Ear Infections in Children: What You Should Know

Am Fam Physician. 2007;76(11):1659-1660

See related article on otitis media.

What causes ear infections?

Ear infections often happen in children with a cold, sore throat, or allergies. These cause the nose and throat to swell and block the tube that drains fluid out of the middle ear (see drawing). Fluid backs up behind the eardrum, and germs spread to the middle ear. This can cause ear pain and fever. This type of ear infection is called otitis media (oh-TIE-tiss ME-dee-ah). Fluid can also collect behind the eardrum but not cause pain or fever. This is called otitis media with effusion (eff-YOO-shun).

Who gets ear infections?

Anyone can get an ear infection, but children get them more often than adults. Most children will have at least one ear infection before they turn three. Children who go to daycare, who use a pacifier, or who are around cigarette smoke are more likely to get ear infections.

How can I tell if my child has an ear infection?

Some symptoms of an ear infection include:

Fever
Earache
Pulling or rubbing the ear
Not eating as much as usual
Problems sleeping
Fluid coming out of one or both ears

How are ear infections treated?

Over-the-counter medicines such as acetaminophen (one brand: Tylenol) or ibuprofen (one brand: Motrin) can help with fever and pain. Do not give your child aspirin. Putting a warm cloth or hot water bottle on the area around the ear can also help with the pain. Eardrops made especially for earaches (one brand: Auralgan) can help your child feel better. Saline nose drops and a humidifier can help with nasal congestion. Cold medicines containing antihistamines or decongestants will not help your child get better faster and should not be used in children younger than six years.

Does my child need antibiotics?

Many ear infections will get better without antibiotics. If your child's ear infection is mild, your doctor might want you to wait a few days to see if the infection gets better on its own. If your child does not feel better after two or three days, your doctor will prescribe an antibiotic. Children six months or younger and children with very bad ear infections will be given antibiotics right away.

What can I expect?

Your child should start to feel better within a few days after visiting the doctor. If not, call your doctor. If he or she has already prescribed an antibiotic, your child might need a different medicine. The fluid behind the eardrum may not go away for several weeks.

Call your doctor right away if your child starts vomiting or gets a high fever, pain inside or behind the ear, or headaches.

How can I keep my child from getting another ear infection?

Try to keep your child away from the things he or she is allergic to. Keep your child away from people who are smoking. If you smoke, talk with your doctor about quitting. Don't put babies to bed with a bottle. Make sure your child's immunizations are up to date.