Ear infections are among the leading reasons that kids are brought in to see a doctor. They are incredibly common. In some countries, as many as four of five kids are affected, and some kids may experience several ear infections within a year’s time. They often follow colds, flus and sinus infections. The good news is ear infections are not contagious and generally not serious.

girl with earache
Most heal on their own in just a few days’ time, and simple over the counter pain relievers can alleviate symptoms in the interim.
The greatest challenge in dealing with them is that young kids generally do not have the words to describe what they are feeling. Complications may also result in certain situations.
Below is a guide to ear infections in toddlers and babies, with commonly asked questions, ear infection treatments, as well as home remedies, risks, prevention and more.

Causes of ear infections  

There are several types of ear infections. Middle ear infections (also known as otitis media) are caused by viruses and bacteria. Many spread to the ear from the back of the throat, following colds, flus and other respiratory illness.
These infections can cause the eustachian tubes to swell and pinch shut. These tubes supply the inner ear with fresh air (among other functions) so when they tighten or close, fluid traps inside. These fluid heavy pockets are easily infected. Fluid can also build up behind the eardrum as pus. This pushes against the eardrum, irritating it and causing it to bulge and redden.
Kids under three are more susceptible to ear infections because their immune systems are still relatively undeveloped. Their eustachian tubes are also much shorter, and thus more easily pinched shut.
Some kids can experience several ear infections in a year, and in some cases, fluid may stay behind the eardrum after the infection has healed.
Outer ear infections (otitis externa) typically result after physical damage to the ear, often from too much water or something is inserted into the ear.

Ear infection symptoms and earaches

A major challenge with ear infections in babies and toddlers is that the kids cannot speak. This puts greater impetus on the adults around them. Middle ear infection symptoms to look for include:
  • earaches
  • trouble sleeping 
  • tiredness and lagging energy
  • restlessness, irritability and fussiness
  • pain when sucking or chewing
  • touching or pulling on the ear
  • pressure and fullness inside the ear
  • an ear that is too painful to touch
  • fever
  • poor balance
  • trouble hearing or reacting to sounds
  • loss of appetite
  • fluid discharge from the ear
girl with hearing problems
These symptoms usually set in quickly. Sometimes a fever and fussiness may be the only signs. A cough, runny nose or sore throat may also be a precursor to an ear infection.

Home remedies for ear infections

There are a few simple things you can do for kids with ear infections. Over the counter pain relievers are an excellent place to start, as they reduce earaches, pain and fever. A warm folded cloth, flannel or compress placed over the ear for 10-15 minutes may also help. 
Kids should be given fluids. Swallowing often can help open the eustachian tubes and drain fluid to the throat. Keeping the head elevated also increases drainage.
If there’s any fluid discharge from the ear be sure to wipe it up. But do not put anything inside the ear canal — including cotton swabs and tissue. You should also keep the ear free from things like soap and water, and shampoo. Avoid swimming, or submerging fully in the bath.
Do not give a child antihistamines or decongestants — they’ll have no effect on the earache or the infection.
Again, the best course is to simply treat the child’s symptoms with pain relievers for 48-72 hours.

When is it necessary to call a doctor?

Most ear infections in toddlers and babies clear up within a few days’ time. If symptoms haven’t improved by then — or have worsened— you should consult a physician immediately.
Some ear infections do last for upwards of a week, and some kids are more likely to be affected by repeat ear infections.
doctor examining a child
Other symptoms which should lead you to contact a physician include: 
  • children less than six month old
  • a change in hearing, or a hearing loss
  • a very high temperature
  • fevers lasting longer than 48 hours
  • repeated vomiting
  • redness or swelling behind the ear
  • rashes
  • fluid discharge from the ear

Diagnosis & treatment

Your hearing care professional will begin by asking about the child’s general health. You should be prepared to answer a series of related questions, including: How old is the kid? What symptoms is the kid experiencing? Have they had trouble sleeping? Does the child have a cold? Has the child had ear infections before? How long did the infections last? How severe were they? Does the child have any increased risk factors? (See below). Has the child had any other significant illnesses? 
This will be followed by an examination of the middle ear and eardrum with an otoscope. This instrument has a magnifying glass and a flashlight. Many blow puffs of air into the ear, which helps check for blockage and fluid behind the eardrum. 
A tympanometer may also be used. It is effectively a speaker and microphone built into a small plug. When inserted in the ear it tests the internal air pressure and the eardrum’s flexibility.
It is important to understand that many medical professionals may avoid prescribing antibiotics. Most ear infections clear up on their own and antibiotics can have side effects (like allergic reactions and vomiting). Overusing them can also lead to more-resistant bacteria.
Antibiotics may be prescribed if symptoms have not improved after three days, if the child is under two (to prevent further spread), if both ears are infected, or if the eardrum is damaged. 
If this is the case, use all the prescribed medication for the entire recommended course (typically 5-10 days) even if the symptoms improve. Ending use too early can allow infections to return.
Kids under three months may require assessment by a specialist. 

Is it possible to prevent ear infections in kids?  

Ear infections are very common and nearly impossible to prevent, because they are linked to things like colds and flus. Below are some factors which may increase a child’s risk of ear infections.
Secondhand smoke — The effects of smoke on cardiovascular systems are well-documented. Kids exposed to secondhand smoke are at risk for greater damage to their lungs, throats, sinuses and ears.
Allergies — Excess mucus that is produced by allergic reactions commonly finds its way into the eustachian tubes.
Colds and flus — Anything that increases general infections will also increase ear infections in toddlers and kids. These include winter and cold seasons (which drive people indoors) and extensive contact with other kids (nurseries, playgroups and daycare). 
Regular immunizations and flu shots are important, and washing your hands and your child’s hands regularly is an excellent preventative measure. It is also important to teach kids the importance of handwashing.
Bottle feeding — Breast milk has many antibodies which prevent and fight infections. Babies who experience ear infections early in life may be more susceptible later on.
Additionally, when a kid is using a bottle — especially while lying on its back — milk can enter the eustachian tubes and irritate and inflame them. The more kids drink sitting up, and the sooner they use a regular cup, the better. Never put a baby to bed with a bottle.

Who is at higher risk for ear infections?  

As noted, ear infections in babies and toddlers — kids between the ages of six months and three years old — are most common. Kids under the age of five are generally more affected because their eustachian tubes are shorter, and more easily pinched and blocked.
A number of genetic conditions have also been correlated with ear infections, including kids with immune system disorders, those born with a cleft lip or palate, and kids with Down syndrome. Additionally, Hispanic and Native American kids also have more ear infections than other ethnic groups — though it is not clear why.
sick ear

The risks of ear infections  

Middle ear infections create enormous pressure within the head. In some instances they may cause the ear drum to perforate or burst. When this happens a child may feel nauseous or dizzy, and pus and other fluid may leak from the child’s ear. All this sounds worse than it actually is. The child generally feels better because the pressure and pain are reduced. Most perforated ear drums heal within weeks.
However, there is a risk of long term infection if they don’t. In some rare instances these infections may spread from the ear to other tissue nearby. Mastoiditis is a condition that occurs when the bone behind the ear is infected. It causes painful red soft swollen lumps behind the ear. Treatment may include intravenous antibiotics, or surgery to remove the infected cells.

Are ear infections contagious? Why do they come back?  

Ear infections are not contagious, though they are often caused by conditions — like colds and flus —which are.
Nonetheless, some kids have more than their fair share. It is not uncommon for some kids to have five or six middle ear infections in a year. 
One medical solution is a small ventilation tube, which is inserted through the eardrum into the middle ear. This tube improves air flow, prevents fluid from building up, and balances pressure on both sides of the ear drum. The tube is designed to stay in place for six to nine months before falling out. 
The operation is known as myringotomy, and most kids return home the same day. The ear drum will heal on its own in just a few days’ time.
If recurring ear infections still do not stop, doctors may recommend removing the adenoids to prevent future infections.