Otitis media (OM) is an infection of the middle ear. Older children with OM complain of ear pain and hearing loss, or a sensation that they are “under water.” OM is exceedingly common with more than 80% of all children experiencing at least one infection by age 2.1

Can breastfeeding protect against otitis media in children? Several studies2 have shown that infants and young children who were never breastfed were at increased risk of OM. Infants who are fed any formula during the first 6 months have almost double the odds of developing OM as compared to infants who are only breastfed.3, 4 The more formula the baby receives, the greater his or her chances of having a middle ear infection during the first year of life. 

We know that breastmilk contains a particular kind of antibodies that are good at protecting the digestive tract from infection. Since the mouth and middle ear are linked by the Eustachian tube, coating this area in protective antibodies helps to keep bacteria out of the ear.5 Breastfeeding also requires the baby to suckle and swallow in a different way than with a bottle. The way the jaw and throat are positioned while breastfeeding are ideal for protecting the middle ear from contamination. 

This article was adapted by Saneea Almas, MD from an original written by Sonia Shoukat, MD.


1. Auinger P, Lanphear BP, Kalkwarf HJ, Mansour ME. Trends in otitis media among children in the United States. Pediatrics. Sep 2003;112(3 Pt 1):514-520

2. Abrahams SW, Labbok MH. Breastfeeding and otitis media: a review of recent evidence. Current allergy and asthma reports. Dec 2011;11(6):508-512

3. Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. Oct 2009;4 Suppl 1:S17-30

4. McNiel ME, Labbok MH, Abrahams SW. What are the risks associated with formula feeding? A re-analysis and review. Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia. Jul 2010;18(2):25-32

5. Labbok MH, Clark D, Goldman AS. Breastfeeding: maintaining an irreplaceable immunological resource. Nature reviews. Immunology. Jul 2004;4(7):565-572