Good news, mom and dad: ear infections, or acute otitis media (AOM), during a baby’s first year have significantly decreased over the last 20 to 30 years. The reasons for this decline may suggest ways to reduce the risk even further and protect children from other infections, ensuring that parents have a few fewer sleepless nights.

Rates of AOM decreased by 12 percent in three-month-olds, and 16 percent in children aged six months to a year, according to a recent study. The drop appears to be the product of an increase in breastfeeding, a decrease in smoking and the availability of better vaccines.

Second-hand smoke is a risk factor for ear infections because it can cause chronic, low-grade inflammation. When the child gets a cold, this chronic inflammation gets worse and can lead to infection of the Eustachian tubes and the middle ear.

It was just seven or eight years ago that pediatricians began to recommend that infants and children older than six months receive the influenza vaccine, and this helped reduce the rate of AOM. Flu shots help because ear infections are usually a complication of the common cold, and the influenza virus is one of the causes of the common cold.

“We had anticipated the decline in the incidence of AOM because medical progress has been made in the last few decades that should lower the AOM risk in infants and children,” researcher, Tasnee Chonmaitree, a professor of pediatrics at the University of Texas Medical Branch, told TheDoctor.

Increases in the rate of breastfeeding also prevents AOM and upper respiratory infections, Chonmaitree said. Breastmilk passes antibodies and immunity to the infant, she explained. The American Academy of Pediatrics currently recommends breastfeeding for about six months.

The increase in the number of people who have quit smoking has also helped. “We have known for a long time that exposure to second-hand smoke exposure is a risk factor for AOM, because it may cause chronic low-grade inflammation in the mucosa of the respiratory tract,” Chonmaitree explained. When the child gets a cold, this chronic inflammation gets worse, and can lead to infection of the Eustachian tubes and the middle ear.

Parents can help reduce the likelihood of an ear infection by breastfeeding infants during the first few months and making sure they have the pneumococcal and influenza vaccines. The influenza vaccine is the kind of thing parents often miss because it is required once yearly, Chonmaitree points out.

Parents can further help prevent the risk of AOM by avoiding close contact with someone who has a cold. If your child is prone to ear infections, do what you can try to avoid crowded places such as large day care centers, where kids easily pick up bacterial and viral infections. If you or someone else in your home smokes, have them do it outside — or better, help them find a way to quit.

The study is published online in Pediatrics.