Understanding Ear Infections – the Basics

Medically Reviewed by Poonam Sachdev on September 26, 2023
5 min read

About half of kids get at least one ear infection, also known as acute otitis media, before their second birthday. Here's why this condition is so common, and what you can do to help keep your child healthy.

The middle ear is a small space behind your eardrum. It contains tiny bones that vibrate and help you hear. This part of your ear is supposed to be vented by air that passes into your nose and throat and through a passage called the eustachian tube. If anything blocks air from getting through, the middle ear can become damp and warm – a perfect breeding ground for germs.

In babies and kids, the eustachian tube is often very soft and has a hard time staying open. Allergies, post-nasal drainage, sinus infections, common cold viruses, and problems with the tonsils can all prevent enough air from passing into the middle ear.

If a doctor looks at your child's eardrum and sees that it's red and bulging, they'll diagnose them with an ear infection.


Symptoms of an ear infection

Your child may have:

  • Fever
  • Pain in the ear (babies will rub or pull on their ears)
  • Vomiting and diarrhea (in babies only)
  • Trouble hearing
  • Crying or pain when sucking
  • Loss of sleep or appetite

The most common trigger of an ear infection in kids is an upper respiratory infection, like a cold or the flu. These viruses can swell the eustachian tube so that air can't flow into the middle ear. Allergies to pollen, dust, animal dander, or food can have the same effect. So can smoke, fumes, and other environmental toxins. Bacteria can cause an ear infection, but usually these germs come after a virus or an allergic reaction. Bacteria can infect an already inflamed ear and cause other symptoms, like a fever.

A shot called the conjugate pneumococcal vaccine can help protect your child against some of the most common bacteria that cause ear infections. It's routinely given to babies and toddlers to prevent serious illnesses like meningitis, pneumonia, and blood infections. Keeping your child up to date on this vaccine may help prevent at least some ear infections.

Some kids only get an ear infection once, or once in awhile. If so, it's called acute ear infection (or acute otitis media). If the infection clears up but comes back as many as three times in a 6-month period (or four times in a year), your child may be diagnosed with recurrent acute otitis media. That's often a sign that your child's eustachian tube isn't working well. At times, fluid can also build up in your child's middle ear without signs of infection. If so, it's called otitis media with effusion.

 The following can put your child at risk for repeat middle ear infections. 

  • Male gender, or being assigned male at birth
  • A family history of ear infections
  • Being bottle-fed formula (Babies who are fed breast milk have fewer ear infections.)
  • Going to a day care center
  • Living in a home with tobacco smokers
  • An issue with their palate, like a cleft palate
  • A weakened immune system or chronic respiratory disease, such as cystic fibrosis and asthma

About half the time, an ear infection goes away on its own. No medication is needed. But many kids will need an antibiotic, usually amoxicillin, for 10 days. The drug starts to work within a day or so.

Sometimes the fluid in the middle ear doesn't drain, blocking the eardrum and causing temporary hearing loss. This is common. In many cases, another round of amoxicillin or another type of antibiotic will clear it up.

Repeat ear infections can be a concern since they're linked to short-term hearing loss. In early childhood, hearing is key to speech development. If your child has severe hearing loss for a long time, learning to speak and understand language may be harder.

For many years, kids who had repeat ear infections and hearing loss were given "ear tubes." During a short surgery called a myringotomy, tiny tubes are put into the ear to keep the middle ear vented. Now, many doctors opt to skip this surgery. 

Studies show that ear tubes aren't always needed. Putting off surgery for up to 9 months likely won't hurt your child's language skills. If your doctor suggests ear tubes for your child, you might want a second opinion.

Long before ear tubes are discussed, many doctors prescribe antibiotics. This type of drug can reduce the number of infections your child gets. But they also promote the spread of antibiotic-resistant bacteria ("super" germs that antibiotics can't kill). If your child has fluid in their ear but no sign of infection or fever, the American Academy of Pediatrics (AAP) actually advises against antibiotics. 

Because of that, your pediatrician may hold off on giving your child antibiotics when they have an ear infection. If they do prescribe this type of medication, make sure that your child finishes all of it. If not, the germs that made them sick may come back.

For starters, remove as many pollutants from your home as you can, including:

  • Dust
  • Cleaning supplies and household products that contain harsh chemicals 
  • Tobacco smoke

 If your child has allergies, ask their doctor for tips to control them. 

Taking steps to prevent colds, the flu, and other illnesses can prevent some ear infections. To do that:

  • Be sure everyone in your home, including your child, stays up to date on the shots your doctor suggests. That includes flu and pneumococcal vaccines.
  • Make hand-washing a habit that becomes part of your family's routine.
  • If your child goes to day care, look for a center that monitors kids for illness and requests that sick kids stay home, especially during cold and flu season.
  • Breastfeed your baby for at least 6 months, if you can. Babies who are formula-fed have a 70% greater risk of ear infections. If you run into issues, talk to your doctor or a lactation consultant (a provider specially trained to help with breastfeeding).
  • If you bottle-feed, hold your baby's head higher than their stomach. This will help keep their eustachian tubes from getting blocked.
  • Avoid group day care during your child's first year, if that's an option. Caring for them in a home setting could cut back on the number of germs they're exposed to.
  • Avoid tobacco smoke. Babies and kids who are around secondhand smoke are at a higher risk for ear infections.

No matter how hard you try to protect your child, they'll come across germs at some point. To help them through this rough patch:

  • Don't feed your baby while they're lying down. This makes ear pressure and pain worse.
  • Give your child over-the-counter acetaminophen (not aspirin) to help make them more comfortable. Read the label carefully and follow the dosage advice.
  • Try placing several warm (not hot!) drops of mullein or garlic oil in your child's ear. Both are natural antibiotics. (But check with your pediatrician before placing anything in your child's ear.)