Ear infections

What is an ear infection? 

Otitis media, the medical term for middle ear infection, affects about 2 in every 3 children by age 5 and results in millions of doctor visits each year.

Ear infections occur when the eustachian tube—the narrow passage connecting the middle ear (the small chamber behind the ear drum) to the back of the throat—becomes blocked. When children are healthy, this tube fills with air that keeps the space behind the eardrum fluid-free. Sometimes fluid can accumulate in the middle ear. This increases pressure on the ear drum, which in turn causes ear pain, and it may provide a favorable environment for bacteria or viruses to grow. Infants and young children have short, angled eustachian tubes, making them most susceptible to ear infections between the ages of 6 months and 4 years. The tubes, however, become longer and more vertical as children grow, so bacteria have a harder time reaching the middle ear, and middle ear infections become far less common once children enter kindergarten.

What are the symptoms of an ear infection? 

Because most ear infections are preceded by a cold, parents should be on the lookout for signs and symptoms of an ear infection about a week after their child’s cold symptoms appear. Signs of ear infection can include

  • Ear pain, especially when lying down. A baby who cannot communicate ear pain may be unwilling to lie on one particular side, or to lay flat; he may cry when lying down.
  • Difficulty sleeping. Babies may wake more frequently at night. 
  • Low-grade fever. Fever typically ranges from 101° F to 102° F in children ages 6 months to 4 years of age. 
  • Fussiness. Babies who cannot communicate ear pain may act fussier than usual. 
  • Difficulty hearing or responding to sounds. 
  • Loss of appetite. 
  • Loss of balance. 
  • Vomiting and diarrhea. 
  • Drainage of fluid from the ear. If you see blood or pus coming from your child’s ear, it may mean his ear drum has ruptured. Ruptured eardrums almost always heal within a few weeks without treatment, but you should contact your child’s health care provider if your child has ear drainage. 

The American Academy of Pediatrics (AAP) recognizes that “holding, tugging, [and] rubbing of the ear” may be a sign of ear infection in a non-verbal child. However, this isn’t a foolproof sign of infection. Babies, especially those under 1 year of age, may pull at their ears because they are teething or simply because they’ve discovered that their ears can be fun to play with. 

While the cold viruses that often lead to ear infections are contagious, an ear infection itself is not contagious. If your child’s ear infection occurs a week after the start of cold symptoms, your child is likely no longer contagious. Your pediatrician will be able to advise you on whether your child can return to school or childcare.

How are ear infections treated? 

While examining your child’s ear, his pediatrician will determine whether there is inflammation and fluid behind the eardrum. If the ear is infected, the doctor may prescribe an antibiotic to kill the bacteria and reduce the fluid buildup. However, antibiotics may not be necessary. In fact, according to the AAP, many ear infections will resolve within 10 days without antibiotics, since most ear infections are caused by a virus. 

The AAP provides guidance on when antibiotics should be prescribed, as well as when a “wait and see” approach is better: 

  • Antibiotics are appropriate for children ages 6–23 months with both ears infected (even if symptoms are not severe) and for children 6 months and older with one or both ears infected if accompanied by severe symptoms. (Learn more about how and when to use antibiotics here.)
  • “Wait and see” is appropriate for all other cases when symptoms are not severe. (In some cases, pediatricians will write a prescription for an antibiotic, but ask parents to wait a day or two to see if their child’s condition improves before filling it. Studies show that antibiotics are seldom needed.)
  • Follow-up care should be sought if symptoms worsen or fail to respond to antibiotics within 48–72 hours.
  • If your child suffers from recurring acute otitis media, also know as recurring or chronic ear infection, his pediatrician or ear, nose and throat (ENT) specialist may recommend the placement of tympanostomy tubes (ear tubes).  Recurring ear infection is defined as 3 episodes in 6 months or 4 episodes in a year. Ear tubes are surgically inserted to aid with drainage of fluid from the ears. They usually fall out on their own after six months, but sometimes must be surgically removed. Ear tubes may help prevent future speech problems that can result from hearing loss due to persistent ear infections. Parents should discuss all options, as well as possible risks of surgery and anesthesia, with their child’s doctor to determine the best course of treatment. (Learn more about ear tubes here.)

There are steps parents can take to minimize the pain associated with ear infections. Although few studies have been conducted on home remedies, your child may find some relief from a warm, moist washcloth placed over the ear. Prescription eardrops may numb the eardrum and help relieve pain. Your child’s doctor may also recommend acetaminophen or ibuprofen (over-the-counter medications) to ease fever and pain. Be sure to check medication dosages with your child’s doctor, since the appropriate dose for young children is based on weight rather than age. Also, never give aspirin to children with a viral illness, since this has been linked to Reye’s syndrome, a rare but serious illness.

How can ear infections be prevented? 

Although there isn’t a vaccine to prevent ear infections, parents should be aware of the importance of vaccines (the seasonal flu and pneumococcal vaccines, in particular) in preventing illnesses that may lead to ear infections. Parents can also help children ward off colds (which often lead to ear infections) and other illnesses by stressing the importance of handwashing. Finally, parents are urged to take the following steps to reduce their child’s risk of ear infections: 

  • Breastfeed your baby for at least a year (exclusively for the first six months). Breast milk provides antibodies that offer protection from ear infections.
  • If you bottle-feed your baby, hold your baby upright during feedings and don’t “bottle prop.” These practices can allow fluid to build up in your child’s ear canal.
  • Avoid smoke exposure (including secondhand and thirdhand smoke); smoke irritates your baby’s nasal passage and leads to eustachian tube problems. 
  • Limit the use of pacifiers. The AAP recommends giving babies pacifiers at nap/bedtime to reduce the risk of SIDS; however, they recommend discontinuing pacifiers at 6 months of age to reduce the risk of ear infections. (Delay introduction of pacifiers for breastfed infants until breastfeeding is well-established, after about 4–6 weeks.)

When should I call a doctor? 

Most ear infections will go away on their own, if left untreated. However, because complications can occur, it’s advisable to seek medical attention if your child’s symptoms last more than a day or two. You’ll also want to see the pediatrician if your child complains of severe ear pain, is sleepless or irritable after a cold or other respiratory infection, or has fluid (such as pus or blood) coming from the ear.

Last updated January 3, 2022

Suggested Reads