Longer durations of breastfeeding and decreased rates of upper respiratory infections (URIs) have led to a decrease in occurrences of acute otitis media (AOM) during the first 12 months of an infant’s life, according to research published in Pediatrics.

Tasnee Chonmaitree, MD, professor in the Department of Pediatrics at the University of Texas Medical Branch in Galveston, and colleagues conducted a study of 367 healthy infants from near birth to 12 months of age between October 2008 and March 2014. Data gathered for each infant included family history of ear infections, likelihood of cigarette smoke exposure, and breast vs formula feeding, as well as nasopharyngeal specimens. Infants were followed to their first instance of AOM up to 12 months of age.

Over 286 child-years, researchers documented 180 AOM episodes in 143 infants. Cumulative AOM incidence was 6% by 3 months of age, 23% by 6 months of age, and 46% by 12 months of age.

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In 143 infants with AOM, the researchers recorded 466 URI episodes, compared with 393 URI episodes in 168 infants without AOM. Infants with AOM experienced 4.7 URIs per child-year, significantly more than those without AOM (2.3 URIs per child-year).

“Almost half of infants experienced AOM by age 1,” wrote Dr Chonmaitree. “Important AOM risk factors included frequent viral URI, pathogenic bacterial colonization, and lack of breastfeeding.”

Before age 6 months, 70 infants experienced 87 AOM episodes. Infants who did not experience AOM before age 6 months were more likely to be exclusively breastfed for >3 months, have an increased duration of breastfeeding, and have an increased length of time to exclusive formula feeding.

“Prolonged breastfeeding was associated with significant reductions in both colds and ear infections, which is a common complication of the cold. It is likely that medical interventions in the past few decades, such as the use of pneumonia and flu vaccines and decreased smoking, helped reduce ear infections,” Dr Chonmaitree concluded.


  1. Chonmaitree T, Trujillo R, Jennings J, et al. Acute otitis media and other complications of viral respiratory infection. Pediatrics. 2016; Mar. doi: 10.1542/peds.2015-3555.