When it comes to breastfeeding, many parents have strong feelings about it one way or another. It can be an emotionally-charged subject. That said, it’s also a heavily researched subject. For years, scientists have studied the impact of breastfeeding on babies. One question they’ve investigated is, “Does breastfeeding reduce ear infections?” And the research indicates a resounding yes, it does. Let’s take a closer look at the science behind this conclusion and what this may mean for your baby’s health.

What Causes Ear Infections in Babies?

Otitis media, or middle ear infections, are the most frequently diagnosed disease in infants and young children, according to the American Speech-Language-Hearing Association (ASHA). It accounts for at least 24 million clinic visits each year in the United States and is the most common condition for which antibiotics are prescribed. About three out of four children experience at least one bout of otitis media by age three, and nearly half of those will experience three or more ear infections. 

Ear infections in babies are often triggered by a sore throat, a cold, or a respiratory infection. Bacteria and viruses reach the middle ear via the eustachian tube. The eustachian tube connects the back of the throat to the middle ear. In a healthy individual, this tube allows fluid build-up from the ear to drain away. If the tube is inflamed and swollen from infection, however, it can become clogged, trapping fluid and bacteria and causing pain. Compounding the problem is the fact that babies and toddlers have shorter, less angled eustachian tubes than adults, making them far more prone to inflammation and infection. They also have underdeveloped immune systems that are less prepared to stave off infection. For some children, the middle ear can stay blocked for extended periods of time or swell repeatedly, even when there’s no infection.

Though uncomfortable for the baby and stressful for caregivers, most ear infections are mild and resolve on their own. They can, however, have long-term consequences. Severe infections and repeat infections can damage the eardrum, the bones of the ear, or even the hearing nerve and result in permanent sensorineural hearing loss.

How Does Breastfeeding Reduce the Risk of Ear Infections?

Human breast milk is the best source of nutrition for most babies. Not only that, it supplies immunologic protection against numerous infections during infancy. Breast milk contains a wide range of antimicrobial, anti-inflammatory, immunomodulatory, and bioactive molecules and compounds that work together to protect against infection. Breastfeeding also reduces the risk of infectious disease during infancy by promoting mucosal maturation, balancing the gut microflora, interfering with the attachment of antigens to epithelial cells, stimulating neonatal immune systems, and limiting exposure to the germs from foreign dietary antigens.

Nursing at the breast may be even more beneficial than feeding previously expressed breast milk from a bottle in terms of reducing the risk of ear infection, according to a major study by researchers at The Research Institute at Nationwide Children’s Hospital. The study, published in the Journal of Pediatrics, found that one month of feeding at the breast was associated with a 4 percent reduction in the odds of ear infection. Researchers found a 17 percent reduction in the odds for infants nursed at the breast for six months. Among babies who consumed only breast milk (either at the breast and/or pumped breast milk from a bottle) for the first six months, the odds of experiencing an ear infection increased by approximately 14 percent for infants fed pumped milk for 1 month and by 115 percent for infants fed with pumped milk for 6 months. 

While researchers are not entirely sure how ear infections are connected to bottle feeding, they hypothesize it may be due to the negative pressure created by bottles during feeding. This negative pressure is then moved from the bottle to the baby’s middle ear during feedings, which may facilitate ear infections.

In short, breastfeeding significantly reduced the risk of both upper respiratory infections and ear infections. Exclusive breastfeeding for at least three months, longer duration of breastfeeding, and delayed start of exclusive formula feeding were all associated with a lower risk of ear infections. It also appears that breastfeeding protection against ear infections isn’t limited to just babies. Another study, published in Pediatrics: The Official Journal of the American Academy of Pediatrics, suggests that breastfeeding may protect against ear, throat, and sinus infections well beyond infancy.

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What Are Other Ways to Protect Against Ear Infections?

Exclusive breastfeeding for a baby’s first six months provides the most significant amount of protection. Even partial breastfeeding or breastfeeding exclusively for a shorter duration of time will offer some additional protection against ear infections, according to experts. Here are a few other important steps you can take to reduce your baby’s risk of ear infection.

• Avoid smoke. Reduced exposure to secondhand smoke is also associated with fewer ear infections. Avoiding cigarette smoke helps reduce irritation of the mucus membrane lining the nose and eustachian tube. This makes it harder for germs to grow and reach the middle ear.
• Stay current on immunizations, including an annual flu shot. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated. The National Institutes of Health also recommend parents vaccinate their child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 safeguards against more kinds of infection-causing bacteria than the previous vaccine, the PCV7. The vaccine is strongly recommended for children in daycare. 
• Wash hands with soap and water for at least 20 seconds. Frequent hand washing prevents the spread of germs and can help keep your baby from catching a cold that triggers an ear infection.
• Avoid spending time with sick individuals or limit your exposure as much as possible.
• No bottles at bedtime. Avoid putting your infant down for a nap or for the night with a bottle. If a baby drinks while lying flat on their back, the fluid may flow more easily into their eustachian tubes and middle ear, causing an infection.

The Takeaway

Overall, breastfeeding is an excellent way to provide your baby with essential nutrients and protection from infections, including ear infections. It's worth noting that while breastfeeding can help reduce the risk of ear infections, it is not a guarantee that your baby won't develop them. Other factors, such as vaccination status and exposure to secondhand smoke, can also play a role in a baby's risk of developing ear infections.

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions or concerns about your child or yourself, please contact your healthcare provider.

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