Breast feeding exclusively. Immunizations given.

Strong family history of AOM. One brother and one sister both had PE tube surgery.

Mother would like to know what to do to prevent episodes of AOM in this child.

A number of environmental factors can predispose a child to acute otitis media. Grouping children together, particularly in a day care environment, where organisms can be easily passed from one child to another, is a major risk factor. Children in smaller groups (under 5 children) have fewer AOM episodes. We discuss the risk of day care with parents when the babies are 1-2 months old, so that parents can decide about options.

Environmental tobacco smoke exposure also predisposes to recurrent AOM. We encourage adults to smoke outside the house, if they cannot stop smoking. For parents and relatives who are interested, referral to a smoking cessation program may be helpful.

We encourage exclusive breast-feeding for as long as possible to enhance the infant's immune functions.

Children in day care who use a pacifier are also more susceptible to AOM otitis media. This may be due to contamination of the pacifier with secretions from caregivers and other children.

New pneumococcal conjugate vaccines are now available for use in children. They have been shown to reduce AOM episodes by about 6% and the need for tympanostomy tubes by 40%. Children who are in day care are more likely to receive tympanostomy tubes, so these children are most likely to benefit from this vaccine.

Children in day care may also be given influenza virus vaccine when it is available in the fall, since this has also been shown to reduce the incidence of AOM during the flu season.

Children who are fed in the supine position have also been described as having increased numbers of AOM episodes.