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Ear Infections in Babies and Toddlers: Signs and Treatment

Medically Reviewed by Dr. Leah Alexander, MD, FAAP
Find out what causes baby ear infections and how to ease their pain.

Ear infections are a common blight of childhood. If your little one hasn’t yet experienced an ear infection, it’s likely they will. Knowing what ear infections look like and the steps you can take to treat them can help you be prepared for the experience.

Dealing with an ear infection can be overwhelming. Seeing your child in pain is difficult — feeling like there’s nothing you can do to alleviate that pain makes it worse.

Your best defense is arming yourself with the knowledge that can help you tackle ear infections head on — and give your child the care they need.

In this article, we’ll look at why and how ear infections happen and how you can work to avoid them.

What Is an Ear Infection?

An ear infection happens in the middle ear, behind the eardrum in the eustachian tube. Inflammation, fluid build-up, and pressure usually accompany the ear infection. Several days of nasal congestion or a runny nose can precede the development of an ear infection. This can make for a truly miserable experience, especially for young children who can’t vocalize or understand why they’re uncomfortable.

There are two general types of ear infections — acute and chronic. Chronic ear infections never seem to truly resolve, or come back shortly after treatment (1).

Acute ear infections, on the other hand, are short-lived, although they may be quite painful. These ear infections may follow a cold or illness where the sinuses are heavily involved. Both acute and chronic ear infections will likely be treated with antibiotics.

Identifying the cause of the infection is especially important for chronic ear infections that indicate an ongoing problem. Once identified, you can begin to make the necessary changes to help avoid those conditions in the future.

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Why Do Ear Infections Happen?

The eustachian tube runs from the ear to the back of the throat. These tubes are responsible for tying the ears into the sinus system.

The eustachian tubes are small, even in an adult. In young children, they are both smaller and shorter. They also form a horizontal connection between the nasal cavity and the middle ear. This allows any nasal fluid to easily flow into the middle ear. After a few days, bacteria can begin to grow there (2).

Blockages and backups in these tubes can happen easily. Young children are encountering germs and viruses for the first time and are regularly sick. These two situations together contribute to the high rate of ear infections in young children.

While ear infections tend to always operate in the same fashion, their catalysts can be different. Some potential causes for ear infections include:

Sinus infections are nearly impossible for an infant to have. Although infants are born with sinuses, they don’t open until they are much older (3). The sinuses on each side of the nose don’t aerate until 5 years old, and the forehead ones don’t until age 6-7.[/editors-note]

Young babies who are bottle fed and those who use pacifiers may be at a greater risk for ear infections. Babies born prematurely are also more prone to developing ear infections (4).

Does Your Baby Have an Ear Infection?

You may not always be able to identify whether your baby has an ear infection by looking at the outside of the ear.

On the fence about whether you should seek treatment for a potential ear infection? Here are some indicators you should make an appointment with your doctor.

  • Fever: Fevers that accompany ear infections are usually high. Because they are directly related to the body fighting the infection, they will reoccur when your child is not being medicated with ibuprofen or acetaminophen.
  • Unusual behavior: Is your normally upbeat baby or toddler suddenly inconsolable and clingy? These behaviors can be an indication they are battling an ear infection.
  • Ear pulling: Young children may pull, tug, or claw at their ear during bouts of pain. If you notice your child cupping, holding, or paying more attention to their ear than usual, it may be a sign of ear infection.
  • Difficulty sleeping: Lying down can exacerbate pressure-related discomfort, and make night time a nightmare. Does your child tend to go to bed easily and sleep soundly through the night and, suddenly, that same child can’t fall asleep or wakes up crying? You may be dealing with an ear infection.
  • Lack of appetite or interest in food: When a child has an ear infection, it may impact their regular appetite and eating behaviors.
  • Foul or unusual odor: Infections are often accompanied by an unpleasant odor. If you notice foul-smelling ears, you’ll want to get your baby’s ears examined.
  • Drainage: If you do notice any pus-like drainage, don’t delay having your child’s ears evaluated. Your little one may have an infection that’s become severe enough to perforate the eardrum. The sooner this is treated, the better.

Any one of these signs can appear in a baby or young child for another reason altogether. Growing pains and teething might impact sleeping behavior. Normal development stages may explain clingy behavior and anxiety.

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If your child is experiencing several of these symptoms, however, you will need to rule out an ear infection. Leaving an ear infection untreated can cause permanent damage to the ear, and to their hearing (5).

If there’s any concern at all, it’s worth a visit to the pediatrician. With the use of an otoscope, your doctor can easily assess the condition of the ear. If an ear infection is diagnosed, the doctor will likely prescribe an antibiotic medication.

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How to Relieve Ear Infection Pain?

With an effective antibiotic, your child can start experiencing relief from ear infection discomfort after just one dose. You can help make them comfortable while the antibiotics are at work by taking the following steps.

  • Pain relief: Choose your pain reliever of choice and use it to keep inflammation down and keep the pain in check.
  • Keep your baby hydrated: Your child may not be interested in eating or drinking because swallowing may be uncomfortable. If they become dehydrated, though, it will only add to discomfort and lengthen recovery time. Depending upon your child’s age, you might try giving a popsicle — children seldom refuse them!
  • Indulge them: Go ahead and let your little one snuggle up to you and soak up some cuddles. When it comes down to it, you can’t hurry up the healing process — but some quality time doing your child’s favorite things might make the time pass more quickly.
Acetaminophen or ibuprofen are what I most commonly recommend for pain relief. Some of my parents ask me about using warm oil drops (garlic oil, olive oil), but I do not recommend this, especially if there is a potential eardrum perforation. In the past, benzocaine ear drops were prescribed by doctors to numb ear pain. They are no longer recommended (6).
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Editor's Note:

Dr. Leah Alexander, MD, FAAP

If you don’t notice a significant improvement in 48 to 72 hours, you should call your pediatrician and ask to be seen again. It’s possible your prescribed antibiotic isn’t working for the infection. Your doctor can take a quick look at the ear and determine if a different antibiotic needs to be prescribed.

You’ll want to have a follow-up visit with your doctor 4 to 6 weeks after completing treatment. This will give the ear enough time to heal and enough time that a recurrent infection would be trying to set up shop again. Catching an ongoing problem early on will be in your child’s best interest.

How to Prevent Ear Infections

Ear infections may be an unavoidable part of childhood. But there are a few things you can do to lessen your chances of encountering them.

  1. Always practice thorough handwashing. This will cut down on the germs that can cause illnesses which could lead to secondary infections in the ear.
  2. Don’t smoke or expose children to smoky places. Ask visiting friends or family to smoke outdoors. Exposure to smoke increases the likelihood of ear infections.
  3. Breastfeed your baby. This provides helpful antibodies that can help protect the baby from those germs that can lead to colds and ear infections.
  4. When bottle feeding, keep your baby upright. Eating while lying down can allow milk or formula to slide back in the throat and become trapped in the eustachian tubes.
  5. Treat allergies — excessive mucus production can lead to impacted eustachian tubes and ear infections. Keeping that mucus in check can help you avoid ear infections.
  6. Choose to vaccinate your children. Research shows children who receive their vaccines are less likely to experience ear infections.

Do what you can where you can to help prevent ear infections. Even if it only means you avoid one or two things, not having to watch your child suffer through the experience will be more than worth it.

After the Ear Infection

Ear infections can be hard to get through. They are frequently accompanied by significant pain, and it’s hard to see your child in that much discomfort.

Knowing what to look for — and what to do — in the event of an ear infection means you can start treating the problem more quickly. Your child will be on the mend before you know it.

Have you had many ear infections in your home? How did you know what you were dealing with?

What’s the one piece of advice you wish you’d had going into your first experience with ear infections? We’d love to hear about it — leave us a comment below.

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Medically Reviewed by

Dr. Leah Alexander, MD, FAAP

Leah Alexander, M.D. FAAP is board certified in General Pediatrics and began practicing pediatrics at Elizabeth Pediatric Group of New Jersey in 2000. She has been an independently contracted pediatrician with Medical Doctors Associates at Pediatricare Associates of New Jersey since 2005. Outside of the field of medicine, she has an interest in culinary arts. Leah Alexander has been featured on Healthline, Verywell Fit, Romper, and other high profile publications.