By Carrie Madormo, RN, MPH 

 Medically reviewed by John Carew, MD

An ear infection, also known as acute otitis media, is an infection that occurs in the space behind the eardrum. Ear infections are common in babies and toddlers. The National Institutes of Health estimates that five out of six children will experience at least one ear infection before their third birthday.1 

Your little one may develop an ear infection when a virus or bacteria infects and traps fluid behind the eardrum. This extra fluid causes pain and bulging of the eardrum. 

Common signs that your baby has an ear infection include crying, irritability, tugging at the ear, clumsiness, ear drainage, and fever.1 Your pediatrician will be able to diagnose the ear infection by looking in your child’s ear.

Many ear infections resolve on their own. When they don’t, treatment usually includes antibiotics and over-the-counter pain medications. Frequent ear infections may require the placement of ear tubes.2 

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Symptoms of Ear Infections in Babies

Ear infections are common in babies, and it is helpful to know the classic signs to watch out for:1

• Crying and irritability

• Tugging at the ear

• Clumsiness

• Trouble hearing

• Trouble sleeping

• Ear drainage

• Fever

It’s possible for your baby to experience temporary hearing loss with an ear infection. This occurs when the fluid behind the eardrum blocks sound transmission. When hearing is affected, you may notice a change in your baby’s speech as well. Fortunately, these changes are temporary and should resolve as the infection clears up.2

Babies who nurse are less likely to develop ear infections than those who don't, but that doesn't mean they don't get them.3 The signs of ear infection in a breastfed baby are the same as for all babies.

Treatments

Treatment for your child’s ear infection will depend on their age, size, and symptoms.

When Should You Call a Healthcare Provider?

If your child develops signs of an ear infection, call your healthcare provider. Seek emergency treatment if your child’s temperature goes above 104 F or if they develop neck stiffness (can't touch chin to chest), muscle weakness (crooked smile), new vomiting, or bleeding.4 

Under 6 Months

Babies under 6 months with an ear infection are usually prescribed antibiotics. Ear infection-causing bacteria trapped behind the eardrum can spread to other parts of the body, leading to severe infection. In young babies, complications from infection can be especially severe, and because young babies are not fully vaccinated, their risk of severe infection is even greater.5

6 Months-2 Years

For children between six months and two years of age, antibiotics may be prescribed for advanced infections, like when the eardrum ruptures. If the ear infection is not severe, the healthcare provider may recommend taking a "wait and watch" approach for two to three days to see if the infection gets better before prescribing antibiotics.5

2 Years and Up

To help manage pain and discomfort, the child can be given an over-the-counter medication, such as ibuprofen (Advil) or acetaminophen (Tylenol). If the child's symptoms do not get better within two to three days, antibiotics will be considered.5 Do not give your child aspirin, due to the risk of Reye's syndrome.

Sometimes, a child will develop repeated ear infections until they are 5 or 6 years old. In cases like this, a surgical procedure called a myringotomy and tympanostomy tube placement may be considered. A surgeon will insert small tubes into the child's eardrums to improve airflow and prevent fluid buildup.5 The tubes usually fall out on their own as the eardrum heals.6

If your pediatrician recommends antibiotics, give them to your child exactly as prescribed.7 The usual course of antibiotics is 10 days, and it’s important to finish the prescription. Your child will most likely start feeling better within a few days.

Prevention

Ear infections cannot always be prevented, but it’s possible to lower your baby’s risk. The following tips will help:

• Avoid secondhand smoke: A child exposed to cigarette smoke has a higher risk of ear infections.2 Ensure your baby lives in a smoke-free home.

• Stay current with vaccines: Be sure to stay current with your child’s immunization schedule. If your child is old enough for the flu shot, it can help prevent upper respiratory infections that may lead to ear infections. 

• Prevent colds and allergy symptoms: Both of these conditions can lead to swelling and fluid buildup in the ears. Ask your pediatrician about options for treating your little one’s allergies. Take care to wash your hands frequently and avoid letting your child share cups or eating utensils with anyone else. 

• Use proper feeding techniques: If you are bottle-feeding, always hold your baby at an upright angle during bottle time. This means that their head should always be above their stomach. This helps prevent fluid from backing up into their ears.

• Breastfeed: Breastfeeding is a great way to prevent ear infections because the antibodies your baby receives will help fend off infections.8

Summary

If your baby is showing signs of an ear infection, such as fussiness, tugging at their ears, or ear drainage, see your pediatrician for a diagnosis. Your healthcare provider will be able to examine your baby’s ears and prescribe an antibiotic if needed.

It’s helpful to remember that ear infections are incredibly common in babies and young children, and many resolve on their own. Keep your child comfortable at home with over-the-counter pain medications as needed, and always call your healthcare provider if you have questions. 

Sources

National Institute on Deafness and Other Communication Disorders. Ear infections in children, babies & toddlers.

American Academy of Pediatrics. Ear infection symptoms.

Frank NM, Lynch KF, Uusitalo U, Yang J, Lönnrot M, Virtanen SM, Hyöty H, Norris JM; TEDDY Study Group. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr. 2019 Sep 18;19(1):339. doi: 10.1186/s12887-019-1693-2

Seattle Children's. Ear infection questions.

Johns Hopkins Medicine. Ear infections in babies and toddlers.

Nemours KidsHealth. Ear tube surgery.

Siddiq S, Grainger J. The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013. Arch Dis Child Educ Pract Ed. 2015;100(4):193-197. doi:10.1136/archdischild-2013-305550

Li R, Dee D, Li CM, Hoffman H, Grummer-Strawn L. Breastfeeding and risk of infections at 6 years. Pediatrics. 2014 Sep;134(1):13-20. doi:10.1542/peds.2014-0646D

By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.