Everything Parents Need To Know About Ear Infections In Babies, Toddlers, & Kids

Your baby is suddenly fussy, unable to sleep, and messing with their ears a lot — oh, no. If your little one has been sick lately, it could be that their cold has turned into an ear infection. Your baby’s ear infection may look just like this, or they could have no symptoms at all. Either way, the signs of an ear infection will change as your little one grows and develops, though the causes and treatments are the same at any age (time, growth, antibiotics, and yes, sometimes ear tubes).

What is an ear infection?

Ear infections — a.k.a. otitis media — happen behind the ear drum, in the middle ear space. Sometimes they’re called inner ear infections colloquially, or confused with swimmer’s ear, which is an infection of the ear canal in front of the ear drum. But for babies and toddlers, otitis media is the kind of ear infection parents are most likely dealing with.

“Ear infections are one of the most common problems in childhood. Roughly 80% of children will have experienced at least one episode of an ear infection by the time they're 2 or 3 years of age, so it's remarkably common,” says Dr. Soham Roy, MMM, FACS, FAAP, chair of pediatric otolaryngology, head and neck surgery at Children’s Hospital Colorado, and professor and vice chair of the department of otolaryngology at the University of Colorado School of Medicine.

Ear infections are common for children between the ages of 6 months and 3 years, but peak between 9 months and 2 years old, explains Dr. Anna Messner, FACS, FAAP, division chief of otolaryngology/head and neck surgery at Texas Children's Hospital. So, if your child dealt with ear infections as a baby, chances are they will continue into toddlerhood (ugh). Regardless of age, ear infections are generally caused by the same things.

Because of how common ear infections are, it’s important to know the signs and symptoms, and how to help your little one if (or when) an infection strikes.

What causes or contributes to ear infections

Age

Ear infections have a lot to do with anatomy, says Roy, specifically something called the eustachian tube, which connects the middle ear to the back of the nose. “The problem is that in young kids, the eustachian tube is very flat and short, and it’s also relatively floppy and doesn't function very well. That predisposes you to developing ear infections,” he says. “As you get older, that ear, that eustachian tube starts to get more of an angle to it, so you have gravity working in your favor, and it gets stronger and longer. This is why most people with childhood ear infections will outgrow it by the time they get into an adulthood.”

Viruses

“At any age, oftentimes it will start with a virus,” says Messner. “You'll see a runny nose, maybe a little cough, and then a couple days later the ear infection will show up. In some cases, the kids will have no other viral symptoms and they'll just have the ear infection.”

Attending daycare or school

Attending daycare is a contributing factor, Roy says, noting children in daycare are twice as likely to develop “recurrent episodes of ear infection” because they’re exposed to more illnesses than children kept at home. “Most of these ear infections are actually seeded from upper respiratory infections. So just about every parent will tell you, ‘It started with a cold, and then my child developed an ear infection,’ and that's why they're so common in the daycare environment,” he says.

Genetics

According to Roy, a tendency to develop ear infections can be genetic (since anatomy plays such a big role), so be mindful if you or your older children had chronic ear infections.

Secondhand smoke or vape exposure

If you smoke or vape, be mindful about exposing your child to it — your precautions could help prevent ear infections. “Families who smoke, their child is much more likely to develop otitis media, in addition to developing asthma and things like that. If you smoke, smoke outside, don’t smoke around your child, and when you come in, wash your hands and change your clothes so your child doesn't breathe it in off of your clothing.”

Signs and symptoms of an ear infection

In babies

Common ear infection symptoms for babies include:

• Difficulty sleeping
• Fever
• Fluid leaking from the ear (which means the ear drum has ruptured)
• Fussiness
• Smacking at the ears or side of the head

That said, not all children experience a fever, or show symptoms at all. “Kids can have ear infections and be totally asymptomatic,” says Roy. “I don't know if that’s because they’re not experiencing ear pain or, you know, my theory is that there are a lot of kids who have had frequent ear infections who have just grown accustomed to it. They just assume this is what life is, this is what your body feels like.”

Both experts say that some babies just like to touch and tug on their ears for comfort, or because they’re learning about their bodies. By itself, your baby messing with their ears shouldn’t worry you too much.

In toddlers and kids

Babies and toddlers will have many of the same ear infection symptoms, like a fever and ear pain. But there are a few notable differences:

• Frequently waking up at night and especially fussy
• Balance issues
• Pointing to their ears and complaining of pain/discomfort
• Hearing loss and/or speech delay
• In older kids, fevers are less common.

“Very commonly, the main symptom is frequent waking up at night,” says Messner. “You have a child who was sleeping through the night and now they wake up and they’re fussy. One other thing is that some children will have balance issues when they have a lot of fluid in their middle ear.”

“Toddlers are much more likely to be able to express their discomfort, so they can actually say ‘ow’ and point at their ears, tell you their ears hurt, things like that,” says Roy.

Treatment

For babies

The treatment plan for your baby’s ear infection will likely depend a lot on the severity of the infection how Baby is reacting to it. Here’s what a doctor may advise to treat your baby’s ear infection:

• Watchful waiting
• Tylenol or ibuprofen
• Ear drops
• Antibiotics (oral)

If your child is diagnosed with an ear infection but doesn’t seem uncomfortable, Roy says your pediatrician may advise “watchful waiting” (rechecking the child in 48 hours to see if the infection is improving on its own). If so, antibiotics may not be necessary. But if your kid is feeling crummy, you’ll likely skip right to the pharmacy, prescription in hand. Most children will receive oral antibiotics, but occasionally, ear drops might do the trick.

“If there is a hole in the eardrum or there is a tube in the eardrum, the ear will be treated with topical antibiotic ear drops,” says Messner. “If you do not have a hole in the eardrum either naturally or via tube, then the topical drops won’t work. And it’s always important for pain control to use Tylenol or ibuprofen. Those are very safe medications. They don’t recommend ibuprofen for children younger than 6 months, but Tylenol can be given at any age. And if your child has an ear infection and is fussy or waking, then it can help with the pain.”

For toddlers

If the usual antibiotics aren’t working for your toddler, or they’re getting ear infections frequently, your pediatrician may refer you to an ENT to discuss getting ear tubes for your child. Ear tubes, also called tympanostomy tubes or myringotomy tubes, are tiny hollow cylinders placed in the ear drum to allow fluid from the middle ear to drain out, which helps relieve infections.

“Tubes are generally put in for one of two purposes. One is for kids who have recurrent middle ear infections. And the second is for kids who have chronic fluid buildup in their ears, which affects their hearing and speech and language development,” says Roy. “The general rules of thumb are [a child qualifies for tubes after] three infections within a six-month period, or four infections within a 12-month period. And once you’ve met one of those two criteria, that’s when we start to consider placing ear tubes.”

An ENT may also recommend tubes if fluid from past ear infections isn’t draining from your child’s ears after three or more months, or causing hearing loss or speech delay, Roy says.

For kids

Just like babies and toddlers, kids with ear infections will likely be treated with either the “watchful waiting” method or oral antibiotics, these experts say. Roy adds that it’s not unheard of for children to need ear tubes after toddlerhood, so if your kid is dealing with repeated infections, don’t hesitate to bring up the procedure with your pediatrician.

Seeing your child sick or dealing with ear pain is the worst, no matter how old they are. Rest assured that there are tried and true methods for treating ear infections, even in the most stubborn little ears.

Sources:

Dr. Anna Messner, FACS, FAAP, division chief of otolaryngology/head and neck surgery at Texas Children's Hospital

Dr. Soham Roy, MMM, FACS, FAAP, chair of pediatric otolaryngology, head and neck surgery at Children’s Hospital Colorado, and professor and vice chair of the department of otolaryngology at the University of Colorado School of Medicine