Signs Your Baby Has an Ear Infection

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. 

Your little one may develop an ear infection when a virus or bacteria infect and trap 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, difficulty feeding, ear drainage, and fever. 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. 

Signs of an Ear Infection

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

• Crying and irritability
• Tugging at the ear
• Difficulty feeding
• Trouble sleeping
• Ear drainage
• Fever

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. The signs of ear infection in a breastfed baby are the same as for all babies.

Crying and Irritability

Your baby’s ear is most likely painful, so expect crying and irritability. You may notice more crying when your baby lies down. This is because the ear pressure increases with lying down, leading to an increase in pain and discomfort during an ear infection.

Tugging at the Ear

Because your baby is too young to tell you that their ear hurts, look for signs such as tugging on the affected ear. 

Difficulty Feeding

The act of sucking and swallowing causes changes in ear pressure and is usually uncomfortable during an ear infection. You may notice that your baby is hungry and seems eager to eat, but stops right away.

Trouble Sleeping

Expect a restless night or two when your baby has an ear infection. Because lying down is painful, your little one will probably wake throughout the night. 

Ear Drainage

It’s possible for your baby to develop ear drainage with an ear infection. The drainage will appear different than normal ear wax, which is orange-yellow or reddish-brown. Infected drainage may appear white, green, yellow, or blood-tinged and have a foul odor. 

Fever

It’s estimated that about 50% of babies and children will develop a fever with an ear infection. 

Causes

An ear infection is caused by bacteria or a virus that infects and traps fluid in the middle ear. The infection usually starts out as a cold or upper respiratory infection. It can then spread to the middle ear by the eustachian tube. This tube connects the middle ear to the back of the throat; there is one in each ear. 

When a virus or type of bacteria travels through the eustachian tube, it can block the tube, causing fluid to build up in the middle ear.

Babies and young children are more likely to experience ear infections because their eustachian tubes are shorter and more horizontal than those of adults. This makes the tubes more likely to become blocked and stop draining properly.

Infants’ and young children’s immune systems are still developing, so they are generally not as effective as those of adults. 

Risk Factors

Other than a cold, ear infections are the most common childhood illness. Risk factors include:

• Age: Babies and young children are most at risk for ear infections. Ear infections occur most often in children aged 3 months to 3 years, and are common in children up to age 8. 
• Illness: Having a cold or upper respiratory virus puts you at a higher risk of developing an ear infection.
• Allergies: When your child has seasonal allergies, their nasal passages can become swollen. This can cause swollen adenoids, which can lead to a blocked eustachian tube in the ear. Because this tube usually drains liquid from the inner ear, a blockage can cause liquid to build up and become infected. 
• Secondhand smoke: Secondhand smoke in the household can increase the likelihood of a middle ear infection.
• Ethnicity: People of Hispanic or Native American descent are more likely to experience ear infections.
• Family history: Your risk for experiencing an ear infection goes up if other members of your family have frequent ear infections.

Diagnosis

Your pediatrician will be able to diagnose your baby’s ear infection with a physical exam. They will examine your baby’s ears to look for a red, inflamed eardrum. The fluid that collected behind the eardrum causes it to appear swollen. Your pediatrician cannot diagnose an ear infection over the phone or via a telehealth visit. 

Treatment

Treatment for your child’s ear infection will depend on their age, size, and symptoms. It is not uncommon for pediatricians to take a wait-and-see approach with mild ear infections rather than prescribing antibiotics right away.

Antibiotics

The American Academy of Pediatrics recommends that all children with severe symptoms or a fever of 102.2 or above receive antibiotics right away. If your child’s symptoms are mild or they don’t have a fever, your pediatrician may recommend waiting a few days before starting antibiotics. 

If your pediatrician recommends antibiotics, give them to your child exactly as prescribed. 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.

It may be tempting to stop the antibiotic once your child seems back to normal, but stopping it early can lead to a more severe infection and antibiotic resistance.

If your child is having trouble tolerating the antibiotic, call your pediatrician. If your child’s ear infection is severe enough that their eardrum ruptures, they will require antibiotic ear drops as well. 

Other Medications

Your pediatrician will most likely recommend an over-the-counter pain medication such as Tylenol (acetaminophen) or Motrin (ibuprofen) to keep your child more comfortable. Give these medications according to the package instructions, and never give your baby aspirin.

If the pain medication is helping, be sure to schedule a dose at bedtime, as this is usually the time of day when your child will be in more pain from lying down. 

Prognosis

Most ear infections in babies either clear up on their own or with antibiotics. Ear infections are common in little ones. Most children who receive an antibiotic will start feeling better in two or three days. 

Rarely, an untreated ear infection can lead to serious complications. When an ear infection worsens and is not treated, your baby is at risk of temporary hearing loss, speech delay, a ruptured eardrum, and infection spread. 

Prevention

Ear infections cannot always be prevented, but it’s possible to lower your baby’s risk. Start by ensuring that your baby lives in a smoke-free home. Being exposed to cigarette smoke puts infants at a higher risk of experiencing ear infections.

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

Prevent allergy and cold symptoms as best you can, as both of these conditions can lead to swelling and fluid backing up into the ears. Ask your pediatrician about options for treating your little one’s allergies. To prevent catching colds and upper respiratory viruses, wash your hands frequently and avoid letting your child share cups or eating utensils with anyone else. 

Feeding techniques can also help prevent ear infections in your baby. 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.

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

A Word From Verywell

Seeing your child in pain is hard for all parents, and it can be difficult to know what to do. If your baby is showing signs of an ear infection, see your pediatrician for 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.