Ear Infections in Children: When to Worry and When to Wait
Ear Infections in Children: When to Worry and When to Wait
Ear infections are one of the most common reasons parents bring their children to the pediatrician, with most children experiencing at least one ear infection by age 3. Understanding when to seek treatment and when to take a watchful waiting approach can help your child feel better faster and avoid unnecessary antibiotic use.
What Causes Ear Infections?
An ear infection, medically known as acute otitis media, occurs when bacteria or viruses infect the middle ear, the small space behind the eardrum. Ear infections often develop as a complication of a cold, flu, or other respiratory infection. When your child has a respiratory illness, the Eustachian tubes can become swollen and blocked, preventing proper drainage and allowing fluid to accumulate and become infected.
Young children are especially prone to ear infections because their Eustachian tubes are shorter, narrower, and more horizontal than those of adults, making drainage more difficult.
Factors that increase risk include: age between 6 months and 2 years, attending daycare, bottle-feeding while lying down, exposure to secondhand smoke, pacifier use after 6 months, recent cold, family history of ear infections, and allergies causing nasal congestion.
Recognizing the Symptoms
In babies and toddlers, watch for: tugging or pulling at ears, increased crying or fussiness (especially when lying down), difficulty sleeping, fever between 100°F and 104°F, fluid draining from the ear, difficulty hearing, loss of appetite, and loss of balance.
Older children may complain of ear pain, pressure or fullness in the ear, difficulty hearing, headache, fever, trouble sleeping, or balance problems.
When to Call Your Pediatrician
Parents in Princeton and Hamilton should contact our office if your child has: fever of 100.4°F or higher in infants younger than 3 months, fever above 102.2°F at any age, severe ear pain that doesn't improve with pain medication, symptoms lasting more than 2-3 days without improvement, fluid draining from the ear, or frequent ear infections.
Seek immediate medical care if your child has a stiff neck with ear pain and fever, severe headache with vomiting, extreme drowsiness, or swelling behind the ear.
Treatment Options
Treatment depends on your child's age, severity of symptoms, and whether one or both ears are infected. Many ear infections resolve on their own within 2 to 3 days without antibiotics. We may recommend watchful waiting for children over 2 years with mild symptoms in one ear.
Antibiotics are typically recommended when your child is younger than 6 months, symptoms are severe, both ears are infected, fluid is draining from the ear, or symptoms don't improve after 2-3 days of observation. The most common antibiotic prescribed is amoxicillin.
Pain relief is key: give age-appropriate doses of acetaminophen or ibuprofen, apply a warm compress over the affected ear, keep your child upright, and encourage fluids. Never put anything into your child's ear canal without consulting us first.
Prevention Tips
Keep vaccinations up to date, including the pneumococcal conjugate vaccine (PCV) and flu vaccine. Breastfeed if possible, avoid secondhand smoke, practice good hand hygiene, limit pacifier use after 6 months, avoid prolonged bottle use when lying down, and treat allergies to prevent congestion.
When Ear Tubes Might Be Needed
Children with frequent ear infections may benefit from ear tubes. We may refer your child to an ENT specialist if they have three or more ear infections in 6 months, four or more in a year, persistent fluid for more than 3 months, or hearing loss related to chronic ear infections.
If you have concerns about your child's ear pain or hearing, our practice serving families in Robbinsville, Bordentown, and East Windsor is here to help.
What to Expect
With proper treatment, most children feel better within 2 to 3 days. However, fluid may remain in the middle ear for several weeks or months after the infection clears. This is normal and usually doesn't require treatment unless it affects hearing or lasts longer than 3 months.
Frequently Asked Questions
How do I know if my child's ear infection needs antibiotics?
Not all ear infections require antibiotics. Your pediatrician will decide based on your child's age, severity of symptoms, and whether there's visible infection in both ears. Children under 6 months, those with severe pain or high fever, or infections in both ears are more likely to need antibiotics.
What can I do to relieve my child's ear pain at home?
Use acetaminophen or ibuprofen for pain relief, apply a warm compress to the affected ear, and keep your child's head elevated. Over-the-counter numbing ear drops can provide temporary relief but check with your doctor first.
How can I prevent ear infections in my child?
Keep your child up-to-date on vaccinations, avoid smoke exposure, breastfeed if possible during the first 6 months, and don't let babies drink bottles while lying flat. Reducing pacifier use after 6 months may also help.
Can my child go to daycare or school with an ear infection?
Yes, ear infections are not contagious. As long as your child is feeling well enough and doesn't have a fever, they can attend school or daycare.
Why does my child keep getting ear infections?
Some children are more prone to ear infections due to shorter, more horizontal eustachian tubes, frequent colds, allergies, or daycare attendance. Most children outgrow this tendency by age 5-6 as their ear anatomy develops.
Need Personal Guidance?
This article provides general information. For questions specific to your child's health, please call our office or book an appointment online.