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Home Breastfeeding

100% Higher Risk Of Ear Infections When Not Breastfeeding

Emily Brittingham, IBCLC, BHSc
by Emily Brittingham, IBCLC, BHSc
Last updated December 15, 2023
Reading Time: 5 min
Ear Infections And Breastfeeding

Breastfeeding is so important for many health reasons. Not breastfeeding, on the other hand, increases a baby’s risk of illness through infection, including the risk of gastrointestinal and respiratory infections, namely throat, eye or ear infections.

According to Australia’s leading health organisation, the National Health and Medical Research Council (NHMRC), not breastfeeding increases a baby’s risk of gastrointestinal infection by 178%, and increases the risk of being hospitalised for lower respiratory tract infections, in the first year, by 257%.

The NHMRC also indicates that not breastfeeding increases the risk of ear infections by 100%.

For more information about this, read BellyBelly’s articles:

5 Benefits Of Breastfeeding For Baby and Mother

Breastfeeding Is Not Best – And Here’s Why.

This article discuss the link between not breastfeeding and ear infections.

New research: not breastfeeding increases risk of ear infections

Supporting previous research, a new study has further established the increased risk of otitis media (ear infection) in babies who are not breastfed. In this new study, 491 surveys completed by mothers were analysed.

After accounting for demographic and other related factors, the study found that 1 month of breastfeeding was associated with a 4% reduction in the odds of ear infection and, in the case of babies breastfed for 6 months, there was a 17% reduction. This is how the authors in the study chose to present this information.

Since breastfeeding is the biological norm, another way to present this information could have been to refer to the increased risks associated with not breastfeeding rather than showing how breastfeeding reduces the risk.

This study also found that feeding a baby with expressed breastmilk in a bottle for the first month, compared with direct breastfeeding for the first month, increased the risk of ear infection by 14%. Feeding expressed breast milk in a bottle for the first 6 months, compared with direct breastfeeding for the first 6 months, increased the risk of ear infection by a huge 115%.

How does bottle feeding increase the risk of ear infections?

How exactly does bottle feeding (with formula or expressed breast milk) increase the risk of ear infection?

Breast milk has many anti-infective, anti-inflammatory and immune modulating factors, which have protective effects and which help promote optimal immune function. For babies who are formula fed, the lack of these increases their risk of infection.

For more information, you can read BellyBelly’a article 5 Ways Breastmilk Is Important For A Baby’s Immune System.

Bottle feeding can also result in a negative pressure being transferred to the middle ear during feeding, increasing the risk of ear infection in bottle fed babies.

According to Sarah Keim, one of the authors of the study, ‘While it is not completely clear why ear infections may be related to bottle feeding, it could be because bottles can create a negative pressure during feeding. This negative pressure is then transferred from the bottle to the middle ear of the infant during feedings, which may precipitate ear infections’.

With the increasing practice of exclusively expressing and bottle feeding a baby with expressed breast milk, research such as this highlights the importance of differentiating between breastfeeding at the breast, bottle feeding with expressed breast milk, and bottle feeding with formula.

For more information, you can read BellyBelly’s article Exclusively Pumping Breast Milk – 7 Secrets to Success.

How to reduce the risk of ear infections while bottle feeding

If you are bottle feeding, feed your baby expressed breast milk, if possible. Unlike infant formula, breast milk contains immunoglobulin A (IgA), which is protective against the bugs that cause otitis media.

Its been suggested you should avoid bottle feeding your baby in a fully reclined position; laying the baby too flat might allow milk to enter the eustachian tubes and cause inflammation, increasing the risk factors for infection.

Babies born prematurely are more susceptible to this, as they have shorter eustachian tubes, which also allows germs from the throat to travel to the middle ear more easily.

Instead, hold your baby in a semi-upright position, with the bottle held parallel to the floor. This helps your baby to coordinate the ‘suck, swallow, and breathe’ pattern while feeding, helping to prevent milk from getting into the eustachian tubes.

There are many ways to make bottle feeding more like breastfeeding. this might help prevent ear infection.

You can read more about this is BellyBelly’s article Bottle Nursing | 6 Steps to Better Bottle Feeding.

How to reduce the risk of ear infections in breastfed babies

The most effective way to reduce your breastfed baby’s risk of ear infection is through exclusive breastfeeding for the first 6 months of your baby’s life.

If you are unable to exclusively breastfeed for six months, breastfeeding for a shorter duration, or mixing breast and bottle feeding, will also help protect your baby against ear infections.

Although breastfeeding has protective effects on the risk of ear infections, it doesn’t guarantee that breastfed babies will never suffer an ear infection. It does, however, reduce the risk of your baby experiencing acute otitis media or repeat ear infections.

Another very important way to reduce babies’ risk of ear infection is to avoid exposing them to secondhand smoke. Secondhand smoke can increase the duration and severity of ear infections.

Symptoms of ear infections in babies

One of the challenges of parenting a baby is learning to communicate without words. A very young baby’s most important form of communication is crying and many parents wish that when their baby cried they could simply ask, ‘What’s wrong?’

If babies are particularly fussy or crying more than usual, it could be a sign they’re in pain.

Other common symptoms of ear infections in babies include:

  • Low grade fever
  • Trouble sleeping
  • Tugging or pulling at the ears
  • Fluid draining from ears
  • Loss of appetite (feeding for shorter periods or less frequently than usual)
  • Previous sinus infections or other upper respiratory infection.

How to treat ear infections in breastfed and formula fed babies

Ear infections can cause severe pain in babies, so if you suspect your baby has an ear infection, it’s important to seek advice from your healthcare provider.

In severe cases, repeated ear infections can lead to permanent damage or hearing loss.

Over the counter medications might be required for pain relief, in addition to antibiotic treatment.

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Emily Brittingham, IBCLC, BHSc

Emily Brittingham, IBCLC, BHSc

Emily Brittingham is a qualified International Board Certified Lactation Consultant (IBCLC) with more than 7 years of experience in the profession.

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