Childhood Ear Infections: When To See a Doctor

Most children will have at least one ear infection by the time they’re 3 years old. The good news is that most will clear up on their own without any lasting effects.

But how do you know when your child needs to see a doctor or if it’s safe to take a watch-and-see approach? That largely depends on your child’s age and overall health.

Types of Ear Infections

A middle ear infection is the most common bacterial infection in children. It develops when the connection between your child’s middle ear and throat (the estuation tube) becomes inflamed and fills with fluid where bacteria grow. Colds and allergies increase the likelihood that this tube gets clogged and infected.

An outer ear infection, commonly known as swimmer’s ear, affects the skin of the ear canal or outer ear and develops when bacteria grow in the moisture of the ear. Children with eczema and seborrheic dermatitis, also called cradle cap, have a weaker skin barrier and are more likely to develop an outer ear infection, as well as those who spend a lot of time in the water.

Detecting a Middle Ear Infection

Your child is most likely to develop ear infections between the ages of 6 months and 2 years because the connection between the ears, nose and throat is narrow, short and more horizontal, making it easier for fluid to become trapped. Plus, children have weaker immune systems than adults and cannot fight off infections as well.

Symptoms of a middle ear infection include:

• Ear pain, which is indicated by rubbing or tugging ears, crying more than usual, trouble sleeping and acting fussy
• Loss of appetite
• Irritability
• Poor sleep
• Fever
• Drainage from the ear
• Trouble hearing

Diagnosing Ear Infections

Your child’s doctor will examine the outer ear and then use a small flashlight called an otoscope to view the ear canal and middle ear. If your child has an outer ear infection, the doctor will see skin changes and possibly pus drainage. A middle ear infection typically causes bulging of the eardrum.

Treating Ear Infections

Helping your child heal from an ear infection involves a two-step approach: treating the infection and the pain. Your child’s doctor will recommend a treatment plan based on your child’s medical conditions and age. It’s important to personalize treatment because 80 percent of middle ear infections improve on their own without antibiotics. And if they do not improve on their own, it is very rare for ear infections to lead to more severe infections. Avoiding antibiotics, when safe, is ideal because it decreases antibiotic resistance, allergic reactions and gastrointestinal upset.

Babies younger than 6 months almost always require antibiotics because they are not fully vaccinated and complications from ear infections can be more serious at this age.

If your child is older than 6 months, the American Academy of Pediatrics recommends you and your child’s healthcare provider decide together how to treat ear infections that are not severe. It often is best to watch your child for two to three days before antibiotics are started.

With both types of ear infections and at all ages, starting to treat the pain on the first day of symptoms will provide the maximum relief. Your child’s doctor usually will recommend acetaminophen or ibuprofen for the pain.

Does My Child Need Ear Tubes?

Children who suffer from recurrent infections may benefit from a surgical procedure in which doctors insert small tubes in the eardrums. The ear tubes help drain the fluid that is trapped behind the eardrum to prevent bacteria from growing and allow the eardrum to move normally for hearing and language development.

When a child has a middle ear infection after having ear tubes placed, antibiotic drops can be used instead of oral antibiotics to treat it.

Typically ear tubes are considered when children have fluid behind the ears for at least three months or they have multiple ear infections, such as at least three infections in six months or four infections in a year. Your child’s pediatrician will refer your child to an ear, nose and throat (ENT) specialist for an evaluation.

Preventing Ear Infections

There are things you can do to reduce your child's risk of developing ear infections, including:

• Consider breastfeeding. Antibodies in breast milk may reduce the rate of ear infections.
• Bottle-feed in an upright position. Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tubes.
• Make sure your child gets vaccinations. Preventing viral infections and other illnesses helps prevent ear infections.
• Avoid secondhand smoke. Studies show that children who are exposed to secondhand smoke are up to three times more likely to develop ear infections.
• Prevent colds. Don’t share toys, foods, drinking cups or utensils, and wash your hands frequently. Most ear infections start with a cold.
• Control allergies. Inflammation and mucus caused by allergic reactions can block the eustachian tubes and make ear infections more likely.

Once children reach elementary school, they usually age out of ear infections because the shape of their eustachian tubes become more vertical and the area gets larger as they grow.