Ear Infections in Infants

At some point in your baby or toddler’s life, it’s likely they will have an ear infection. If you’re wondering what causes ear infections, and what signs and symptoms to look out for in your baby and toddler, we’ve got you covered. Read on to find out more about this common childhood illness, and how it can be treated.

How Common Are Ear Infections in Babies and Toddlers?

Ear infections, also known as otitis media, are a common infection of the middle ear. Most children get an ear infection in their first few years of life, most frequently between 6 months and 3 years of age. Moreover, 66 percent of children have had an ear infection by the time they turn 2 years old. Ear infections in young children are also more common during the cold and flu season of winter and early spring. Luckily, recurrent ear infections tend to drop off for most children between the ages of 4 and 6 years old. However, that doesn’t mean they won’t crop up again since anyone, including adults, can get an ear infection.

Signs and Symptoms of an Ear Infection in Your Baby or Toddler

So, how do you know if your baby or toddler has an ear infection (otitis media)? It’s not easy to figure this out with babies (toddlers will often tell you that their ears hurt), but there are some signs you can look for. Here’s how to tell if your baby or toddler has an ear infection:

• You may see your baby or younger child pulling at their ear. An older child may tell you their ear hurts

• Crying, especially for babies during a feeding, because the sucking and swallowing may cause a change in pressure in the middle ear

• Trouble sleeping

• Decreased appetite

• Fever, typically between 100.4 to 104 degrees Fahrenheit

• Your toddler may appear to be off-balance when walking since an ear infection affects balance due to fluid in the middle ear

• Drainage from the ear that's either pus or a blood-tinged yellow fluid. This may indicate your child’s eardrum has developed a small hole due to the infection; this eventually heals by itself

• Not hearing well due to the fluids behind the eardrum, making the transmission of sound difficult. You may notice this if your child is not responsive to softer sounds, or if a child-care provider tells you that your child seems to be inattentive in day care or school. If your child still has hearing issues after the ear infection has been treated or passed, consult their healthcare provider, who may recommend seeing an ear, nose, and throat specialist (ENT).

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What Causes Ear Infections in Babies and Toddlers?

You may be asking yourself, “How do babies and toddlers get ear infections?” There are quite a few situations that can lead to your child developing an ear infection, including the following:

• Your child previously had a cold. Statistically, 70 percent of ear infections occur after a child’s immune system has been weakened by a cold.

• Underdeveloped Eustachian tubes. Since children are still growing and developing, their Eustachian tubes (connecting the middle ear to the throat) are small and short, making them more susceptible to infections.

• Your child attends childcare. Children under 1 year old who attend child care tend to get more ear infections than those who are cared for at home, since they’re exposed to more viruses in the presence of other children.

• Feeding your baby in a lying position. Feeding your infant in a lying position or having your infant self-feed from a bottle in a lying position can increase the chances of an ear infection, since the breast milk or formula can flow into the inner ear.

• Your child’s gender. Boys get more middle ear infections than girls; medical experts aren't sure why this is.

• It’s hereditary. Surprisingly, ear infections can run in the family. If you had many ear infections while growing up, or if another of your children was prone to have many ear infections in early childhood, your baby or toddler may be more likely to get ear infections.

• Secondhand smoke. If your child breathes in tobacco smoke, it can increase their risk of getting an ear infection, as well as other illnesses like bronchitis, pneumonia, and asthma.

How to Prevent Ear Infections in Babies and Toddlers

There are a few ways you can get ahead of your child’s chance of getting ear infections:

• Breastfeeding your baby. Since breast milk contains antibodies, it’s been known to promote a lower rate of ear infections in breastfed babies compared to formula-fed babies

• Always bottle-feeding your baby in an upright position. Feed your baby so their head is above the level of the stomach to prevent the Eustachian tubes from getting blocked by the fluid

• Not smoking around your child

• Ensuring your child has received their latest vaccinations

• Practicing good hygiene, like frequent handwashing

• Providing your child nutritious meals.

Other Preventive Measures

In some older children, ear infections might happen due to seasonal allergies. If you think there’s a connection between your child’s ear infections and seasonal allergies, consult their healthcare provider, who may suggest testing for allergies and/or a prescription for antihistamines. If your child continues to have frequent ear infections, the healthcare provider may recommend they be seen by an ENT, who can recommend preventive measures. In certain cases of recurrent ear infections that cause hearing loss, the ENT may recommend that tiny tubes be inserted into your child’s eardrums. During this medical procedure, your child would be placed under sedation and would not feel anything. The tubes help prevent fluid and infection-causing bacteria from entering the middle ear as well as restore proper hearing. If you’re concerned about your child’s frequent ear infections, consult their healthcare provider or an ENT for more information on preventive measures as well as the possibility of the aforementioned medical treatment including its advantages and disadvantages.

Treatment for a Baby or Toddler’s Ear Infection

If you suspect your baby or toddler has an ear infection, you’ll want to contact their healthcare provider. Before or after the appointment, you may try the following home treatment strategies:

• If they have a high fever, help keep them comfortable by

  • dressing them in light clothing

  • keeping the home’s temperature cool

  • giving them more fluids (exclusively breast milk or formula before 6 months of age, with water only recommended after 6 months old).

• For fever and pain, after checking with the provider, you may give your child an age-appropriate dose of acetaminophen or ibuprofen (but not aspirin, which isn't safe for children)

• For an older child, with the provider's approval, place a warm compress or heating pad over your child’s ear to help manage the pain

• Use pain-relieving eardrops to help ease your child’s pain, but check with the healthcare provider first.

At the appointment, the healthcare provider will check your child's ears for fluid in the middle ear space behind the eardrum. The provider may use various instruments to check for their sensitivity level and to see how the eardrum moves. In some cases what you may have thought was an ear infection could simply be earache caused by your baby’s teething, a foreign object lodged in your toddler’s ear canal, or a buildup of earwax. The provider will rule these out during the examination. Most ear infections don’t require antibiotics as they can resolve on their own. But in some cases, the provider may decide to prescribe an antibiotic and/or eardrops. Follow the dosage schedule closely and make sure to finish using all the medicine. Stopping the medicine before your child is fully recovered can encourage the ear infection to come back with vengeance.

Recovering From an Ear Infection

If the healthcare provider prescribes an antibiotic for your child, be sure to follow the dosage instructions carefully. If you’re following the provider’s guidelines regarding the antibiotic dosage, your child may start feeling better in one to two days, with the fever and ear pain disappearing. During this time your child may also feel fullness or popping in the ear, which is a good sign that the recovery is under way. The provider may very likely ask to see your child again to monitor the recovery. The provider will once again check to see if there’s fluid in the middle ear. Fifty percent of children may still have fluid in the ear three weeks after treatment with medicine. But in 90 percent of those children, the fluid in the middle ear disappears within 3 months. If the fluid doesn’t go away, the provider may refer your child to an ENT. Oftentimes, in these instances, the ear infection may not be responding to the specific type of antibiotic that was first prescribed. The ENT may decide to have your child do another round of antibiotics, but this time prescribing a stronger one.

Should You Limit Your Child’s Activities During an Ear Infection?

There’s no need to limit your kid’s activities during an ear infection unless they have a fever. In that case, it’s best to keep them home from day care or school. Otherwise, they can attend while recovering from the ear infection. Just be sure to let the child care director or school nurse know of your child’s ear infection and how the prescription medicine should be administered. Some antibiotics may need to be refrigerated, so it’s a good idea to check that the child care centre or school has a refrigerator where it can be safely stored. Make sure the medicine is labeled with your child’s name and dosage instructions. If your baby or toddler participates in swimming, it may be OK for them to swim while recovering from an ear infection as long as they don’t have drainage from the ear or a perforation in the eardrum. You may want to clear this with the healthcare provider first. If you need to travel by airplane with your baby or toddler, know that’s it’s OK for your baby to travel while recovering from an ear infection. However, they may experience pain from the pressure. This can be remedied by nursing your baby or offering them a pacifier, as the sucking and swallowing can ease any discomfort.

The Bottom Line

Ear infections, also known as otitis media (an infection of the middle ear) are very common in babies and toddlers. Being exposed to colds and other childhood illnesses in a child-care setting can increase the chance of your child also getting an ear infection. Smoking around your baby or bottle-feeding them in a lying position can also increase the chance of them getting an ear infection. Ear infections may often include fever and earaches. Until you’re able to have your child seen by their healthcare provider, you can keep your little one comfortable by using a pain-relieving medication or eardrops with permission from the provider. Your child may need antibiotics to completely recover from the ear infection. The provider may ask to see your child again after the full course of antibiotics have been taken to double-check on your child’s recovery. During this time, your child can go about their days as normal—there’s no reason to keep them home from day care or school. Most ear infections tend to be minor and clear up on their own without causing your child problems, so take heart that your child will soon recover from their ear infection and be back to their usual self.