By: Noah Alter & Samuel Ostrower, MD, FAAP
When parents and caregivers talk about health concerns they see in their children, ear infections often top the list. Maybe that's because nearly
5 out of every 6 children will experience one before their third birthday—and for some, painful infections will become an ongoing pattern that causes sleep loss, low mood and more.
Why are ear infections so common in children, and what's the best way to prevent and treat them? Here are answers to the questions pediatricians hear most often, along with research findings that offer helpful guidance.
What causes ear infections?
An ear infection happens when bacteria or viruses infect the small space behind the eardrum, known as the middle ear. This area is normally filled with air and contains three tiny bones that help us hear.
Middle ear infections (otitis media)
This type of ear infection in the middle ear is also known as otitis media. A small passageway called the eustachian tube connects the middle ear to the back of the nose and throat. When the eustachian tube becomes blocked, usually due to a cold or allergies, fluid can build up in the middle ear. This creates an environment that is perfect for bacteria or viruses to grow. This infection can cause an earache, fever and difficulty hearing.
While most ear infections go away on their own, some require medication such as antibiotics to treat the infection. Infection of the middle ear (otitis media) is different from an infection of the ear canal (otitis externa), which is also called
swimmer's ear.
How can I tell when my child has an ear infection?
Many adults assume that if a child tugs or pulls at their ear, this suggests they have an ear infection. However, many babies and small children do this to self-soothe or simply play with their ears. Here are additional symptoms of ear infection to look for in your child:
Ear pain. This can be a sharp pain or dull, throbbing ache. Discomfort might come and go or remain constant. It is common for the pain to be worse at night.
Trouble hearing. Your child might complain that their ear is plugged up or that they can't hear very well. Babies and toddlers might not respond as they normally would when you speak to them. Some children with prolonged hearing loss related to ear infections may have delayed speech and language development.
Fever. Your child's body temperature may be higher than 98.6 degrees, which is generally considered normal.
Ear drainage. Sometimes pus or fluid can come out of your child's ear, which can be a sign of an infection which may have ruptured the eardrum.
Headache: Your child might complain of pressure or pain in the head or ear(s).
Rest assured that if your child isn't hearing well right now, the problem will clear up when the infection does. Generally, there is no danger of lasting damage to their hearing—but this doesn't mean you should put off calling your pediatrician. Ear infections can cause serious discomfort and sleep loss, so it's important to have your child checked right away.
Why do kids get more ear infections than grownups?
Kids are more susceptible to ear infections because:
Their immune systems are still developing, which makes it harder for them to fight off any infection.
The eustachian tube that connects a child's middle ear to the back of their throat is shorter, narrower and more horizontal than an adult's. This makes it harder for fluid to drain out of the ear, which can lead to fluid buildup and bacterial growth.
What other factors can cause ear infections (or make them worse)?
Your child may develop an ear infection when:
They have a cold, flu or allergy symptoms that cause congestion and sneezing, causing fluid to build up in the ear.
They have daily exposure to germs that cause colds, flu and other respiratory illnesses—for example, at school or child care.
They drink from a bottle, especially when lying down for a nap or overnight.
They spend time around people who smoke, or in environments where smokers have been. Secondhand and
thirdhand smoke have been shown to elevate a child's risks for ear infections and other health issues such as bronchitis,
pneumonia, susceptibility to colds and even
tooth decay.
How are childhood ear infections diagnosed?
Diagnosis and treatment planning for ear infections involves 3 recommended steps:
Your pediatrician will determine whether an infection is present by checking their temperature and using a scope to look inside the ear. If the eardrum is red and bulging, this suggests an infection is present. If the outer ear canal is inflamed but the eardrum appears normal, swimmer's ear might be the cause.
You and your pediatrician will talk about risk factors for ear infections and how to reduce them. This can help prevent chronic infections that affect your child's well-being.
If your child has an infection, you and your pediatrician will keep an eye on your child's symptoms to ensure they are recovering without pain.
Will my child need antibiotics?
When it comes to safely treating a child's ear infection, studies show that less is more. Even though your doctor wants to provide quick relief, they may also want to wait 48 to 72 hours before prescribing antibiotics for a possible infection. Here's why.
Around 80% of childhood ear infections clear up on their own without medication.
Frequent use of antibiotics can lead to
antibiotic resistance, which can actually make it harder for your child's immune system to fight off future infections of all kinds (including life-threatening ones).
So what are the best options for treating ear infections?
In many cases, the best course of treatment involves no antibiotics. In this case, your pediatrician may suggest:
Over-the-counter pain relievers such as acetaminophen or ibuprofen can help reduce pain and fever associated with ear infections. (Due to risks of
Reye syndrome, a rare but serious condition seen in children under 15 months,
NEVER give aspirin to your baby or toddler. For guidelines on which over-the-counter pain relievers are safe for kids and how much to give, check out this helpful
article.)
Watchful waiting to make sure the infection clears up within a few days to a week.
Your child's doctor may decide that antibiotics are a better option if:
Your child is under 2 years old (which means they are more susceptible to complications from an ear infection).
The infection is severe, or your child is suffering from serious pain or fever.
Symptoms have lasted for several days and appear to be getting worse.
Your child has a weakened immune system or another medical condition that makes them more susceptible to complications.
If antibiotics are prescribed, what do I need to know?
For more severe or widespread ear infections, oral antibiotics may be prescribed.
Follow these steps to protect your child's health when taking antibiotics:
Make sure they finish all their medication. Skipping the last few doses of an antibiotic can allow the infection to return, which can ultimately make it even harder to get rid of.
Consider adding probiotics to protect your child's
gut microbiome from the possible effects of antibiotics. Here's
how probiotics work to keep your child's digestive and immune systems healthy.
Watch for
side effects. Around 1 in 5 children have nausea, diarrhea, stomach pain, rashes or allergic reactions when they take antibiotics. Talk to your pediatrician if you see these symptoms in your child. Make sure to tell your child's medical team if you know they have an allergy to a specific medication or they've had a negative reaction to antibiotics in the past.
My child has chronic ear infections. Will ear tubes help?
Certain children—those with severe recurring ear infections, trouble hearing and/or speech delay after multiple ear infections, multiple antibiotic allergies, and other complications from ear infections—may benefit from ear tubes. Surgically inserted through the eardrum, these small tubes make it easier for fluids to drain from the ear.
Pediatricians and other health experts may recommend tubes less often, however, since studies have shown that standard treatment (including careful use of antibiotics) works equally well.
If you're wondering about this treatment for your child, ask your pediatrician for more insights.
What else do I need to know about treating and preventing childhood ear infections?
Your child can't catch an ear infection from others. Ear infections aren't contagious—which means that as soon as they feel good enough, kids can return to child care or school while recovering from an ear infection. But keep in mind that many ear infections do start with colds, flu or RSV—which can result from viruses passed along by others. Hand washing, healthy eating and other steps that build immunity against infection will reduce your child's risks for chronic ear infections.
Breastfeeding protects your child from ear (and other) infections by strengthening their immune system from the very start. Learn more about breastfeeding and your child's long-term health
here.
Vaccinations help prevent ear infections. Following
vaccine guidelines can reduce your child's risks for conditions that can lead to ear infections, including pneumonia and meningitis. The flu vaccine can also help prevent childhood ear infections.
More questions? Talk with your pediatrician
Because ear infections are so common in kids, your child's doctor has extensive experience in diagnosing and treating them. When you're worried about possible signs of an infection or wondering how to care for your child, talk with your pediatrician.
More information
About Dr. Alter
 Noah E. Alter is a third-year medical student at the Kiran C. Patel College of Allopathic Medicine. His current research interests include cochlear Implantation, endocrine surgery and facial plastic and reconstructive surgery.
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About Dr. Ostrower
 Samuel T. Ostrower, MD, FAAP, FACS, is the Chief of Pediatric Otolaryngology—Head & Neck Surgery and Medical Director of the Cochlear Implant Center at Joe DiMaggio Children’s Hospital in Hollywood, Florida. He is a member of the American Academy of Pediatrics (AAP) Section on Otolaryngology—Head and Neck Surgery, and the Florida chapter of the AAP.
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