HOUSTON -

Three out of four children will have an ear infection by the age of three.

But before rushing to the doctor to ask for antibiotics, the American Academy of Pediatrics urges parents to watch and wait.

Many parents can see the infections coming as kids tug at their ears, are reluctant to eat, and become irritable.

“Not wanting to go to sleep at night, they might start to hurt. If they're taking a bottle or they're breast-feeding, they may pull away because the sucking motion can cause the ears to hurt,” said Dr. Debra Cutler with the Kelsey-Seybold Clinic.

According to Dr. Cutler, there’s a good explanation why half of all babies will get an ear infection before their first birthday.

“Younger children, the Eustachian tube is horizontal. (If) you get any kind of cold, the congestion can back up and it can't drain. Then with time, age 2 to 3 years, it's angling down. So even with congestion, it’s constantly draining. So that's why you reduce the risk of having ear infections as you get older,” said Cutler.

Doctors have shied away from handing out prescriptions for antibiotics because of increasingly resistant bacteria and side effects like diarrhea.

AAP, the nation's largest pediatric group, has updated its guidelines, giving parents and doctors more stringent criteria for treating ear infections.

“If the child comes in and there's red bulging ear, having a fever of 102 or greater, (and they’re) in pain, then they should have antibiotics,” said Cutler.

In cases with milder symptoms, she AAP recommends that parents wait a couple days to see if the infection clears up on its own.

“There's over the counter ear drops for pain. Doctors can call in ear drops for pain. Ibuprofen works. Heating up a little sweet oil or olive oil in the ear can help,” said Cutler.

Parents are advised to schedule an evaluation with an ear, nose and throat specialist if their child has three or more ear infections in six months or four or more in a year.