Ear Infections in Children

Ear infections are very common in small children. Most cases of ear infections are not serious, but they can be very painful.

At Banner Children’s, we’re here to help. Below, we share all you need to know about ear infections and treatments.

What is an ear infection?

An ear infection happens when fluid containing bacteria or viruses gets trapped in the ear, causing an infection.

Ear infections are common in babies and young children. Most children will have an ear infection before age 3.   

What are the main types of ear infections?

The most common type of ear infection in children is acute middle ear infection (otitis media).

When an ear is infected, the eustachian tube (the narrow tunnel that connects the middle ear to the back of the throat) becomes blocked. When this happens, fluid does not drain away from the middle ear as it usually does. This may cause an infection.

Children can also develop ear infections in the outer ear and ear canal (otitis externa). Otitis externa is also known as swimmer’s ear because bacteria can grow in the water left in the ear after swimming or bathing.

What causes ear infections?

An ear infection in children usually follows a cold, sore throat, sinus infection or allergies.

Babies and younger children get more ear infections than older children and adults because their eustachian tubes and immune systems are still growing.

Young children have short and narrow eustachian tubes, making it more likely for fluid to get stuck. As children get older these tubes grow longer and have a steeper angle, so they drain better, making ear infections less likely to happen.

Several other things can also increase a child’s risk for ear infections:

• Family history: If ear infections run in your family, your child is more at risk.
• Exposure to germs: Children in crowded places (like daycare centers) are at higher risk because they are around more germs.
• Bottle-feeding: Feeding a baby lying down can lead to infections.
• Secondhand and thirdhand smoke: Exposure to smoke increases the risk.

Are ear infections contagious?

Ear infections are not contagious, but the bacteria or virus that caused the infection can be passed to other people. Most ear infections happen after a child already has a cold or upper respiratory infection.

What are the symptoms of an ear infection in children?

Most older children can tell you their ear hurts, but babies, toddlers and non-verbal children don’t have the language skills to tell you their ear hurts.

Here are some tell-tale signs your child has an ear infection:

• Mild fever: A fever means the body is fighting off an infection.
• Fussy: Due to pain and pressure, your child may cry and be harder to soothe.
• Trouble sleeping: Your child may have difficulty falling asleep and staying asleep.
• Ear tugging: Your child may pull or hit on their ear.
• Difficulty hearing: Your child might temporarily lose hearing or not respond to sounds.
• Loss of appetite: Infections can make chewing, sucking and swallowing painful because of pressure changes in the ear.
• Fluid drainage: Sometimes, pus or fluid might drain from the ear.

How is an ear infection diagnosed in children?

If you suspect your child has an ear infection, it’s important to have them checked by their health care provider.

The provider will do a physical exam and look inside their ear with a small lighted instrument called an otoscope. If the ear is infected, they will give you a treatment plan.

How are ear infections treated?

Treatment may depend on many factors, including your child’s age, how painful it is and if the fluid stays in the middle ear for a long time.

Watchful waiting

Because many children with ear infections get better without treatment, your provider may not immediately recommend antibiotics.

This “wait and see” option lowers the use of unnecessary antibiotics and their side effects. Also, overuse of antibiotics can lead to antibiotic-resistant bacteria, making it much harder for everyone to treat infections.

Treatment usually begins with the following:

• Managing pain with ear drops and over-the-counter pain relievers such as children’s strength ibuprofen and acetaminophen. Your provider can tell you the correct dose for your child.
• Keeping an eye on the infection to see if it gets better on its own. 

Medication

If your child has a moderate to severe infection, or if symptoms don’t improve or get worse, your child’s health care provider may prescribe antibiotics (such as amoxicillin) to treat the infection.

Most children take an antibiotic for five to 10 days, and most feel better after a day or two. Even if your child is feeling better, though, they must take the entire prescription. The infection can return if your child doesn’t take all of the medicine.

Ear tubes (tympanostomy tubes)

Your child may need ear tubes if they have frequent ear infections or trouble hearing.

Glue ear, or otitis media with effusion, is a chronic (ongoing) condition where fluid builds up in the middle ear and doesn’t go away. It might not cause pain, but it can make it hard for your child to hear.

An ear, nose and throat specialist (ENT) will insert a small tube (grommet) into the eardrum. The tube helps keep air pressure normal on both sides of the eardrum and helps fluid drain. Your child will be able to go home after the short procedure.

The tubes usually stay in place for 12 to 18 months. They may fall out on their own or the ENT specialist may need to remove them. Once the tubes are gone, the holes will heal and close.

When should I seek medical attention?

Children with the following symptoms should be seen by a health care provider immediately (within hours):

• Fever: 100.4 (38°C) or higher for infants 2 months and younger
• Headache with stiff neck
• Seizures
• Not waking up or not acting normally

Call or see your child’s health care provider if the following symptoms occur:

• Fever: Over 104°F (40°C) for children older than 2 months
• Fever that lasts for more than three days
• Hearing loss
• Persistent vomiting

What can I do to prevent ear infections?

Here are some ways you may be able to lower the risk of ear infections:

• Practice good hygiene: Teach your child how to wash their hands properly and how to cover their mouth and nose when they cough or sneeze.
• Upright feeding: Feed your baby in an upright position.
• Breastfeeding: Antibodies in breast milk fight viruses and bacteria that cause infections.
• Immunizations: Keep your child’s vaccinations up to date. Several recommended childhood vaccines prevent viruses and bacteria that cause ear infections.
• Avoid smoke: Keep your child away from tobacco and fire smoke as much as possible.

Our expert specialists

Banner Children’s caring staff is here to help treat, diagnose and guide you through every phase of your child’s life.

Most ear infections get better quickly and are not serious. If you want to know more about medical care, schedule an appointment with one of our pediatric specialists.