Ear Infections in Kids: Symptoms, Pain Relief, Antibiotics and When to Call the Doctor

Quick answer: middle ear infections are common in babies and young children and often follow a cold. Signs include ear pain, tugging at the ear, fussiness, trouble sleeping, fever and sometimes fluid draining from the ear. Treat pain with acetaminophen or, for babies 6 months and older, ibuprofen dosed by weight, and call your pediatrician. Under American Academy of Pediatrics (AAP) guidance, doctors may prescribe antibiotics right away or, for some children 6 months and older with milder symptoms, watch for 48 to 72 hours first. Call promptly for any baby under 6 months with symptoms, fever of 102.2 degrees F or higher, severe pain, pus or blood draining from the ear, swelling or redness behind the ear, a stiff neck or a child who seems very ill.

If you have ever spent a night rocking a crying toddler who keeps grabbing at an ear, you know how miserable ear infections can be. They are among the most common reasons young children visit the doctor and get antibiotics. Most clear up without lasting problems, and knowing what to watch for helps you decide when to call and how to keep your child comfortable. This guide is part of our family safety guide.

Information in this article comes from the American Academy of Pediatrics (AAP), including its clinical practice guideline on acute otitis media and HealthyChildren.org, the National Institute on Deafness and Other Communication Disorders (NIDCD) and the U.S. Food and Drug Administration (FDA). It is general information, not a substitute for medical advice. Always follow your child’s doctor’s guidance.

Table of Contents

What an Ear Infection Is

The most common type in children is acute otitis media, an infection of the middle ear, the air-filled space behind the eardrum. It usually develops after a cold or other respiratory infection causes swelling and fluid buildup. Bacteria or viruses in that trapped fluid can cause infection, pressure and pain.

Why Kids Get More Ear Infections

Children’s eustachian tubes, which connect the middle ear to the back of the throat, are shorter and more horizontal than adults’. That makes it easier for fluid to collect and harder for it to drain. Young children also catch more colds, and their immune systems are still developing. According to the NIDCD, five out of six children will have at least one ear infection by their third birthday.

Signs of an Ear Infection

In Babies and Toddlers

Little ones cannot always tell you what hurts. Watch for:

Tugging, pulling or rubbing an ear
Unusual fussiness or crying, especially lying down
Trouble sleeping
Fever
Poor feeding, since sucking and swallowing can hurt
Fluid draining from the ear
Not responding to quiet sounds
Clumsiness or balance problems

In Older Children

Ear pain or a feeling of fullness
Muffled hearing
Fever
Headache
Fluid draining from the ear
Feeling unwell after a cold

Ear tugging alone, without other signs, is common in babies and does not always mean infection.

Pain Relief at Home

Pain is often the hardest part of an ear infection, and treating it helps whether or not antibiotics are needed.

Acetaminophen can be used for children as directed by weight on the label or by your pediatrician.
Ibuprofen is an option for babies 6 months and older, dosed by weight.
Do not give aspirin to children or teens, because of the risk of Reye’s syndrome.
A warm or cool compress held against the outer ear may soothe pain.
Rest with the head slightly raised may ease pressure for older children; follow safe sleep guidance for babies, who should always sleep flat on their backs.
Offer fluids and soft foods.

Ask your pediatrician before using any ear drops. Do not put drops in an ear that is draining fluid or may have a hole in the eardrum unless prescribed.

How Doctors Diagnose Ear Infections

A doctor looks at the eardrum with an otoscope, checking for redness, bulging and fluid. They may use a small puff of air to see how the eardrum moves, which helps detect fluid behind it. Your child’s age, symptoms and history guide treatment.

Antibiotics or Watchful Waiting

Many ear infections improve on their own within a few days. AAP guidelines allow two approaches, depending on age, severity and whether one or both ears are affected.

When Antibiotics Are Usually Prescribed

Babies younger than 6 months
Kids with severe symptoms, such as moderate to severe pain, pain lasting 48 hours or more or fever of 102.2 degrees F (39 degrees C) or higher
Children 6 to 23 months with infections in both ears
Children whose ears are draining because of infection

When Watchful Waiting May Be Offered

For some children 6 months and older with milder symptoms, doctors may suggest treating pain and watching for 48 to 72 hours. If symptoms do not improve or get worse, antibiotics are started. Some doctors provide a “wait-and-see” prescription to fill only if needed.

If Antibiotics Are Prescribed

Amoxicillin is usually the first choice, unless your child has a penicillin allergy or recently took amoxicillin. Give the full course as directed, even if your child feels better. Call the doctor if your child is not improving within 48 to 72 hours, has a rash, diarrhea or other side effects, or seems worse.

When to Call the Doctor or Seek Care

Call your pediatrician if:

Your baby is younger than 6 months and has signs of an ear infection or fever
Your child has a fever of 102.2 degrees F or higher
Ear pain is severe or lasts more than a day or two
Pus, blood or fluid drains from the ear
Your child has trouble hearing
Symptoms continue after 2 to 3 days of antibiotics

Seek urgent care right away if your child has:

Swelling, redness or tenderness behind the ear, or an ear that sticks out
A stiff neck, severe headache or confusion
Weakness on one side of the face
Extreme sleepiness, or is hard to wake
Signs of dehydration

These can signal rare but serious complications, such as mastoiditis or meningitis. Our guide to fever in kids and when to call the doctor covers fever warning signs for every age.

Caring for Your Child During an Ear Infection

Comfort goes a long way while an ear infection runs its course. Offer extra cuddles, quiet activities and favorite books or shows during the worst of the pain. Give pain relievers on a schedule your pediatrician recommends, especially at bedtime, when lying down can make pain worse. Keep a simple log of doses, temperatures and symptoms so you can share accurate information with the doctor and avoid accidental double doses when more than one caregiver is helping.

Keep children home from daycare or school if they have a fever or seem too uncomfortable to take part. Our guide on when to keep your child home from school explains common rules for fever and illness. A well-stocked family first aid kit with a reliable thermometer, dosing syringes and children’s pain relievers makes nighttime ear pain easier to handle.

Ear Infections in Babies

Young babies need extra caution. Fever in a baby younger than 3 months, with or without ear symptoms, needs immediate medical attention, since it can signal a serious infection. Babies under 6 months with ear infection symptoms should always be seen. Respiratory viruses such as RSV often come before ear infections in infants, so watch for breathing problems, too; our guide to RSV in babies and young kids explains the warning signs.

Hearing, Speech and Fluid

Fluid can stay behind the eardrum for weeks after an infection clears. While it is there, children may hear sounds as muffled, as if they were underwater. Most fluid goes away on its own, and hearing returns to normal. If fluid lasts three months or longer, or if you notice your child turning up the TV, not responding to their name or falling behind in speech, ask your pediatrician about a hearing test. Children at higher risk for speech or learning delays may need closer follow-up.

Recurrent Ear Infections and Ear Tubes

Some children get ear infections again and again. Doctors may consider ear tubes, tiny tubes placed in the eardrum during a short surgery to let fluid drain and air flow. The AAP guideline describes recurrent infection as three or more episodes in six months, or four or more in a year with at least one in the past six months. Tubes may also be considered for long-lasting fluid that affects hearing or speech. Ask your pediatrician or an ear, nose and throat specialist about the benefits and risks.

Swimmer's Ear

Swimmer’s ear is an infection of the outer ear canal, often from water staying in the ear after swimming or bathing. Signs include itching, redness, pain when the outer ear is touched or pulled and drainage. Treatment usually involves prescription ear drops. To help prevent it, dry ears with a towel after swimming, tilt the head to let water drain and ask your doctor about drying drops if your child gets it often.

Questions to Ask at the Doctor's Visit

Appointments can feel rushed, especially with a fussy child. Bringing a short list of questions helps:

Is this an ear infection in one ear or both?
Should we start antibiotics now or wait and watch?
What dose of pain reliever is right for my child’s weight?
When should symptoms start to improve?
What signs mean we should come back or go to urgent care?
Does my child need a follow-up ear check?
Could allergies, reflux or something else be contributing?

Write down the answers or ask for an after-visit summary, so other caregivers have the same instructions.

Myths About Ear Infections

Several common beliefs about ear infections do not hold up:

“Wet hair or no hat causes ear infections.” Middle ear infections come from germs and fluid behind the eardrum, not cold air.
“Every ear infection needs antibiotics.” Many clear on their own, which is why watchful waiting is an option.
“Ear tugging always means infection.” Babies often tug their ears when tired, teething or exploring their bodies.
“Swimming causes middle ear infections.” Water in the outer ear can cause swimmer’s ear, a different condition.

Preventing Ear Infections

Keep vaccines up to date, including pneumococcal and yearly flu vaccines. See our guide to flu season and kids for more on the flu vaccine.
Avoid secondhand smoke, which increases the risk of ear infections.
Breastfeed if you can, since breastfeeding is linked to fewer ear infections in babies.
Do not prop bottles, and feed babies in a more upright position.
Wash hands often to reduce colds.
Limit pacifier use after about 6 months, which the AAP notes may lower ear infection risk.

Ear Safety Tips

Never put cotton swabs or objects into a child’s ear canal.
Keep small objects like beads and button batteries away from young children.
Protect hearing with earmuffs at loud events.
Help children swallow or yawn during airplane takeoff and landing, such as nursing or offering a bottle or drink.

Frequently Asked Questions

Do ear infections always need antibiotics?

No. Many mild ear infections improve on their own. Your doctor will decide based on age, symptoms and severity.

Are ear infections contagious?

The ear infection itself is not contagious, but the colds that often lead to them can spread.

Can my child go to daycare or school with an ear infection?

Usually yes, if they have no fever and feel well enough to participate. Follow your daycare’s policies.

How long does an ear infection last?

Many improve within two to three days, with or without antibiotics. Fluid may linger for weeks.

Can my child fly with an ear infection?

Ask your doctor. Changes in pressure can hurt, so swallowing and pain relief can help.

When do children outgrow ear infections?

Ear infections usually become less common as children get older and their eustachian tubes grow.