Ear Infection Questions
Is this your child's symptom?
- Your child was diagnosed with an ear infection
- Your child's ears were recently looked at by a doctor
- You are worried that the fever or ear pain is not getting better fast enough
- Your child is still taking an antibiotic for the ear infection
Symptoms of Ear Infections
- The main symptom is an earache.
- Younger children will cry, act fussy or have trouble sleeping because of pain.
- About 50% of children with an ear infection will have a fever.
- Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
Cause of Ear Infections
- A bacterial infection of the middle ear (the space behind the eardrum)
- Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
- Blockage results in middle ear fluid (called viral otitis).
- If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
- Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
- The onset of ear infections is often on day 3 of a cold.
- How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
When to Call for Ear Infection Questions
Call 911 Now
- Not moving or too weak to stand
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Stiff neck (can't touch chin to the chest)
- Walking is not steady
- Fever over 104° F (40° C)
- Ear pain is severe and not better 2 hours after taking ibuprofen
- Crying is bad and not better 2 hours after taking ibuprofen
- Pink or red swelling behind the ear
- Crooked smile (weakness of 1 side of the face)
- New vomiting
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Contact Doctor Within 24 Hours
- Taking antibiotic more than 48 hours and fever still there or comes back
- Taking antibiotic more than 3 days and ear pain not better
- Taking antibiotic more than 3 days and ear discharge still there or comes back
- You think your child needs to be seen, but the problem is not urgent
Contact Doctor During Office Hours
- You have other questions or concerns
Self Care at Home
- Ear infection on antibiotic with no other problems
- Normal hearing loss with an ear infection
- Prevention of ear infections
- Ear tube (ventilation tube) surgery questions
Treatment for an Ear Infection
- What You Should Know About Ear Infections:
- Ear infections are very common in young children.
- Most ear infections are not cured after the first dose of antibiotic.
- Often, children don't get better the first day.
- Most children get better slowly over 2 to 3 days.
- Note: For mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral.
- Here is some care advice that should help.
- Keep Giving the Antibiotic:
- The antibiotic will kill the bacteria that are causing the ear infection.
- Try not to forget any of the doses.
- Give the antibiotic until it is gone. Reason: To stop the ear infection from flaring up again.
- Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: Fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
- Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
- Cold Pack for Pain:
- Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
- Note: Some children prefer heat for 20 minutes.
- Caution: Heat or cold kept on too long could cause a burn or frostbite.
- Limits on Activity:
- Your child can go outside and does not need to cover the ears.
- Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum.
- Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse.
- Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier may help as well. Children over age 6 can chew gum.
- Return to School:
- Your child can go back to school when any fever is gone.
- Your child should feel well enough to join in normal activities.
- Ear infections cannot be spread to others.
- What to Expect:
- Once on antibiotics, your child will get better in 2 or 3 days.
- Make sure you give your child the antibiotic as directed.
- The fever should be gone by 2 days (48 hours).
- The ear pain should be better by 2 days. It should be gone by 3 days (72 hours).
- Ear Infection Discharge:
- If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes.
- The pus may be blood-tinged.
- Most often, this heals well after the ear infection is treated.
- Wipe the discharge away as you see it.
- Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
- Call Your Doctor If:
- Fever lasts more than 2 days on antibiotics
- Ear pain becomes severe or crying becomes nonstop
- Ear pain lasts more than 3 days on antibiotics
- Ear discharge is not better after 3 days on antibiotics
- You think your child needs to be seen
- Your child becomes worse
Treatment for Hearing Loss with an Ear Infection
- Brief Hearing Loss:
- During an ear infection, fluid builds up in the middle ear space.
- The fluid can cause a mild hearing loss for a short time.
- It will slowly get better and go away with the antibiotic.
- The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months.
- Permanent harm to the hearing is very rare.
- Talking With Your Child:
- Get close to your child and get eye contact.
- Speak in a louder voice than you usually use.
- Decrease any background noise from radio or TV while talking with your child.
- Call Your Doctor If:
- Hearing loss not better after the antibiotic is done.
Prevention of Recurrent Ear Infections
- What You Should Know:
- Some children have ear infections that keep coming back.
- If this is your child's case, here are some ways to prevent future ones.
- Avoid Tobacco Smoke:
- Contact with tobacco smoke can lead to ear infections.
- It also makes them harder to treat.
- No one should smoke around your child. This includes in your home, your car or at child care.
- Avoid Colds:
- Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children.
- Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care.
- Antibodies in breast milk lower the rate of ear infections.
- Breastfeed your baby during the first 6 to 12 months of life.
- Do Not Prop the Bottle:
- During feedings, hold your baby with the head higher than the stomach.
- Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear.
- Having babies hold their own bottle also causes milk to drain into the middle ear.
- Get All Suggested Vaccines:
- Vaccines protect your child from serious infections.
- The pneumococcal and flu shots also help to prevent some ear infections.
- Control Allergies:
- Allergies may lead to some ear infections.
- If your baby has a constant runny or blocked nose, suspect an allergy.
- If your child has other allergies like eczema, ask your child's doctor about this. The doctor can check for a milk protein or soy protein allergy.
- Check Any Snoring:
- Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth.
- Large adenoids can contribute to ear infections.
- Talk to your child's doctor about this.
Ear Tube Surgery Questions
- Ear Tubes:
- Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor.
- The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter the space.
- This lowers the risk of repeated ear infections and returns the hearing to normal.
- Ear Tubes - When Are They Needed?
- Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid.
- Also, the fluid has caused a hearing loss greater than 20 decibels.
- Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed.
- Ear infections that do not clear up after trying many antibiotics may need tubes.
- Prevention should be tried before turning to surgery.
- Talk to your child's doctor about when ear tubes are needed.
- What to Expect:
- In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax.
- If the tubes stay in over 2 years, talk with your child's doctor. The surgeon may need to take them out.
- Risks of Ear Tubes:
- After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn't heal. Both of these problems can cause a small hearing loss.
- Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when giving anesthesia to young children.
- Therefore, doctors suggest ear tubes only for children who really need them.
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 10/02/2022
Last Revised: 09/18/2022
Copyright 2000-2022. Schmitt Pediatric Guidelines LLC.