''Ear Infections are the most frequently diagnosed, misdiagnosed, and over-treated of all childhood illnesses.'' EARS, An Owner's Manual, Rod Moser P.A., Ph.D

Current literature warns that the excessive use of antibiotics is causing resistant strains of bacteria, and now there are dark warnings that early antibiotic use leads to greater - not less - recurrence, pain, worry, and expense. Even worse is the apparent lowered resistance following antibiotic use leading to a frustrating series of ear infections later on. A number of studies have shown that most ear infections resolve themselves spontaneously if given the chance. Waiting for the body to build its own resistance without antibiotics is more widely practiced in other countries, especially in Holland and England.

''Watchful'' is important because ear infections can develop into rare but serious medical problems, but these do take time to develop. Even if the ear drum does rupture, which you should try to avoid, it is not an emergency and, strangely enough, in most cases will soon repair itself.

Being able to look into the ear canal will help you track the infection, watching it get better or worse. As you get used to using an Earscope you will recognize what is normal and what is not, and will be better prepared for any future infections. If you phone your medical provider you will be able to describe what you see in the ear canal and perhaps save a trip to the clinic.

Many parents are exasperated when they take a suspected ear infection to the doctor only to be told that there was nothing wrong with the ears, something they could have found out at home.

Complications

But you must watch conditions carefully. Serious complications of ear infections can happen. If ear pain is accompanied by any redness, tenderness, pain, or swelling around the bones behind the ears (mastoiditis), or if there is persistent headache (older kids can tell you), stiff neck, or continued vomiting (meningitis), get medical attention fast. If you have any concern that your child might have something more serious than a cold or an ear infection, call your medical provider and describe the symptoms.

Sometimes fluid in the middle ear (serous otitis media or ''SOM'') can cause hearing loss. Following a cold and with a clogged Eustachian tube, fluid can fill the middle ear cavity behind the eardrum. Often this condition has few symptoms, is difficult to see with an otoscope, and can persist for months. If both ears are affected, and hearing loss lasts longer than 3 months, it can affect language development, especially in kids from 1 to 3 years old.

If this same middle ear fluid gets infected it often leads to the familiar sharp pain and eardrum stress and redness associated with acute otitis media (AOM) when the body defenses try to deal with the infection.

To confuse the issue further, not all ear pain nor even inflammation is caused by infection, not all infection is caused by bacteria, and not all bacterial infections need antibiotics. Waiting helps sort out some of this.

The threats of mastoiditis and meningitis (now rare) and possible hearing loss are the reasons why providers are so cautious and tend to over prescribe antibiotics. These are also the reasons why you should seek medical advice, but all of these conditions take time to develop in kids older than infants.