Ear drop instillation in pediatrics is the process of administering liquid medication directly into a child’s external auditory canal to treat or manage ear-related conditions. This localized method ensures targeted action with minimal systemic absorption, making it especially suitable for infants and young children.
Indications for Pediatric Ear Drop Instillation
| Purpose | Examples |
|---|---|
| Treat ear infections | Antibiotic drops for otitis externa or media with perforation |
| Relieve pain or inflammation | Analgesic or anti-inflammatory drops (e.g., antipyrine/benzocaine) |
| Remove earwax or debris | Cerumenolytics like carbamide peroxide or saline |
| Dry the ear canal | Acetic acid or alcohol-based drops post-swimming (swimmer’s ear prevention) |
| Kill insects or foreign bodies | Oil-based drops to immobilize insects before removal |
| Anesthetize before procedures | Local anesthetic drops prior to ear irrigation or suctioning |
Preparation
- Warm the bottle in your palm to prevent dizziness or nausea.
- Explain the procedure to the child and caregiver in age-appropriate terms.
- Position the child:
- Infants and young children: Supine or side-lying with the affected ear facing up.
- Older children: Sitting or lying with the head tilted to the side.
Procedure
- Wash hands.
- Warm the bottle in the palm of the hand to prevent dizziness and nausea.
- If the medication is suspended, shake the bottle well.
- Gently pull up and out from center of outer ear. This will straighten the ear canal and ensure the drops will have maximum effect (for infant and young child: pull pinna downward and backward).
- Draw up medication in the dropper and slowly place prescribed number of drops into the ear canal from 1 inch away. Do not touch the dropper to any surface.
- Keep the child in the same position for at least 2 minutes to allow drops to enter ear completely.
- You may loosely tuck a small piece of cotton ball in the ear canal.
- If the drops are ordered for the other ear, wait 5-10 minutes before turning to the opposite side and then repeat the procedure.
- Wash hands.
- Document administration of the medication immediately.
Post Procedure Care
- Insert a loose cotton ball if prescribed (not tightly packed).
- Praise the child and provide comfort.
- Wash hands and document the medication, dose, time, and child’s response.
Tips for Caregivers
- Warm the drops: Cold drops can cause dizziness or discomfort. Roll the bottle between your palms for a few minutes before use.
- Stabilize your hand: Rest your wrist on the child’s cheek or head while instilling drops to avoid sudden movement injuries.
- Massage the tragus: Gently pressing the small flap in front of the ear helps the drops reach deeper into the canal.
- Cotton ball use: If advised, place a loose cotton ball at the ear opening to prevent leakage—never push it deep.
Special Considerations
- Do not use if there is visible discharge, bleeding, or tympanic membrane perforation, unless prescribed.
- Avoid cold drops—they can cause vertigo or discomfort.
- Monitor for allergic reactions or worsening symptoms.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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