness and difficulty sleeping are other signs of possible ear pain.

According to the Mayo Clinic, physical signs and symptoms include a fever over 100 degrees Fahrenheit, yellowish or whitish ear discharge, and a foul smell coming from the ear.

Many ear infections clear up on their own without treatment—your pediatrician may recommend infant acetaminophen or ibuprofen to help reduce pain and inflammation. In some cases, antibiotics are used to clear up persistent or worsening ear infections.

According to researchers at Children’s Hospital of Pittsburgh, a predisposition for ear infections can be genetic, so some tots are simply destined to get more. But if you’d like your baby to be in the slight majority—just over half—of infants who steer clear of ear infections, take steps to prevent them by staying up-to-date on childhood vaccinations, breastfeeding for at least six months, and keeping your baby’s space free of secondhand smoke. Kids with mothers who smoke are 86 percent more likely to have surgery for middle ear problems, compared to children in non-smoking households. A smoke-free home is a healthier home—especially when it comes to your baby’s tiny, adorable ears.

Malia Jacobson is an award-winning health and parenting journalist and mom of three.

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