Other interventions parents can take are breast-feeding, using smaller day care situations and not smoking around the child. Approximately five years ago, we demonstrated that children who were born with low cord blood pneumococcal antibody concentrations against the most prevalent types of pneumococci had significantly earlier onset of otitis media. No associations between otitis and prenatal diet or use of drugs, alcohol or medication have been established. Additionally, it is not associated with maternal illness in the third trimester. However, there clearly is a genetic influence.
Boys are more likely to develop otitis media than girls.
The problem with socioeconomic factors as epidemiologic risk factors is that they are all intermixed. Crowding is associated with poor nutrition, poor hygiene, poor treatment compliance and delay in seeking medical attention. It has not been established whether the feeding position or the breast milk itself offers the protective effects. The biggest risk factor, however, is attending day care. As the prevalence of multidrug-resistant pneumococci goes up, so does the prevalence of serious disease.