By KidsDirect Editorial Team
Earaches and Ear Infections
It’s the middle of the night, your baby is screaming, and tugging at one ear. Chances are good you’re looking at an ear infection. They’re one of the most common reasons kids see the doctor, especially between 6 months and 2 years. They’re also very treatable, and most clear up without lasting problems. Here’s how to spot one, ease the pain, and know when to call. This is about baby ear infections.
What an Ear Infection Is
Most earaches come from an infection of the middle ear, the small space behind the eardrum. It often starts after a cold. Swelling in the nose and throat can block the tiny tube that drains the ear, so fluid builds up and germs grow in it. Allergies can cause the same blockage. Babies and toddlers get more infections than older kids because their tubes are shorter and flatter, and they drain less easily.
Ear infections aren’t contagious. Your child can catch the cold that led to one, but the ear infection itself doesn’t spread from person to person. An baby ear infection can lead to a lot of pain.
Signs in Babies and Toddlers
Babies can’t say their ear hurts, so you’ll look for clues. Tugging or rubbing an ear is a classic one. Many babies also run a fever, cry more than usual, and seem fussier than normal. Lying down often makes the pain worse because of the pressure change, so some babies fight sleep or wake more at night. Pain can also flare when your baby sucks or swallows, which may mean a baby who starts a bottle or breast and then pulls away crying.
Older children can tell you. Some say their ear hurts, and some say it feels full or like they’re underwater. You might also notice trouble hearing, because fluid muffles sound. Our page on crying in babies covers other reasons a baby may be fussy.
When to Call the Doctor
Call right away if your baby is under three months old and has a fever of 100.4°F (38°C) or higher. For older children, the CDC says to contact a provider for a fever of 102.2°F or higher, fluid or pus draining from the ear, symptoms that keep getting worse, or symptoms that last more than two or three days. Also call if you notice hearing loss.
Get urgent care if your child has a stiff neck or very high fever, or looks very sick. The same goes for redness or swelling behind the ear, or severe pain that doesn’t ease about two hours after a pain reliever, according to Seattle Children’s.
How Doctors Treat Ear Infections
Here’s what surprises many parents. Antibiotics aren’t always the first step. Many mild infections clear up on their own, so for the right child your doctor may suggest watchful waiting for 48 to 72 hours while you manage pain at home. Some doctors give you a prescription to fill only if things don’t improve.
Whether to wait depends on age and how sick your child seems. Pediatric guidelines generally call for antibiotics right away for babies under 6 months, for babies 6 to 23 months with infections in both ears, and for any child with severe symptoms. Older toddlers and kids with a mild infection in one ear are more likely to be offered the wait and see approach. Your doctor will decide what fits your child.
If your child gets antibiotics, finish the full course even if they seem better after a day or two. Call your doctor if there’s no improvement after two to three days of treatment.
Easing the Pain at Home
Ear infections hurt, so don’t skip the pain relief. Acetaminophen is the usual choice for babies under 6 months, and the CDC says acetaminophen or ibuprofen can be used for older children. Your doctor will tell you the right dose based on your child’s weight. Don’t give aspirin to children. Offering extra fluids and rest helps too.
Lying flat can make the pain worse, so holding your baby upright for naps and feeds is often easier. If your baby has trouble sleeping, our page on sleeping habits has tips, though a baby with ear pain should always sleep on the back in a safe crib. Don’t put drops, oils, or cotton swabs in the ear unless your doctor says to.
If the Eardrum Breaks
Sometimes pressure builds up so much that the eardrum develops a small tear. You’ll see pus or blood tinged fluid draining from the ear. It looks scary, but it doesn’t mean the infection got worse, and the tear usually heals on its own in a few days. The pain often gets better right after it happens. Wipe away the drainage, don’t plug the ear with cotton, and let your doctor know.
Hearing After an Infection
Fluid can stay in the middle ear for weeks after the infection is gone, which may dull your child’s hearing for a while. Hearing usually returns to normal. If it doesn’t, or if the fluid hangs around for months, ask your doctor about a hearing test. Hearing matters for learning to talk, so don’t let it slide.
When Ear Infections Keep Coming Back
Some children seem to get one infection after another. If that’s your child, your doctor may refer you to an ear, nose, and throat specialist. Treatment may include small ear tubes, which let fluid drain and air flow in and can help prevent more infections. It’s a quick procedure, and many kids get the tubes done and go home the same day.
Lowering the Odds
You can’t prevent every infection, but a few habits help. Keep your child up to date on vaccines, including the pneumococcal shot and the yearly flu shot. Our page on influenza vaccines explains why the flu shot matters for little ones. Wash hands often, and keep your baby away from cigarette smoke. Breastfeeding also helps. If you’re bottle feeding, hold your baby at an angle instead of lying flat. Dry your child’s ears after swimming.
Worth knowing. Every child is different, and your pediatrician knows yours best. For more on everyday baby care, browse our BabiesDirect section.