Ear Infections in Babies: Causes, Symptoms, and Treatments

Your baby is crying. They have a runny, stuffy, yucky nose and won’t eat. They’re cutting teeth and have a fever. What should you worry about first? The possibility of your baby having an ear infection. Acute otitis media, the scientific name for a middle ear infection, is the most common reason parents take their sick baby to the doctor. It’s also the most common bacterial infection treated with antibiotics in children and babies.^1,2

Ear infections in babies are tricky for several reasons. First, babies can’t tell you what hurts; they just cry or act more fussy than usual. Second, their ear and sinus anatomy make them prone to ear infections. Third, they’re exposed to many new germs and viruses, and their body hasn’t yet built any immunity. So, they always seem to have a runny nose or cough (or both), which can lead to an ear infection.² Here, we’ll explore how ear infections are treated in children and what you can do to help them.

What Is an Ear Infection in Babies?

A middle ear infection happens when the eustachian tube swells due to an upper respiratory cold or virus or a bacterial infection. See a picture of the ear’s anatomy below:³

The swelling of the eustachian tube causes fluid or mucus to build up behind the eardrum in the middle ear. This fluid usually drains down into the back of the throat, but it grows bacteria when it can’t drain properly. A warm, moist environment is perfect for growing bacteria, leading to an ear infection in a baby.²

It’s important to note that swimmer’s ear, or otitis externa, is an infection of the ear canal (outer ear). Swimmer’s ear is NOT the same as a middle ear infection. The eardrum blocks any water from getting into the middle ear, so things like swimming or taking a bath don’t cause middle ear infections.⁷

Why Are Babies and Children More Likely To Get Ear Infections?

Babies’ immune systems are still developing, making it harder to fight off an ear infection. Also, their eustachian tube anatomy makes them more prone to ear infections. In babies, the eustachian tube is smaller and more horizontal than in adults, so it doesn’t always drain properly. Adults are also more aware of their bodies and what’s normal for them. So, an adult can note and address something abnormal in their body more quickly.²

Signs and Symptoms of Ear Infection in Babies

The signs and symptoms of ear infection can vary and sometimes even be challenging to decipher in babies. For a middle ear infection, there are a few signs you might notice, such as:²

• Tugging and pulling at the ears
• Fluid draining out of the ear
• Ear pain, if your child can tell you

Other more nonspecific signs and symptoms could include:^2,8

• Fussiness and crying
• Trouble sleeping
• Difficulty feeding with breast or bottle or a loss of appetite
• Fever
• Loss of balance
• Not hearing well

When To Call the Doctor

Some ear infections in babies will improve on their own in about 48-72 hours by giving the child lots of fluids, rest, and over-the-counter (OTC) pain relievers, such as acetaminophen or ibuprofen. Ibuprofen tends to work better for ear infections because it has anti-inflammatory properties, which help decrease the swelling in the middle ear.²

Remember that, no matter what, you know your child better than anyone else, including the doctors and nurses. If you feel like something more than a cold is going on with your child, call their pediatrician or bring them in to see a doctor.

How To Prevent Ear Infections in Babies

You can’t always prevent ear infections in a baby. But there are some things you can do to help reduce the risk factors, like the following:

• Breastfeeding a baby for at least three months can help reduce the risk of ear infections by strengthening their immune system.^1,9
• Avoid propping up a bottle to feed your baby. This can lead to the liquid pooling in the back of the throat and getting into the eustachian tubes, leading to an ear infection.¹
• Avoid people smoking around babies and children, as smoke has been proven to increase ear infections. Secondhand or passive smoke can irritate the respiratory tract, which leads to swelling in the eustachian tubes.⁶
• Wash your hands frequently to prevent catching a cold or the flu, and try to keep sick children away from other children.²

Ear Infection Treatment for Babies

The most common treatment for a baby’s ear infection is a course of antibiotics. These are usually prescribed for a seven- to 10-day period.⁸ They might feel better and eat normally again after a few days of the antibiotic. Still, it’s important to give your child all doses of the medication so that all the bacteria are cleared from the ear. Call your doctor if they aren’t feeling better after two to three days on the antibiotic or if they get worse again once you stop the antibiotic. They may need a different antibiotic to attack the infection.¹

Follow the Doctor’s Instructions

If your doctor gives you a follow-up appointment to recheck the ears, it’s essential to keep that appointment in case the infection isn’t entirely gone. Also, ibuprofen (if your doctor approves it) is helpful in the first two days of the infection, especially at bedtime. It helps reduce the swelling in the inner ear and eustachian tubes to decrease the pain.^1,2

Sometimes, your doctor will give you an antibiotic prescription but ask you to wait 48-72 hours before filling it to see if your child will fight off the ear infection on their own without the medication. This is a common practice to help prevent antibiotic-resistant bacteria from developing.^1,2

The Bottom Line

Anyone can get an ear infection, but it’s more likely to happen in children than adults. Ear infections are a basic fact of life for most parents since 5 out of 6 children will have an ear infection before they turn 3 years old. According to the National Institutes for Health (NIH), there’s research being done by the National Institute on Deafness and Other Communication Disorders (NIDCD) to explore ways to help improve the prevention, diagnosis, and treatment of middle ear infections.²

Until the experts or someone else can wave a magic wand to make our children “all better,” we just need to be the best parents we can be and deal with ear infections as they happen.

Frequently Asked Questions