6 Signs Your Baby May Have an Ear Infection
Ear infections are incredibly common in young children, especially babies and toddlers. In fact, according to the American Academy of Pediatrics, five out of six children will have been diagnosed with an ear infection by the time they turn 3! While ear infections are seemingly a right of passage through childhood, they are super frustrating for parents (and babies!).
What is an Ear Infection?
An ear infection, or acute otitis media (AOM), occurs when the middle ear becomes inflamed, usually due to bacteria or viruses settling in. The middle ear is the space behind the eardrum that contains tiny bones that transmit sound vibrations. When this area becomes infected, it can cause pain and other symptoms. A doctor looking in the ear will see the eardrum appear red and bulging.
I have so many friends who have battled persistent ear infections with their children. Whether you are reading this as your baby grapples with his first ear infection or you are an old pro at spotting it, know you are not alone, and the phase will eventually pass.
Ear infections are treatable, but they can be challenging for families! Persistent ear infections lead to time away from daycare/school, time away from work for parents, and lost sleep for everyone. Some kids end up with temporary hearing loss and speech delays. For patients who stop responding to antibiotics, ear tubes or other procedures may be needed.
Why are Babies and Toddlers Prone to Ear Infections?
Because they are small! :) All joking aside, babies and toddlers get ear infections because of their anatomy.
There's a tiny tube in the ear known as the Eustachian tube. The Eustachian tube allows fluid to drain out of the middle ear. In kids, this tube is short and narrow and lies more horizontally. Because of this, fluid doesn't drain as well and can build up, especially in the setting of congestion from a cold or allergies.
All those boogers back up everywhere! When the fluid isn't draining, germs can grow and cause an infection. As you can imagine, every child is different in their ear anatomy and ability to fight off infection. This explains why some kids are prone to ear infections while others aren't.
Symptoms of Ear Infections in Babies and Toddlers
Some parents will tell you that recognizing an ear infection is more art than science. Kids get "the look" (red-rimmed eyes, general misery, fussy as heck), and their caregivers just know.
For others, recognizing the signs of an ear infection in young children can be challenging. Babies and toddlers can't verbalize their discomfort or tell you, "Hey, my ear hurts!" (Although if your older toddler or young child can tell you that, there's your clue!)
For younger and non-verbal children, here are some common symptoms to watch for:
- Fever, defined by most pediatricians as a temperature greater than 100.4 degrees Fahrenheit
- Trouble hearing (your baby may not respond to sounds as they typically would)
- Fussiness and crying, especially at night or when lying down
- Interrupted sleep
- Fluid draining from the ear
- Decreased appetite
Many parents also report that their children tug at their ears when they have an ear infection. Most scientific sources say this isn't a reliable sign and that young babies just tug on their ears. If I see my toddler doing this, I take note but don't necessarily assume an ear infection.
Parents also report that teething pain can cause some similar symptoms: fussiness, crying, tugging at the ears, and interrupted sleep. That is certainly true; however, teething pain will come and go and not typically last more than a day at a time. In contrast, ear infection pain is more persistent.
It's easy to tell when your baby is unhappy, but hard to tell why—even with a background in pediatric medicine, I have found myself questioning, "Is it teeth? Is it ears?" on so many occasions.
Older toddlers and children may exhibit the above signs and symptoms but also complain of ear pain, trouble hearing or communicating, balance issues, or pressure in the ear.
It's important to note that these symptoms can vary from child to child, and not all children will experience all of these symptoms. It's also important to note that these symptoms can be associated with other common childhood illnesses. Only a medical professional can confirm if your child has an ear infection.
When to Call the Doctor
Did you know that many ear infections self-resolve and may not require antibiotics? Sometimes, ear infections are caused by viruses that antibiotics can't help with. Sometimes, even bacterial ear infections can be healed by the body's natural defenses without antibiotics. In fact, guidelines state that in many cases, families "watch and wait" for 2-3 days to see if a mild ear infection will clear on its own.
As a parent, I know this is frustrating. Your kid has an ear infection; they are miserable, and everyone needs to return to life as scheduled. However, this watch-and-wait period is important as we want to avoid unnecessary antibiotics whenever possible. It makes sense to wait a couple of days and see if your child feels better on their own.
That being said, there are circumstances in which you should reach out to your pediatrician for guidance and a decision on whether to treat with antibiotics! Use the following tips as a guide:
- Your child is younger than 6 months old and shows signs of an ear infection
- Symptoms persist for more than 2-3 days
- Your child experiences severe ear pain or severe fussiness
- You notice fluid, pus, or bloody discharge coming from the ear
- Your child has a high fever (102°F or higher)
- Your child shows signs of hearing loss or balance problems
Preventing Ear Infections
Unfortunately, there's no surefire way to prevent ear infections. Some children are just prone to them. If your child experiences several ear infections in a season, your pediatrician may refer you to see an ear, nose, and throat specialist (commonly known as an ENT or ORL physician). Kids who suffer from chronic ear infections may need ear tubes placed in the canal to assist with drainage and prevent recurrence.
There are some things you as a caregiver can do at home:
- Stay on track with the childhood vaccine schedule. The flu shot and pneumococcal vaccines are important for general health but may help reduce the incidence of ear infections as well
- Do not let your baby be exposed to secondhand smoke
- Practice good hand hygiene
- Breastfeed if possible
- If bottle feeding, hold your baby upright while they take the bottle
Unfortunately, group childcare settings like daycares are a risk factor for ear infections, as the types of bacteria that like to settle in the ears circulate in childcare settings. Daycare is not something that I consider an avoidable risk, but if your family is in the position to choose between group childcare or private childcare, it is a consideration to be aware of.
In conclusion, ear infections are a very common childhood illness that almost all parents will deal with at some point. Learning how to recognize them and when to call your doctor will be helpful! Check out our blog post on treating ear infections to learn more.
The following references were used to compile this information:
American Academy of Pediatrics. (2021). Ear infection information. https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Ear-Infection-Information.aspx
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. https://doi.org/10.1542/peds.2012-3488
National Institute on Deafness and Other Communication Disorders. (2022). Ear infections in children. https://www.nidcd.nih.gov/health/ear-infections-children
This article has been reviewed by Andrea Morrissey, PharmD, Board Certified Pediatric Pharmacy Specialist, and Chief Content Officer of Kids Med Guide. The content is for educational and entertainment purposes only and does not replace professional medical advice. Always consult your healthcare provider for medical guidance, and call 911 in an emergency.
Kids Med Guide is not liable for your interpretation or reliance on this material. You assume full responsibility for its use and any resulting decisions.
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