Few things are harder for a parent than seeing their little one in pain and knowing they don’t have the words yet to tell them exactly where it hurts. Ear infections are incredibly common. Most children will have at least one by the time they are 3 years old.
If your child is fussy, pulling at their ears, or having trouble sleeping, an ear infection might be the cause. Here’s a guide to help you understand what’s happening and how to get your child back to their happy, playful self.
An ear infection (which your doctor might call “otitis media”) usually happens when fluid gets trapped behind the eardrum and in the middle ear. When this fluid stays in the middle ear, it can become a breeding ground for bacteria or viruses. This can often happen during a cold or a period of allergies.
The reason this happens so much more often in little ones is due to their anatomy. Children have smaller, more horizontal “eustachian tubes”—the tiny tunnels that connect the ear to the throat. Because these tubes aren’t as tilted as an adult’s, it’s much easier for fluid and germs to get stuck in there instead of draining away naturally.
Since babies and young toddlers can’t tell us where it hurts, they often use their bodies to communicate. You might notice your child tugging or pulling at their ears more than usual. While some babies do this just for comfort, a child with an infection is often doing it because of the pressure building up inside.
This pressure is also why you might see extra fussiness or crying when they lie down. That position can make the ear ache more, leading to trouble sleeping and frequent wake-ups.
You might also notice a fever ranging from 100°F to 104°F, or even a bit of clumsiness. Because the ear controls balance, that extra fluid can make your little one a bit wobbly on their feet.
In some cases, you might see fluid draining from the ear that looks yellow, white, or even slightly bloody. If you see this, or if your child stops responding to quiet sounds, it’s a good time to reach out to your pediatrician.
Treatment isn't a one-size-fits-all approach. Doctors look at your child's age and how long they've been feeling poorly before deciding on the best path forward.
For babies under 6 months: Because their immune systems are still getting stronger, most doctors will prescribe antibiotics right away to clear the infection quickly.
For toddlers 6 months to 2 years: If the symptoms are mild and there isn't a high fever, your doctor might suggest a wait-and-see approach for about 48 hours. However, if the pain is severe or the fever is high, they will likely prescribe antibiotics to help your child feel better.
For children over 2 years: At this age, many ear infections clear up on their own. Doctors often recommend observation first. If the ear still hurts or the fever persists after two days, then antibiotics are usually the next step.
If your child is prescribed medicine, be sure to follow your doctor’s specific directions. It is typically important to finish the full course of any prescription to ensure the infection is completely cleared, even if your child seems to feel better after a day or two.
While the medicine (or time) does its work, you can help soothe the ache. Holding a warm, damp washcloth gently against the outside of the affected ear can provide some relief from the pressure.
You can also talk to your pediatrician about using infant acetaminophen or ibuprofen to help with the pain and fever. Sometimes, simply keeping your child upright while they cuddle or play can help reduce the throbbing sensation in their ear.
While we can’t stop every earache, these daily habits can lower the chances of an infection:
Keep up with routine vaccines: Shots like the flu vaccine and the pneumococcal vaccine protect against the very illnesses that often lead to ear infections.
Feed your baby upright: If you are bottle-feeding, try to keep your baby’s head higher than their tummy. This prevents milk from accidentally flowing back into those tiny ear tubes.
Breastfeed if you can: Breast milk contains antibodies that naturally help your baby fight off infections.
Avoid secondhand smoke: Smoke can irritate the eustachian tubes and make it much harder for fluid to drain.
Wash hands often: Since ear infections often follow a cold, keeping hands clean is one of their best defenses.
Trust your “parent gut.” If your child has a high fever, seems unusually sleepy or less alert, or if the pain is getting worse instead of better, reach out to your pediatrician. They are there to support you and make sure your little one gets back to their happy, healthy self as soon as possible.
