Your baby is fussy and having trouble sleeping. The usual things — rocking, nursing, singing softly — aren’t calming her down. Then you notice her rubbing her ears and wonder: Does my child have an ear infection?
It’s quite possible. Most babies and toddlers will have at least one ear infection by the time they reach the preschool years. Here’s what you need to know about ear infection symptoms in kids, typical treatments, and when to call the doctor.
What Is an Ear Infection?
An ear infection is exactly what it sounds like — an infection that occurs within the ear.
Children are much more likely than adults to get ear infections, according to the National Institutes of Health. In fact, five out of six children will have an ear infection by their third birthday.
There are different types of ear infections. An outer ear infection (also called swimmer’s ear or medical name: otitis externa) develops when the skin inside the canal is irritated by something and then becomes infected; that something could be anything entering the ear canal — water, sand, hearing aids, earplugs, or even a cotton swab or toy. While it can occur at any age, this is the most common type of ear infection diagnosed in older children, teens, and adults.
Babies and toddlers, however, are much more likely to get a middle ear infection (medical name: acute otitis media). A middle ear infection affects the sensitive area behind the eardrum. It can cause pain, fever, and trouble sleeping.
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What Causes Middle Ear Infections?
Here’s how it happens: Ear infections usually develop a few days after your child gets congested, whether that’s from a cold, allergies, or any other reason.
Inflammation associated with the congestion causes swelling in the tiny tubes (eustachian tubes) that normally drain fluid from the middle ear. When the tube(s) become blocked, fluid builds up behind the eardrum, creating an ideal place for germs, viruses, and bacteria, to grow and causing an infection in one or both ears.
Younger children get more respiratory infections than adults and are therefore more prone to middle ear infections. Their little noses are often runny and congested. Kids are more likely to share germs — at school or day care, or with an uncovered cough or sneeze. Their less mature immune systems aren’t as good at preventing illnesses. Because a child’s eustachian tubes are smaller and drain less efficiently than those of an adult, they can become more easily blocked, creating the conditions for that ear infection to
Risk Factors for Ear Infections in Babies and Toddlers
Some children are at higher risk for ear infections than others. Your child is more likely to get ear infections if they:
- Are under 5 years old. The younger the child, the more likely they are to be congested and for their eustachian tubes to get blocked.
- Have allergies. Allergies can cause runny noses and congestion, which lead to inflammation and mucus.
- Are not breastfed. Breast milk has antibodies that help to fight infections. Studies have shown that breastfed babies get fewer ear infections than those who are not.
- Drink from a bottle or sippy cup while lying down. This can cause liquid to enter the eustachian tubes and cause inflammation.
- Exposure to smoke. Whether living in a house with smokers or exposed elsewhere, this causes inflammation of the nose, lungs, and eustachian tubes and can lead not only to ear infections but also other health problems.
- Attend day care. They have more opportunity to catch illnesses from other children sharing their germs.
Preventing ear infections is difficult because we can’t truly prevent all congestion or control all these risk factors, but do what you can. Try to avoid smoke exposure and illnesses. Treat nasal congestion with gentle suctioning, nasal saline, and moist air. Any of that may help. Sadly, while it may make good sense, keeping their ears covered, avoiding windy days, and staying out of the rain won’t prevent ear infections or other illnesses.
Ear Infection Symptoms
All ear pain does not equal an infection, but that is the most common symptom. Your baby may not be able to tell you that their ears hurt. Other the symptoms of ear infections in toddlers and babies may include:
- Crying more than usual.
- Fussiness or irritability.
- Trouble sleeping.
- Rubbing or tugging at the ears.
- Hurts to touch the ear.
- Ear is swollen and red.
- Fluid draining from the ears.
- Hearing that seems “off.”
- Difficulty balancing.
How Do Doctors Diagnose Ear Infections?
Your doctor can diagnose an ear infection by asking about your child’s symptoms and doing a physical exam. As part of the exam, they will look at your child’s ear canal and eardrum with a special instrument called an otoscope.
Using the otoscope, the doctor can see the color and position of the ear drum and look for fluid in the middle ear. A red, bulging eardrum with infected fluid (or pus) in the middle ear indicates an infection.
Treatment for Ear Infections
The good news is that many ear infections go away on their own. Your doctor will likely start with the most conservative treatment for your child’s ear infection.
Your doctor may recommend waiting a day or two to see if the ear infection gets better on its own. Your child’s immune system will often fight off an ear infection on its own, especially when it is caused by a virus.
Treatment at the onset of an illness is focused on helping your child feel better. TLC, rest, extra fluids, and warm compresses on the ears can help decrease the symptoms. Your doctor may also recommend over-the-counter (OTC) pain relievers like acetaminophen (or ibuprofen in children over 6 months old) to help.
Using these same treatments, you can keep your child comfortable until they can be seen by their doctor and avoid the need for that inconvenient or late night trip for emergency care.
If your child’s symptoms are severe or don’t improve in a couple of days, your doctor will want to examine your child and may prescribe an antibiotic.
Remember, an antibiotic will only work on a bacterial infection, not a viral one, and can cause side effects such as vomiting and diarrhea. Overprescribing antibiotics can also lead to antibiotic resistance. This is why your doctor won’t prescribe antibiotics unless they are necessary.
If your doctor prescribes an antibiotic, you should:
- Give it to your child exactly as prescribed.
- Make sure your child takes it for the full amount of time, even if your child no longer seems sick. (Your child will feel better before the infection has completely cleared.)
- Continue with pain relief efforts such as warm compresses on the ears. OTC pain relievers like acetaminophen (or ibuprofen in children over six months old) can help.
If your child has recurrent ear infections, or ongoing problems with fluid in the middle ear, your doctor may suggest ear tubes. These tubes, inserted through the eardrum into the middle ear, help drain fluid and keep air pressure normal on both sides of the eardrum.
Ear tubes require an operation by an ear, throat, and nose surgeon. It’s usually an outpatient procedure. That means your child can go home the same day.
When Should I Call the Doctor?
Most children get over ear infections quickly. If your doctor prescribes antibiotics, they should start feeling better within a few days. However, you should call your pediatrician right away if your child has:
- A fever of more than 102° F.
- Pus, discharge, or other fluid coming from the ear.
- Hearing loss.
- Symptoms that are getting worse despite treatment.
- Symptoms of a middle ear infection that last longer than three days.
Thankfully, most ear infections aren’t serious. Children tend to outgrow them as they reach the elementary school years. And your pediatrician is always available to help with your questions and concerns about anything, including ear infections.
National Institutes of Health, Ear Infections in Children, Link
NHS, Ear Infections, Link
CDC, Ear Infection, Link
CDC, Preventing and Treating Ear Infections, Link
National Library of Medicine, Ear Infections, Link
National Library of Medicine, Ear Infection — Acute, Link
Canadian Paediatric Society, Ear Infections, Link
Kidshealth.org, Middle Ear Infections (Otitis Media), Link
Connect with UPMC
From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.