Ear Infection in Babies: Signs, Treatment and When to See a Doctor

01Why

Why babies get ear infections

Babies and toddlers have short, narrow, more horizontal Eustachian tubes, the channels that connect the middle ear to the back of the nose. During colds, these tubes become swollen and blocked, so fluid collects behind the eardrum, where bacteria or viruses can multiply. Babies also have frequent colds, especially in nursery, and their immune systems are still developing. Ear infections are most common between six months and two years of age.

02Signs

Signs of an ear infection in babies

• Crying and irritability, often worse when lying down.
• Pulling, rubbing or tugging at an ear (though babies also do this when teething or tired).
• Trouble sleeping or waking more often at night.
• Fever.
• Poor feeding, as sucking and swallowing can hurt.
• Fluid, pus or blood draining from the ear (a sign the eardrum may have burst, which relieves pain).
• Not responding to quiet sounds or seeming off-balance.
• Cold symptoms such as a runny nose and cough, often in the days before.

03Know

How to know if your baby has an ear infection

No single sign is reliable at home. Ear pulling alone is a poor indicator. The combination of a recent cold, new fussiness, worse crying when lying down, poor sleep and fever makes an ear infection more likely. Only a doctor looking at the eardrum with an otoscope can confirm it: a bulging, red, cloudy eardrum indicates acute otitis media. Fluid without signs of infection (otitis media with effusion, or glue ear) is different and usually does not need antibiotics; see fluid in the ear.

04Pain

Pain relief at home

• Give paracetamol (acetaminophen) or ibuprofen at the correct dose for your baby’s age and weight; ibuprofen is suitable from three months and over 5 kg in many countries; check the label or ask a pharmacist.
• Offer extra feeds and fluids.
• Hold your baby more upright, which can ease pressure.
• A warm (not hot) cloth held against the ear may soothe older babies.
• Do not put anything inside the ear, including cotton buds, oils or drops, unless prescribed.
• Avoid smoke exposure.

05Antibiotics

When are antibiotics needed?

The American Academy of Pediatrics guideline recommends antibiotics for babies under six months with a confirmed ear infection, for children of any age with severe symptoms (high fever of 39°C or more, severe ear pain or pain lasting more than 48 hours), and for children under two with infections in both ears. For older children with mild symptoms in one ear, doctors may offer watchful waiting for 48 to 72 hours, starting antibiotics if symptoms do not improve. Amoxicillin is usually the first choice. Always complete the course as prescribed.

06Burst

If the eardrum bursts

Sometimes pressure from an infection makes a small hole in the eardrum, and fluid, pus or blood drains out. Pain often eases quickly. Most perforations heal on their own within a few weeks once the infection clears. Keep the ear dry, clean only the outside with a damp cloth, and see a doctor, who may prescribe antibiotics. Our guide to a perforated eardrum explains healing.

07Recurrent

Repeated ear infections and grommets

Some children have repeated ear infections, often defined as three or more in six months or four or more in a year. Others have fluid that persists for months and affects hearing, which can slow speech development. An ENT specialist may recommend a hearing test and, in some cases, grommets (ear tubes): tiny tubes placed in the eardrum during a short operation to let air in and fluid out. Children who are late to talk should have their hearing checked; see late talker.

08Prevent

Reducing the risk of ear infections

• Breastfeed if possible, especially in the first six months.
• Avoid smoking around your baby and in the home or car.
• Feed bottle-fed babies upright rather than lying flat.
• Keep vaccinations up to date, including pneumococcal and flu vaccines.
• Wash hands often to reduce colds.
• Limit dummy (pacifier) use after six months, as it is linked with more ear infections.

09Cases

Three common situations

• Ten-month-old with a cold, fever and crying at night: give pain relief and see a doctor to check the ears.
• Toddler who tugs at ears while teething but is otherwise well: teething is likely; watch for fever or unusual crying.
• Six-week-old with a temperature of 38°C: seek urgent medical care regardless of the cause.

10Summary

Key points to remember

• Ear infections are common in babies, often after a cold.
• Fussiness, poor sleep, fever and ear pulling are typical signs.
• Pain relief is the first treatment; antibiotics are needed in some cases.
• Babies under three months with fever need urgent assessment.