Ear infections are one of the most common reasons parents bring young children to a pediatrician — most children have at least one before their third birthday. Most are manageable, but knowing what to watch for helps you know when a visit is genuinely needed.
What an ear infection actually is
Acute otitis media is an infection of the middle ear, usually following a cold, where fluid builds up behind the eardrum and becomes infected — this is what's usually meant by "ear infection." A related but different situation is otitis media with effusion: fluid remains behind the eardrum after an infection clears, without active infection. This fluid can affect hearing temporarily and doesn't need antibiotics, but it's worth having checked if it persists.
Why young children get them so often
Children have shorter, more horizontal eustachian tubes (the passage connecting the middle ear to the back of the throat) than adults, which makes it easier for fluid and germs from a cold to reach the middle ear and get trapped there. This is why ear infections so often follow, or occur alongside, an ordinary viral cold — see Recurrent Cough and Cold in Children for more on why colds are so frequent at this age.
Symptoms — and why babies mostly just seem unsettled
Older children can usually tell you their ear hurts. Infants and toddlers often can't, so the signs are less direct:
- Pain, often worse when lying down (which can mean worse sleep at night)
- Fussiness or irritability that's hard to settle
- Poor feeding, since sucking and swallowing can increase ear pressure
- Fever
- Pulling or tugging at the ear — though this alone isn't reliable, since babies also do this out of habit or self-soothing, not just pain
- Fluid draining from the ear
- Reduced response to sound
Do all ear infections need antibiotics?
Not always. This is genuinely a judgment call your pediatrician makes based on several things together, not a single cutoff:
- Age — younger children, especially under 2, are somewhat more likely to be treated, but age alone doesn't decide it
- Severity — significant pain, high fever, or a child who looks generally unwell points toward antibiotics
- One ear or both — infection in both ears, especially in a younger child, is more often treated than a milder infection in one ear
- How long symptoms have lasted, and whether they're improving or worsening
- Whether fluid is actively draining from the ear
- The child's overall clinical picture, including any conditions affecting their immune system
For a child with a mild, uncomplicated infection in one ear who is otherwise well, a short period of watchful waiting — typically 48–72 hours, with pain relief — is a reasonable option when follow-up is available to check the child again if they don't improve. This approach reduces unnecessary antibiotic use without worsening outcomes for most children who are appropriate candidates for it. It isn't the right approach for every child, which is exactly why this is a conversation with your pediatrician rather than a fixed rule.
Never use leftover antibiotics
If your child has antibiotics left over from a previous illness, don't give them for a new episode without checking with your doctor first. The right antibiotic, dose, and duration depend on your child's current weight, age, and situation — an old prescription may be wrong or unnecessary, and using it can mask what's going on or contribute to antibiotic resistance.
Managing pain and fever at home
- Age-appropriate pain and fever relief (such as paracetamol or ibuprofen) can be used as advised by your pediatrician for your child's weight and age
- Never give aspirin to a child for fever or pain, because of the risk of a serious condition called Reye's syndrome
- A warm compress against the outer ear can be soothing
- Avoid putting any oil, drops, or home remedies into the ear without your doctor's advice — this can be harmful if the eardrum has a perforation, which isn't something you can check for at home
There's no good evidence that feeding position or cold foods/drinks cause ear infections — the real driver is the viral infection and eustachian tube anatomy described above. For general guidance on evaluating fever itself, see our Fever in Children article.
When to seek prompt or urgent care
See your pediatrician promptly for typical ear infection symptoms, and seek care urgently if you notice:
- Severe ear pain, or a baby who is inconsolable
- High fever, especially in a young infant
- Pus or fluid draining from the ear
- Swelling, redness, or tenderness behind the ear (this can suggest the infection has spread and needs prompt assessment)
- Any new hearing difficulty
- A very young infant (under 3 months) with fever or ear symptoms
Recurrent ear infections
Some children get several ear infections over a short period. If this happens, your pediatrician may suggest a hearing check and, in some cases, referral to an ENT specialist to discuss ear tubes (small tubes placed in the eardrum to aid drainage) — though standard management works about as well as tubes for many children, so this is decided individually.
Prevention
- Breastfeeding, where possible, is associated with fewer ear infections
- Staying up to date with routine vaccinations, including those that protect against pneumococcus and influenza, reduces risk
- Regular handwashing reduces the colds that often lead to ear infections
- Avoiding exposure to cigarette smoke
See our Cough, Cold and Respiratory Problems service page for more on how related symptoms are assessed at this clinic.
Frequently asked questions
My baby keeps tugging their ear but seems otherwise fine — is it an infection? Not necessarily. Ear-tugging alone, without fever, fussiness, or other symptoms, is often just habit or self-soothing. It's still reasonable to mention it at your next visit if it continues.
Will untreated fluid behind the eardrum affect my child's hearing long-term? Usually not, if it's monitored. Fluid behind the eardrum often clears within a few weeks, but in some children it can persist for longer. Fluid that lingers and is affecting hearing or speech development is worth a follow-up check with your pediatrician rather than assuming it will resolve on its own.
Further reading
General, current guidance for educational purposes — not individualized medical advice. Always confirm specific care and treatment decisions for your child with your own pediatrician.