How to Tell if Your Child Has an Ear Infection, When to Go to the Doctor

A local pediatrician explains what to look for when you think your child has an ear infection, why a doctor may not prescribe antibiotics and when ear tubes might be necessary.

Child with earacheMany of us remember getting ear infections as a child and the intense pain and bubble-gum flavored medicine that went with them. Ear infections are common in children and many kids suffer at least one. They become less common after childhood because the anatomy of the ear changes.

Here’s a rundown of what patients and parents need to know about middle ear infections:


What is an ear infection and what causes it?

The ear is made up of three parts: the outer, the middle and the inner ear. The middle ear is the space just behind the eardrum. Sometimes, excess fluid can pool in this space and lead to infection.

Acute middle ear infections (or acute otitis media) are painful infections that last a few days. They are often caused by the same viruses that cause the common cold, or by bacteria. The distinction between viral and bacterial causes is important because only bacterial causes respond to antibiotic treatment and some bacterial infections get better even without antibiotics.

Sometimes with an infection, the eardrum can rupture and have a hole that remains. When fluid from the infection fails to clear, or a hole is present, doctors call this a chronic middle ear infection.

What symptoms should parents look for?

Acute ear infections can be quite painful. Common symptoms include fever, irritability, trouble sleeping and eating, and sometimes pus or bloody fluid leaking from the ear. Very young children who cannot talk may pull or pick at their ears, “head bang,” or shake their head repeatedly.

Chronic ear infection symptoms may be more difficult for parents to spot. Children may complain of hearing loss, a sensation of pressure in their ears, and a loss of balance. Sometimes a discharge will come from the ear. There may be a delay in the development of speech and language.

When should parents take their child to a doctor?

If children have ear pain that is very severe or lasts more than a day, or if there is discharge from the ear, parents should take a trip to the doctor. A very young child who is not babbling or a child who complains of not hearing well should be checked for chronic middle ear infection.

Why don’t doctors always prescribe antibiotics? 

Many ear infections are caused by a virus, and antibiotics won’t help treat a viral infection. If a child does have an acute infection, the doctor will likely recommend a pain reliever to help with the fever and earache and start antibiotics if the symptoms don’t improve after a few days.

What if a child keeps getting them?

Doctors may recommend the placement of ear tubes in the eardrum. The tympanic membrane is the thin sheet of tissue that separates the outer from the middle ear. Tubes in the eardrum “ventilate” the middle ear and so prevent recurrent middle ear infections. Ear tubes also allow fluid to drain from the ear when an infection does occur.

What is surgery for tubes like? 

In general, surgery takes about 15 minutes. Doctors will place tubes in both ears during the same procedure. Children are under general anesthesia for the surgery, which means they will be completely asleep. After surgery, they should in most cases go home the same day.

Children may have mild discomfort and a bloody or pus-like drainage from the ears for about a week but can usually do all activities, including bathing, right away. A custom wax or putty earplug can be used if the child swims in water deeper than three feet.

Udayan K. Shah is a professor at Sidney Kimmel Medical College at Thomas Jefferson University and chief of otolaryngology at Nemours/A.I. duPont Hospital for Children.

From Merck Manual Consumer Version (Known as Merck Manual in US and Canada and MSD Manual elsewhere.), edited by Robert Porter. Copyright 2019 by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, Kenilworth, NJ. Accessed Nov. 2019 at home.

Categories: Care, Health & Nutrition, Medical