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Breastfeeding, a decrease in smoking and the use of new bacterial and flu vaccines have helped reduce the incidence of ear infections in babies age 12 months or younger in recent years, according to a new study, “Acute Otitis Media and Viral Respiratory Infections” in the April 2016 Pediatrics.

The study found that nearly half of 367 infants monitored during their first year experienced acute otitis media, or a middle ear infection. The percentage of infants with ear infections at ages 3 months, 6 months and 12 months, though, has declined compared with data from the 1980s and 1990s.

Acute otitis media still remains one of the most common childhood infections and is the leading cause of doctors’ visits by children, as well as the leading cause for antibiotic prescription in the United States.

Risk factors for ear infections include frequent colds, a lack of breastfeeding and exposure to tobacco smoke, according to the study conducted between October 2008 and March 2014 by the University of Texas Medical Branch. Data collected showed that 46 percent of infants experienced an upper respiratory infection – or the common cold — before being diagnosed with an ear infection.

Over the past few decades, bacterial and viral vaccines have become available to help eliminate germs that can cause respiratory infections in children. Further investigation is needed into complex viral-bacterial interactions.