Ear Infections in Kids: Symptoms, Antibiotics & Care

Quick answer: Ear infections in kids are infections of the middle ear, the small air-filled space behind the eardrum. They usually follow a cold, and the most common signs are ear pain (often worse at night or when lying down), fever, fussiness, trouble sleeping and, in babies, crying more during feedings. Many ear infections get better on their own within 2 to 3 days. Depending on your child’s age and how sick they are, your pediatrician may prescribe antibiotics right away or suggest “watchful waiting” for 48 to 72 hours while you treat the pain. Babies under 6 months, children with severe pain or a fever of 102.2°F (39°C) or higher, and kids who aren’t improving need to be checked.

Ear infections are one of the most common reasons young children see a pediatrician, and they tend to pile up during cold and flu season. According to the American Academy of Pediatrics (AAP), nearly 5 out of every 6 children have at least one before their third birthday. This guide explains how to spot an ear infection, when antibiotics help, how to keep your child comfortable, and which symptoms mean you should call the doctor or go to the ER.

What is an ear infection?

The middle ear connects to the back of the nose and throat through a narrow passage called the eustachian tube. When a cold, the flu or allergies make that tube swell, fluid can get trapped behind the eardrum. Bacteria or viruses can then grow in that fluid, causing a painful, bulging eardrum. The medical name is acute otitis media.

The CDC says the two most common bacterial causes are Streptococcus pneumoniae and nontypeable Haemophilus influenzae, and viruses can cause ear infections too.

A few related problems are easy to mix up:

Otitis media with effusion: fluid sits behind the eardrum without an active infection. It doesn’t cause fever, ear pain or pus, according to the CDC, but it can muffle hearing for a while.
Swimmer’s ear (otitis externa): an infection of the outer ear canal, not the middle ear.

Why young children get so many

The AAP explains that young children’s eustachian tubes are shorter, narrower and more horizontal than an adult’s, so fluid drains poorly. Their immune systems are also still developing. Things that raise the risk include frequent colds, group child care, bottle-feeding while lying down, and exposure to secondhand or thirdhand smoke.

Ear infections in kids: symptoms to watch for

Ear pain: the most common symptom. Older kids can tell you their ear hurts. Babies and toddlers may just cry, act irritable or fuss more during feedings, because sucking and swallowing change the pressure in the middle ear.
Trouble sleeping and a poor appetite
Fever: the AAP notes it can range from normal up to about 104°F (40°C)
Muffled hearing or not responding to quiet sounds. This is usually temporary and clears as the fluid drains, though it can last several weeks.
Fluid draining from the ear: yellow, white or blood-tinged, sometimes smelly. Pain often eases when this starts, because a small hole has opened in the eardrum. It isn’t an emergency, but your child should see the pediatrician.
Balance problems or clumsiness in some children

What about ear tugging? The CDC lists rubbing or tugging at the ear as a possible sign, but the AAP cautions that tugging alone isn’t reliable, since many babies pull their ears to self-soothe or while teething. Look at the whole picture: a recent cold, fever, fussiness and poor sleep together are more telling.

Only a doctor can confirm an ear infection by looking at the eardrum. It can’t be diagnosed over the phone, which is why a visit is needed if you suspect one.

Antibiotics vs. watchful waiting

For years, almost every ear infection got antibiotics. That has changed. The AAP says about 80% of childhood ear infections clear up without them, and the CDC notes the immune system often fights off the infection on its own. Antibiotics also have downsides: the AAP reports that about 1 in 5 children get side effects like diarrhea, stomach pain or rash, and overuse adds to antibiotic resistance.

Under the AAP’s clinical guideline for children 6 months and older, the decision depends on age and how severe the infection is:

Severe symptoms at any age 6 months and up (moderate to severe ear pain, pain lasting 48 hours or more, or a fever of 102.2°F / 39°C or higher): antibiotics are recommended.
6 to 23 months, infection in both ears: antibiotics are recommended, even if symptoms are mild.
6 to 23 months, one ear, mild symptoms: your doctor may offer watchful waiting, decided together with you.
2 years and older, mild symptoms: watchful waiting is an option whether one or both ears are infected.

Babies younger than 6 months aren’t covered by the watchful-waiting approach and should always be seen. The NHS lists them among the children who are usually considered for antibiotics. Children with a weakened immune system or other serious health conditions are also more likely to get antibiotics right away.

A note on how sources compare: some parent-facing summaries simplify this to “antibiotics for kids under 2.” The full AAP guideline is more specific, and watchful waiting can be an option for a mild infection in one ear even in a toddler. Your pediatrician will make the call after examining your child.

How watchful waiting works

Watchful waiting doesn’t mean doing nothing. You treat your child’s pain and watch closely for 48 to 72 hours. If your child gets worse or isn’t improving in that time, your doctor will start antibiotics. Some doctors use delayed prescribing: they give you a prescription but ask you to wait 2 to 3 days before filling it, since your child may recover without it.

When an antibiotic is needed, amoxicillin is usually the first choice. Give every dose for as long as prescribed, even once your child feels better, and tell your doctor about any drug allergies or side effects.

Home care: how to ease ear pain

Treat the pain first. The AAP guideline says pain should be treated whether or not antibiotics are used.
Use the right pain reliever for your child’s age. The CDC says babies under 6 months should get only acetaminophen, while children 6 months and older can have acetaminophen or ibuprofen. Follow the package directions or ask your pediatrician for the right dose for your child’s age and weight.
Never give aspirin to children or teens. It’s linked to Reye’s syndrome, a rare but serious illness.
Skip cough and cold medicines and decongestants. The NHS says there’s no evidence decongestants or antihistamines help ear infections, and the CDC advises against cough and cold medicines for children under 4 unless a doctor says otherwise. (More in our guide to cough and cold medicine for kids.)
Offer fluids and rest. Small, frequent drinks help, especially if your child is eating less.
Don’t put anything in the ear, such as cotton swabs, oils or home remedies. If the ear is draining, gently wipe the outside with a clean cloth or cotton ball.

The good news: the NHS reports that more than half of children with earache feel better within 4 days, and almost all are better within a week.

When to call the doctor

Call your pediatrician or schedule a visit if your child:

Is younger than 3 months and has a temperature of 100.4°F (38°C) or higher. The CDC says to contact a provider right away. (See when to call the pediatrician about a fever.)
Is under 6 months and you think they have an ear infection
Has a fever of 102.2°F (39°C) or higher
Has ear pain that is severe or lasts more than 2 to 3 days
Has pus, fluid or blood draining from the ear
Seems to have trouble hearing, or hearing hasn’t returned after the infection
Isn’t improving 48 to 72 hours after starting antibiotics or watchful waiting
Has side effects from an antibiotic, such as a rash, hives or ongoing diarrhea
Has had several ear infections close together
Shows signs of dehydration, such as no urine in 8 hours, a dry mouth or no tears

When to go to the ER / call 911

Ear infections rarely lead to serious complications, but an infection can spread to the bone behind the ear (mastoiditis), which can in turn affect the facial nerve or, rarely, cause meningitis, according to Children’s National Hospital.

Call your pediatrician right away (same day) if your child has pain, redness or swelling behind the ear, an earlobe that starts to stick out, a severe headache that doesn’t ease with pain medicine, new dizziness or loss of balance, or weakness on one side of the face.

Go to the ER or call 911 if your child:

Is very sleepy, hard to wake or confused
Has a stiff neck along with fever and seems very ill
Has a seizure. (Fever can trigger febrile seizures in young children.)
Is breathing very fast, working hard to breathe, or has pauses in breathing
Looks pale, blue or mottled, or feels unusually cold to the touch
Has a rash that doesn’t fade when you press a glass against it

Ear tubes and repeat ear infections

Some children get one ear infection after another. The AAP guideline says doctors may offer ear tubes (small tubes placed through the eardrum to let fluid drain) for children with 3 infections in 6 months, or 4 in a year with at least 1 in the past 6 months. Tubes may also be considered when fluid causes ongoing hearing problems or speech delays. The AAP notes tubes are recommended less often than in the past, and the guideline advises against daily “preventive” antibiotics.

How to prevent ear infections

Keep vaccines up to date, especially the pneumococcal vaccine and a yearly flu shot. Ear infections often follow the flu, colds and RSV.
Wash hands often to cut down on the colds that set up ear infections.
Breastfeed if you can. The AAP encourages exclusive breastfeeding for at least the first 6 months.
Avoid smoke exposure, including secondhand and thirdhand smoke.
Don’t prop bottles or let babies drink lying flat.

Not sure if it’s a cold, the flu or something else? Our guide to cold vs. flu vs. RSV vs. COVID in kids can help, and flu in kids covers flu-specific warning signs.

Frequently Asked Questions

How can I tell if my baby has an ear infection?

A baby with an ear infection often has a recent cold, then becomes fussy, cries more during feedings or when lying down, sleeps poorly and may have a fever. Ear tugging alone isn’t a reliable sign. Only a doctor can confirm an ear infection by looking at the eardrum, so call your pediatrician if you suspect one.

Do all ear infections in kids need antibiotics?

No. About 80% of childhood ear infections clear up without antibiotics, according to the AAP. For mild infections, pediatricians often recommend watchful waiting for 48 to 72 hours while treating pain. Antibiotics are generally recommended for severe infections, infections in both ears in children 6 to 23 months, and kids who don’t improve, and babies under 6 months should always be seen.

How long does an ear infection last in a child?

Most ear infections in children start to improve within 2 to 3 days, and almost all are better within a week, with or without antibiotics. Muffled hearing from leftover fluid behind the eardrum can last several weeks before it clears on its own.

Are ear infections contagious?

Ear infections themselves aren’t contagious, but the colds, flu and RSV that often lead to them are. Children can usually go back to school or child care once they feel well enough, according to the AAP. Check your child care center’s policy.

What can I give my child for ear infection pain?

For ear infection pain, the CDC says babies under 6 months should get only acetaminophen, and children 6 months and older can have acetaminophen or ibuprofen. Follow the package directions or ask your pediatrician for the right dose. Never give aspirin to children, and don’t put drops or oils in the ear unless a doctor tells you to.

When is an ear infection an emergency?

Go to the ER or call 911 if a child with an ear infection is very sleepy, hard to wake or confused, has a seizure, has a stiff neck with fever, or is struggling to breathe. Call the pediatrician the same day for swelling, redness or pain behind the ear, an ear that sticks out, or weakness in the face, which can mean the infection has spread.

Can my child fly or swim with an ear infection?

Swimming: the NHS advises avoiding swimming and keeping water out of the ear while an ear infection is active. Flying: ask your pediatrician before a trip, especially if your child is in a lot of pain.

Related guides

Sources

This article is for general information and is not a substitute for advice from your child’s doctor. In an emergency, call 911.

Ear Infections in Kids: Symptoms, Antibiotics vs. Watchful Waiting and When to Call