How to Tell if Your Child Has an Ear Infection

Parenting |


Ear Infection Web

If you have a little one, you’ll likely have to deal with an ear infection at some point. That’s because ear infections are one of the most common illnesses in kids apart from the common cold.

If you have a little one, you’ll likely have to deal with an ear infection at some point. That’s because ear infections are one of the most common illnesses in kids apart from the common cold. “Infants and children are more pre-disposed to getting earaches because their Eustachian tubes—a passageway between the middle ear and the throat that helps equalize air pressure behind the ear drum—are both shorter and more horizontal than adults are, making it easier for fluid to build up behind the ear drum,” says John P. Dahl, MD, PhD, MBA, a pediatric otolaryngologist at Riley Hospital for Children at Indiana University Health. “The reason kids tend to outgrow earaches is because the Eustachian tube becomes longer and more vertical as you get older, letting gravity do its job so fluid is less likely build up behind the ear drum.” Ear infections tend to be most common among one to two year olds, tapering off by three to four years of age.


That little Eustachian tube allows mucus to drain from your ear into your throat, but it can backfire when teething, allergies, or a cold trigger congestion and interferes with its ability to regulate air pressure. “Having fluid buildup in your ear doesn’t necessarily mean you have an infection,” says Dr. Dahl. “Another common misconception is that most ear infections are bacterial, but most are actually viral.” However, having buildup in your middle ear makes it a breeding ground for bacteria and viruses to grow, so it increases your odds of getting an infection.

Signs and Symptoms

Fluid buildup behind the eardrum leads to a lot of pressure, which can cause pain and even temporary hearing issues. Older kids can tell you when they’re feeling ear pain, but clues that an infant may have an earache include trouble sleeping (laying down puts more pressure on the eardrum); loss of appetite (chewing can also aggravate ear pain); and not responding as usual to soft noises. (He points out that pulling on the ears may not necessarily be a sign of an infection, since babies and toddlers are at a stage where they’re exploring and discovering their bodies.)

“Ear infections can be hard to diagnose,” says Dr. Dahl. The difference between a bacterial infection, which can be helped with antibiotics, and a viral infection, which cannot, is that bacterial infections tend to come with more pain, a higher fever, and lethargy, says Dr. Dahl. Bacterial infections are usually caused when bacteria makes its way into the Eustachian tube, and having a lot of fluid here can help it to multiply.

In more severe cases, excess pressure on the eardrum can cause it to rupture, creating a hole for the fluid to drain. “Most holes in the ear drum will close spontaneously and don’t usually cause permanent hearing damage,” says Dr. Dahl.


The type of ear infection your child has will determine treatment. When doctors diagnose your child with an ear infection, they typically mean a bacterial or viral infection that accompanies fluid buildup in the middle ear area near the eardrum, rather than the other common swimmer’s ear infection, which is a fungi or bacterial infection of the ear canal itself and is often treated with anti-bacterial ear drops.

Many doctors try the “wait and see” approach rather than prescribing antibiotics right away. There are a few reasons for this, one being the risk of antibiotic-resistant bacteria and the other being that these meds won’t help viral infections, which are hard to distinguish from bacterial. Instead, your physician may recommend you control the pain with infants’ or children’s acetaminophen or ibuprofen or pain-relieving ear drops, as most earaches and viral ear infections will go away on their own in a few days.

However, if your child has a high fever, gets frequent ear infections, is really young, or has other conditions such as Down syndrome, your doctor may prescribe a 10-day antibiotic, or five- to seven-day antibiotic for kids ages six and older.

Some children need tympanostomy tube surgery, where a tiny metal or plastic tube is inserted into the eardrum to help fluid drain and equalize the pressure. The outpatient procedure usually takes about 15 minutes and calls for anesthesia. Usually the tubes fall out on their own after about a year. “Kids who have had persistent fluid behind their ear drums for three months or greater may be considered for it, but there’s no magic number of ear infections for getting tubes anymore,” says Dr. Dahl. “Also, those who are at greater risk with things such as speech delays or who have conditions such as Down syndrome are more likely to get tubes.”


Ear infections aren’t contagious, but the colds that can sometimes trigger them are. That’s why practicing good hygiene such as hand washing is key, says Dr. Dahl. “Also important is keeping the immune system strong with healthy food and plenty of rest.”

-- By Holly C. Corbett