Ear Infection in Children

If your little one is fussy, tugging at an ear and not sleeping well after a cold, an ear infection could be the reason. Ear infections are one of the most common reasons parents take their kids to the doctor. The American Academy of Pediatrics says nearly 5 out of every 6 children get at least one before their third birthday.

The good news is that most ear infections get better in a few days. Here is what causes them, the signs to watch for, how they are treated and how to lower your child's risk.

What is an ear infection?

Most ear infections in kids happen in the middle ear, the small space behind the eardrum. Doctors call this otitis media. It is different from swimmer's ear, which is an infection in the outer ear canal.

An ear infection often starts after a cold, the flu or allergies. These can block the small tube that connects the middle ear to the back of the throat. This is called the eustachian tube. When it is blocked, fluid gets trapped behind the eardrum, and germs can grow in it.

Why do kids get more ear infections?

The AAP says there are two main reasons:

• A child's eustachian tube is shorter, narrower and flatter than an adult's. This makes it harder for fluid to drain.
• A child's immune system is still growing, so it is harder for their body to fight germs.

The Cleveland Clinic says ear infections are most common between 6 months and 2 years old. Kids in daycare, kids around cigarette smoke, and kids who drink from a bottle while lying down also get them more often.

Signs of an ear infection

The CDC lists these common signs:

• Ear pain, which is often worse at night
• Fever
• Fussiness or crying more than usual
• Rubbing or tugging at an ear
• Trouble sleeping
• Fluid or pus coming out of the ear
• Trouble hearing or not responding to sounds

Babies may also have trouble eating, because sucking and swallowing can make the ear hurt more. Keep in mind that ear tugging alone does not always mean an infection. The AAP says many babies pull on their ears just to calm themselves or play.

How are ear infections treated?

A doctor can check your child's ear with a small light to see if there is an infection. Treatment depends on your child's age and how sick they are.

Watch and wait

The Cleveland Clinic says most ear infections go away on their own in about 3 days. For a mild infection, the CDC says your doctor may suggest waiting 2 to 3 days to see if your child gets better before starting antibiotics. Some doctors give you a prescription to fill only if your child is not better in 2 to 3 days.

Antibiotics

The CDC says severe ear infections, or ones that last longer than 2 to 3 days, need antibiotics. The AAP says doctors are more likely to give antibiotics to children under 2 because they have a higher chance of problems. If your child gets antibiotics, give every dose, even if they feel better.

Pain relief

You can help with the pain while your child's body fights the infection. The CDC says:

• For babies under 6 months, give only acetaminophen, like Tylenol.
• For kids 6 months and older, you can give acetaminophen or ibuprofen, like Motrin or Advil.
• Never give aspirin to children. It can cause a rare but serious illness called Reye's syndrome.
• Ask your doctor for the right dose for your child's age and weight.

The Cleveland Clinic says to call your doctor before giving acetaminophen to a child under 2.

Rest and comfort

Give plenty of fluids and let your child rest. A calm bedtime can help when ear pain makes sleep hard. Try our By Your Side Lullaby, where a mommy penguin rocks her baby to sleep and sings "I will be here by your side." Our Honey Don't You Cry Lullaby is about a mommy penguin caring for her sick baby. You can find more bedtime lullabies on our music page.

When to call the doctor

Call your child's doctor if your child has signs of an ear infection. The CDC says to get medical care for:

• A fever of 102.2°F (39°C) or higher
• Pus, discharge or fluid coming from the ear
• Symptoms that get worse
• Symptoms that last more than 2 to 3 days
• Hearing loss

If your baby is younger than 3 months and has a fever of 100.4°F (38°C) or higher, call the doctor right away. For more warning signs, read our post on when to call a doctor.

If your child is nervous about the checkup, try our Doctor Song. It shows a gentle checkup with a stethoscope, a look at a sore throat and a lollipop at the end for being brave.

How to prevent ear infections

The CDC and AAP suggest these steps:

• Keep up with vaccines. The flu shot and the pneumococcal vaccine help protect against germs that cause ear infections.
• Wash hands often. This helps stop colds, which often lead to ear infections.
• Breastfeed if you can. The CDC suggests breastfeeding only until 6 months and then for at least 12 months.
• Don't let your baby drink a bottle lying down. Hold your baby upright when feeding, and don't put them to bed with a bottle.
• Keep your child away from smoke. Being around cigarette smoke raises the risk of ear infections.

Ear infections often follow colds and other breathing illnesses. Learn more in our post on respiratory tract infections in children.

Questions Parents Ask About Ear Infections

Are ear infections contagious?

No. The AAP says ear infections are not contagious. But the colds and flu that often lead to ear infections can spread from person to person.

How can I tell if my baby has an ear infection?

Look for fussiness, crying more than usual, trouble sleeping, fever, trouble eating, or fluid coming from the ear. Many babies get an ear infection a few days after a cold. Tugging at the ear alone is not always a sign. Call your doctor to check.

Do all ear infections need antibiotics?

No. Many mild ear infections get better on their own in 2 to 3 days. Your doctor may suggest watching and waiting first. Severe infections, ones that last longer than 2 to 3 days, and infections in young children are more likely to need antibiotics.

How long does an ear infection last?

Most ear infections get better in about 3 days. Some fluid can stay behind the eardrum for a while after the infection is gone. It usually clears up on its own, but your doctor may want to check it later.

Can an ear infection cause hearing loss?

Your child may not hear well while they have an ear infection. The AAP says hearing usually comes back when the infection clears. If your child has many ear infections or you notice speech delays, talk to your doctor.

Can my child go to daycare with an ear infection?

Yes. The AAP says your child can go back to daycare or school as soon as they feel well enough, because ear infections are not contagious.

Is swimmer's ear the same as an ear infection?

No. Swimmer's ear is an infection in the outer ear canal, often from water staying in the ear. A middle ear infection happens behind the eardrum, usually after a cold. The CDC suggests drying your child's ears well after swimming.

This post is for general information only. It is not medical advice. If you have questions about your child's health, please talk to your child's doctor.