Ear Infections in Children: Symptoms, Treatment, and When to Ask About Tubes

Why Ear Infections Are So Common in Children

Ear infections are the number one reason parents bring their children to the pediatrician — and for good reason. By age three, nearly 80% of children will have had at least one ear infection. At Hummingbird Pediatrics in Robbinsville, NJ, ear infections are among the most frequent diagnoses we make, particularly in the fall and winter months.

Children are more prone to ear infections than adults because of anatomy: their Eustachian tubes — the small channels connecting the middle ear to the back of the throat — are shorter, more horizontal, and floppier. This makes it harder for fluid to drain and easier for bacteria or viruses to travel from the throat to the middle ear.

Middle Ear vs. Outer Ear Infections

Not all ear infections are the same. There are two common types:

• Otitis media (middle ear infection): The most common type in children. Fluid and infection build up behind the eardrum in the middle ear. This is what most parents mean when they say "ear infection."
• Otitis externa (swimmer's ear): An infection of the outer ear canal, usually caused by water trapped in the ear. More common in older children and summer swimmers.

This article focuses primarily on otitis media, since it's by far the most common in young children.

Recognizing Ear Infection Symptoms by Age

Infants (Under 12 Months)

Babies can't tell you their ear hurts, so watch for these clues:

• Tugging, pulling, or batting at one or both ears
• Unusual fussiness or crying, especially when lying down
• Difficulty sleeping
• Fever (though not always present)
• Fluid draining from the ear
• Trouble hearing or not responding to sounds

Toddlers and Preschoolers

• Complaints of ear pain or saying the ear "hurts" or feels "funny"
• Increased fussiness, especially at bedtime (lying flat increases pressure)
• Fever
• Trouble hearing the TV or asking you to repeat yourself
• Balance problems or unusual clumsiness

School-Age Children

• Direct complaint of ear pain — usually one-sided
• Muffled hearing or a "full" feeling in the ear
• Ringing in the ear
• Fever

How Pediatricians Diagnose Ear Infections

Your pediatrician will use a tool called an otoscope to look inside your child's ear canal and examine the eardrum. In an ear infection, the eardrum typically appears red, bulging, and may have fluid visible behind it. Some offices also use a pneumatic otoscope — which gently puffs air — to check whether the eardrum moves normally, which helps identify fluid even without active infection.

There is no at-home test for ear infections. If you suspect your child has one, an in-person exam is needed for an accurate diagnosis.

Treatment: When Are Antibiotics Needed?

Not every ear infection requires antibiotics. Current guidelines from the American Academy of Pediatrics recommend different approaches based on age and severity:

• Children under 6 months: Antibiotics are always recommended.
• Children 6–23 months with severe symptoms or both ears infected: Antibiotics are recommended.
• Children 6–23 months with mild symptoms in one ear: Your pediatrician may recommend a "watchful waiting" approach for 48–72 hours before starting antibiotics.
• Children 2 years and older with mild symptoms: Watchful waiting is often appropriate. Many ear infections in this age group resolve without antibiotics.

When antibiotics are prescribed, amoxicillin is usually the first choice. It's important to complete the full course even if your child feels better sooner.

Home Comfort Measures

While waiting for antibiotics to work — or during watchful waiting — these steps can ease your child's pain:

• Give an age-appropriate pain reliever to reduce pain and fever — ask your pediatrician which product and dose is right for your child's weight
• Apply a warm (not hot) compress or heating pad on low over the ear for 20 minutes
• Elevate the head slightly during sleep to reduce pressure
• Encourage extra fluids
• Keep follow-up appointments — your pediatrician will want to recheck the ear

Recurrent Ear Infections and Ear Tubes

Some children are prone to repeated ear infections. Recurrent otitis media is generally defined as three or more infections in six months, or four or more in a year. If your child falls into this category, your pediatrician may refer you to a pediatric ear, nose, and throat (ENT) specialist to discuss ear tubes.

Ear tubes (tympanostomy tubes) are tiny cylinders surgically placed through the eardrum in a brief outpatient procedure. They ventilate the middle ear, allow fluid to drain, and dramatically reduce the frequency of infections. For children with chronic fluid in the ear affecting hearing, tubes can also lead to meaningful improvements in speech and language development.

Ear tubes are not right for every child — your pediatrician and ENT will help you weigh the benefits and risks based on your child's specific history.

Preventing Ear Infections

• Breastfeed if possible: Breast milk provides immune protection that reduces ear infection risk
• Bottle positioning: Never prop a bottle — feed infants in an upright position to prevent formula from pooling near the Eustachian tube opening
• Avoid secondhand smoke: Smoke exposure significantly increases ear infection risk
• Stay up to date on vaccines: The pneumococcal (PCV15) and influenza vaccines both reduce ear infection risk
• Limit pacifier use: After 6 months, try to limit pacifier use to sleep times — constant sucking changes pressure in the Eustachian tube
• Wash hands frequently: Most ear infections follow a cold, so good hand hygiene helps

A Note on Hearing After Ear Infections

Temporary, mild hearing loss is common during and shortly after an ear infection due to fluid in the middle ear. This usually resolves once the infection clears. However, if you notice your child still seems to have trouble hearing several weeks after an ear infection, let your pediatrician know — persistent fluid (called otitis media with effusion or "glue ear") can affect hearing and speech development.

At Hummingbird Pediatrics in Robbinsville, NJ, our board-certified pediatricians are experienced in diagnosing and managing ear infections in children of all ages. If you suspect your child has an ear infection or your child seems to get them frequently, call us at (609) 808-3123 or book an appointment online — we're here to help.