Ear Infection Questions

Is this your child's symptom?

  • Your child was diagnosed with an ear infection
  • Your child's ears were recently looked at by a doctor
  • You are worried that the fever or ear pain is not getting better fast enough
  • Your child is still taking an antibiotic for the ear infection

Symptoms of Ear Infections

  • The main symptom is an earache.
  • Younger children will cry, act fussy or have trouble sleeping because of pain.
  • About 50% of children with an ear infection will have a fever.
  • Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.

Cause of Ear Infections

  • A bacterial infection of the middle ear (the space behind the eardrum)
  • Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
  • Blockage results in middle ear fluid (called viral otitis).
  • If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
  • Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
  • The onset of ear infections is often on day 3 of a cold.
  • How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.

When to Call for Ear Infection Questions

Call 911 Now

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Stiff neck (can't touch chin to the chest)
  • Walking is not steady
  • Fever over 104° F (40° C)
  • Ear pain is severe and not better 2 hours after taking ibuprofen
  • Crying is bad and not better 2 hours after taking ibuprofen
  • Pink or red swelling behind the ear
  • Crooked smile (weakness of 1 side of the face)
  • New vomiting
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Taking antibiotic more than 48 hours and fever still there or comes back
  • Taking antibiotic more than 3 days and ear pain not better
  • Taking antibiotic more than 3 days and ear discharge still there or comes back
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Ear infection on antibiotic with no other problems
  • Normal hearing loss with an ear infection
  • Prevention of ear infections
  • Ear tube (ventilation tube) surgery questions

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Treatment for an Ear Infection

  1. What You Should Know About Ear Infections:
    • Ear infections are very common in young children.
    • Most ear infections are not cured after the first dose of antibiotic.
    • Often, children don't get better the first day.
    • Most children get better slowly over 2 to 3 days.
    • Note: For mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral.
    • Here is some care advice that should help.
  2. Keep Giving the Antibiotic:
    • The antibiotic will kill the bacteria that are causing the ear infection.
    • Try not to forget any of the doses.
    • Give the antibiotic until it is gone. Reason: To stop the ear infection from flaring up again.
  3. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  4. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  5. Cold Pack for Pain:
    • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
    • Note: Some children prefer heat for 20 minutes.
    • Caution: Heat or cold kept on too long could cause a burn or frostbite.
  6. Limits on Activity:
    • Your child can go outside and does not need to cover the ears.
    • Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum.
    • Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse.
    • Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier may help as well. Children over age 6 can chew gum.
  7. Return to School:
    • Your child can go back to school when any fever is gone.
    • Your child should feel well enough to join in normal activities.
    • Ear infections cannot be spread to others.
  8. What to Expect:
    • Once on antibiotics, your child will get better in 2 or 3 days.
    • Make sure you give your child the antibiotic as directed.
    • The fever should be gone by 2 days (48 hours).
    • The ear pain should be better by 2 days. It should be gone by 3 days (72 hours).
  9. Ear Infection Discharge:
    • If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes.
    • The pus may be blood-tinged.
    • Most often, this heals well after the ear infection is treated.
    • Wipe the discharge away as you see it.
    • Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
  10. Call Your Doctor If:
    • Fever lasts more than 2 days on antibiotics
    • Ear pain becomes severe or crying becomes nonstop
    • Ear pain lasts more than 3 days on antibiotics
    • Ear discharge is not better after 3 days on antibiotics
    • You think your child needs to be seen
    • Your child becomes worse

Treatment for Hearing Loss with an Ear Infection

  1. Brief Hearing Loss:
    • During an ear infection, fluid builds up in the middle ear space.
    • The fluid can cause a mild hearing loss for a short time.
    • It will slowly get better and go away with the antibiotic.
    • The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months.
    • Permanent harm to the hearing is very rare.
  2. Talking With Your Child:
    • Get close to your child and get eye contact.
    • Speak in a louder voice than you usually use.
    • Decrease any background noise from radio or TV while talking with your child.
  3. Call Your Doctor If:
    • Hearing loss not better after the antibiotic is done.

Prevention of Recurrent Ear Infections

  1. What You Should Know:
    • Some children have ear infections that keep coming back.
    • If this is your child's case, here are some ways to prevent future ones.
  2. Avoid Tobacco Smoke:
    • Contact with tobacco smoke can lead to ear infections.
    • It also makes them harder to treat.
    • No one should smoke around your child. This includes in your home, your car or at child care.
  3. Avoid Colds:
    • Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children.
    • Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care.
  4. Breastfeed:
    • Antibodies in breast milk lower the rate of ear infections.
    • Breastfeed your baby during the first 6 to 12 months of life.
  5. Do Not Prop the Bottle:
    • During feedings, hold your baby with the head higher than the stomach.
    • Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear.
    • Having babies hold their own bottle also causes milk to drain into the middle ear.
  6. Get All Suggested Vaccines:
    • Vaccines protect your child from serious infections.
    • The pneumococcal and flu shots also help to prevent some ear infections.
  7. Control Allergies:
    • Allergies may lead to some ear infections.
    • If your baby has a constant runny or blocked nose, suspect an allergy.
    • If your child has other allergies like eczema, ask your child's doctor about this. The doctor can check for a milk protein or soy protein allergy.
  8. Check Any Snoring:
    • Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth.
    • Large adenoids can contribute to ear infections.
    • Talk to your child's doctor about this.

Ear Tube Surgery Questions

  1. Ear Tubes:
    • Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor.
    • The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter the space.
    • This lowers the risk of repeated ear infections and returns the hearing to normal.
  2. Ear Tubes - When Are They Needed?
    • Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid.
    • Also, the fluid has caused a hearing loss greater than 20 decibels.
    • Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed.
    • Ear infections that do not clear up after trying many antibiotics may need tubes.
    • Prevention should be tried before turning to surgery.
    • Talk to your child's doctor about when ear tubes are needed.
  3. What to Expect:
    • In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax.
    • If the tubes stay in over 2 years, talk with your child's doctor. The surgeon may need to take them out.
  4. Risks of Ear Tubes:
    • After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn't heal. Both of these problems can cause a small hearing loss.
    • Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when giving anesthesia to young children.
    • Therefore, doctors suggest ear tubes only for children who really need them.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.