Also known as acute otitis media, a childhood ear infection is when the middle ear — between the outer ear and the innermost part of the ear — becomes clogged with fluid, infected and inflamed.
This inflammation then results in redness and bulging in the eardrum, pain and often fever. Ear infections are one of the most common childhood illnesses, striking kids younger than 4 most often.
What causes ear infections in babies and toddlers?
Babies get ear infections when they catch a cold or other upper-respiratory infection, which causes the lining of the Eustachian tube (the tube that connects the middle ear to the nose and the back of the throat) to swell, become congested and accumulate fluid. The fluid becomes a breeding ground for infection-causing germs — which could be viral or bacterial. Allergies that cause congestion may also lead to ear infections.
The pain and temporary hearing loss your child may experience are due to the fluid build-up and pressure on the eardrum. The fever he may develop is due to the infection in the middle ear that his little body is fighting.
Ear infections are more common in babies and toddlers because their Eustachian tubes are shorter, narrower and more horizontal than the tubes in adults' (or older kids') ears, making it easy for fluid to get trapped and build up.[1] That's why most kids have at least one ear infection by the time they turn 2.
Some babies and toddlers may be prone to chronic ear infections. While experts aren't entirely sure why some kids get more ear infections than others, there are a few factors that seem to raise the risk, including:
- A family history of ear infections
- Living with a smoker
- Bottle-feeding when lying down (experts believe that this can cause milk or formula to flow into the middle ear, resulting in infection — the sucking motion an infant makes while breastfeeding doesn't have the same effect)
What are the symptoms of ear infections in babies and toddlers?
The signs and symptoms of an ear infection in your baby include:
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- Tugging or pulling at the ear or intentionally hitting his head
- Complaining of pain in his ear or of a headache
- Crying more than usual
- Night waking or trouble sleeping (lying down changes in pressure in the ear, causing pain to worsen at night)
- Failing to respond to sounds, including your voice
- Crankiness and irritability
- Fever
- Dizziness or clumsiness (your toddler may stumble more than usual or bump into things because the ear infection affects his balance)
- Discomfort when lying down, chewing or sucking (all of which can cause painful pressure changes in the middle ear)
- Decreased appetite
- Clear or bloody discharge or pus that drips out from the ear
- Crust in and around the ear
Are ear infections contagious?
No, an ear infection itself is not contagious. However, the cold or illness that led to it could be. So while your child can't catch an ear infection from a friend at day care, he can catch the cold or flu virus that results in an ear infection.
To help prevent this, teach your child proper hygiene, such as washing hands frequently and sneezing or coughing into the crook of his arm or a tissue that is immediately thrown away. Also make sure he's up-to-date on his vaccinations.
If your child already has an ear infection, he can go back to school or day care after his fever clears up and he's no longer in pain.[2]
What’s the difference between an ear infection and an earache?
An earache (pain inside or around the ear) is just one symptom of an ear infection. But just because your child has ear pain doesn't necessarily mean he has an ear infection.
Earaches may have a number of causes besides ear infection, including a sore throat, fluid behind the eardrum, a buildup of earwax, a sinus infection or a tooth infection. They could also be caused by soap or shampoo residue in the ear or by using a cotton-tipped swab.
Because ear infections are so common in young children, call the pediatrician if you notice an earache along with other symptoms of an ear infection.
How do you treat ear infections in babies and toddlers?
If you suspect your baby has an ear infection, take the following steps:
Call the doctor
Your child's pediatrician will check your little one's ears, since you won't be able to see an ear infection from the outside.
Ask about medication
Some pediatricians will take a wait-and-see approach (the infection might clear up on its own), and some will prescribe antibiotics — usually a 10-day course.
Offer your child appropriate pain relievers
Whether or not your child gets antibiotics, your doctor will likely recommend acetaminophen (for babies over 2 months) or ibuprofen (for babies 6 months and older) for pain and fever relief.
Apply heat (or cold)
You can reduce the pain associated with an ear infection by applying heat (in the form of a warm compress) or cold (in the form of an ice pack wrapped in a wet washcloth or a washcloth soaked in cool water) to the outer ear.
Elevate your baby's head
If your baby is older than 1, you may want to insert a pillow under the crib mattress to reduce pain while he sleeps, but be sure to ask your doctor before you try this (and don't use this strategy for babies under 12 months). And remember, never place pillows, wedges or other soft objects on top of the mattress in your baby's crib, as they may pose a suffocation risk.
Once the ear infection has cleared — usually within a week to 10 days — it's not uncommon for there to still be a bit of fluid left over in the ear, which usually resolves on its own. Your pediatrician should continue to check your child's ears at each visit to make sure there's no infection and the fluid clears up.
Do ear infections go away on their own?
Oftentimes, ear infections go away on their own within two or three days. This is why pediatricians sometimes take a wait-and-see approach — for, say, 48 to 72 hours — particularly for children aged 2 and older who have milder ear infections.
Not every childhood ear infection warrants antibiotics, since some are caused by viruses that won't respond to antibiotics, and giving your child too many antibiotics can put him at risk for becoming resistant to these potent drugs when they're really needed.
If your baby is 6 months or younger and it's determined to be acute otitis media, however, your doctor will probably prescribe a course of antibiotics. Pediatricians may also prescribe antibiotics for children aged 6 months to 2 years who are having more severe symptoms.[3] Your doctor may also start your child on antibiotics if his symptoms haven't gotten better within two to three days.
Even if your doctor has suggested a wait-and-see approach for past ear infections, that may not be what your child needs for this one. So if you suspect your child has an ear infection, call your pediatrician to get your child's ears examined.
When should I take my baby to the doctor for an ear infection?
Call during normal office hours if you suspect an ear infection (as it's not an emergency). And be sure to get in touch right away if you notice any of the following:
Fever
While some pediatricians have different standards for what constitutes a fever, if you suspect an ear infection and your child is running any kind of fever, don't worry about "bothering" your pediatrician with a call to the office.
Definitely call the doctor immediately if your infant is under 3 months old and has a temperature of 100.4 degrees Fahrenheit or higher. This could be a sign of a serious infection and your child will probably need to get a COVID-19 test.
Also call if your child is between 3 months and 3 years old and the fever reaches 101.5 degrees F or higher (though any temp of 100.4 degrees F or more will likely warrant a COVID test).
A discharge of blood, fluid or pus from the ear (or crust in and around the ear)
This could mean that the pressure from the buildup of fluid in the ear has caused your child's eardrum to rupture — which is not as scary as it sounds. The release of pressure usually relieves some pain, and the eardrum typically heals itself within a few weeks.
Still, you'll want to see the pediatrician within a day or so since your child may need antibiotics to kill any bacteria that may have caused the ear infection.
No improvement in your child's symptoms
Call if symptoms haven't diminished after three days with or without antibiotics. Or get in touch if the infection seems to get better and then returns, which could mean that your child has a chronic ear infection.
When is it more than an ear infection?
There are a couple of cases when your child may be experiencing more than a standard ear infection:
Chronic ear infection
One or two ear infections a year, while never fun to handle, are fairly normal. A chronic ear infection may be the result of an acute ear infection that does not clear completely.
Recurrent ear infections
If your child has three episodes in six months or four in a year (with at least one in the past six months), then you've got a case of recurrent ear infections.
Otitis media with effusion (OME)
Sometimes fluid from an ear infection remains in the middle ear and doesn't clear even after treatment. When fluid remains for too long in the ear even after an infection clears, it's considered otitis media with effusion, or OME.
While typically temporary — lasting four to six weeks — OME could lead to temporary hearing loss. Since the hearing loss can become permanent if the condition continues untreated for many months, it's important for your child to see the pediatrician.
How to prevent childhood ear infections
While you can't do much to change your child's family history, you can take the following steps to prevent ear infections:
- Avoid secondhand smoke. Exposure to secondhand smoke can make children more vulnerable to ear infections.
- Wash your child's hands often. Hand washing can reduce your child's risk of getting an upper-respiratory infection, which can lead to an ear infection. It's also a good idea to steer clear of sick kids.
- Stay up-to-date on your child's immunizations. The pneumococcal conjugate vaccine (Prevnar 13), which is given to prevent serious infections such as pneumonia and meningitis, may also reduce the risk of ear infections. And since ear infections are a common complication of the flu, make sure your baby receives a yearly flu vaccine once he reaches 6 months of age.
- Breastfeed your baby for at least six months, if you can. Breast milk contains antibodies that may offer protection from ear infections.
- Hold your baby upright during feedings, if you feed him from a bottle. If your baby is lying down during a feeding, milk or formula can get into the middle ear.
- Limit pacifier use to sleep time only.
- Wean off the bottle between 12 and 18 months.
- Consider ear tubes. While tubes are becoming less common, your doctor may suggest ear tube insertion if your infant or toddler has suffered from recurrent ear infections or if he experiences OME for more than three months and/or if that fluid causes hearing loss. These tiny tubes (also called myringotomy or tympanostomy tubes) help prevent fluid and bacteria from building up inside your child's ear, reducing the incidence of infections and the risk of hearing loss. The insertion procedure only takes a few minutes and is done by an ear, nose and throat specialist under general anesthesia. Your tot will be up and running as early as the next day. The tubes will fall out on their own anywhere from six to 18 months after the insertion.
- Dry your child's ears after swimming or bathing. Using a towel to dry off your child's ears can help prevent swimmer's ear (otitis externa), a different type of ear infection that affects the outer ear canal, but is nonetheless common in children who have recently gone swimming. If your child is prone to swimmer's ear, inserting ear plugs into your child's ears before swimming or bathing can help, as can over-the-counter swimmer's ear drops (though be sure to check with your pediatrician before using them on your little one).
Baby and toddler ear infections, while unpleasant, are fairly common. Your doctor will be able to confirm the diagnosis during an in-office visit, and will likely treat the infection with a wait-and-see approach or a course of antibiotics.
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