Ear Infection in Children: Signs and When to Worry
In short: Most ear infections in children are middle ear infections (acute otitis media) that start after a cold. Symptoms usually last about three days and can last up to a week, and most children get better without antibiotics. Regular pain relief is the main treatment. Babies under six months, children who are very unwell, and any child with fluid coming out of the ear should be seen by a doctor.
Key takeaways
Ear infections are one of the most common reasons young children see a doctor, and most children have at least one before their third birthday.
A middle ear infection usually follows a cold, because mucus blocks the short Eustachian tube that drains the middle ear in young children.
Symptoms typically last about three days and can last up to one week, and most children improve within three days without antibiotics.
Antibiotics are more likely to help children under two with infection in both ears, children with discharge from the ear, and children who are very unwell.
Ear infections themselves are not contagious, but the colds and flu viruses that trigger them spread easily in taska, kindergarten and school.
What is an ear infection, and why do children get so many?
Children get more ear infections than adults because the tube that drains their middle ear is shorter, narrower and flatter, so mucus from a cold gets trapped and germs can multiply behind the eardrum.
The middle ear is a small air space behind the eardrum, drained by the Eustachian tube into the back of the nose. In toddlers this tube is nearly horizontal and swells shut easily during a cold. Fluid collects, germs grow in it, and pressure builds against the eardrum. That pressure causes the pain.
Ear infections are most common between about six months and three years of age, and become much less frequent after the age of five or six.
Which kind of ear problem does my child have?
Parents often use "ear infection" for three different things:
Acute otitis media: a middle ear infection, usually with pain and often fever, that follows a cold. This is the main topic of this article.
Otitis externa (swimmer's ear): an infection of the ear canal skin. The ear hurts when you touch or pull the outer ear, and it is common after swimming.
Glue ear (otitis media with effusion): sticky fluid that stays behind the eardrum without active infection. It is usually painless but can dull hearing for weeks.
Are ear infections contagious?
No. What spreads is the cold, flu or RSV that sets one off, which is why children in taska or kindergarten tend to have more ear infections.
What are the signs of an ear infection in a baby or toddler?
The most reliable signs are ear pain, fever and unusual irritability that starts a few days into a cold, often worse at night or when lying down.
Older children who can tell you
Pain in one or both ears, sometimes sudden and sharp
A blocked feeling or muffled hearing
Fever, tiredness and loss of appetite
Babies and toddlers who cannot tell you
Crying more than usual, especially when lying down at night
Rubbing or tugging an ear together with fever or a cold
Refusing feeds or pulling off the breast or bottle, because sucking and swallowing change the pressure in the ear
Not responding to quiet sounds as usual
Yellow or cloudy fluid coming out of the ear, which can mean the eardrum has burst
Does ear pulling always mean an ear infection?
No. Many babies pull at their ears when teething, tired, or simply because they have discovered them. Ear pulling in a happy, feeding, fever-free baby is rarely an infection. Ear pulling plus a cold, fever and a bad night is much more suggestive.
How do doctors diagnose an ear infection?
A doctor diagnoses an ear infection by looking at the eardrum with an otoscope, checking for a red, bulging eardrum with fluid behind it.
The check takes less than a minute and does not hurt, although many toddlers dislike being held still. I will usually also look at the throat and listen to the chest, because ear pain can come from tonsillitis or teething, and fever can have other causes. Home otoscopes and ear thermometers cannot reliably tell you whether there is an infection.
Does my child need antibiotics for an ear infection?
Often not. Most ear infections clear on their own within about three days, so many children only need pain relief and a review if things do not improve.
Antibiotics shorten symptoms only slightly in most children, and they can cause diarrhoea, nausea and rashes. If they are prescribed, give the full course and never use leftover antibiotics from a sibling.
When do doctors usually wait and watch?
For a child over two who is not very unwell, with mild symptoms in one ear, many doctors suggest no antibiotic or a "back-up" plan. You are given clear instructions to start the antibiotic, or return for review, if your child is not starting to improve after about three days, or gets worse at any point.
When are antibiotics more likely to help?
Babies under six months with a confirmed ear infection
Children under two with infection in both ears
Any child with discharge coming from the ear
Children who are very unwell, have a high fever or severe pain
Children with a weakened immune system or a condition that raises the risk of complications
What can I do at home to help my child's ear pain?
Regular pain relief, plenty of fluids, rest and a slightly raised head during sleep help most children feel better while the infection settles.
Babies under six months
Arrange a doctor's review rather than treating at home, even if the baby seems only mildly unwell.
Keep feeding little and often. Holding the baby more upright during feeds can ease ear pressure.
Only give paracetamol if a doctor has advised it, at the dose they give you for your baby's weight.
Six months to two years
Paracetamol or ibuprofen can be used for pain, at the dose on the pack for your child's age and weight, or as your pharmacist advises.
Offer smaller, more frequent feeds or drinks if swallowing seems to hurt.
Watch the pattern: a child who is perking up by day three is usually on track.
Children over two
Regular pain relief in the first one to two days, rather than waiting for pain to peak, gives a better night's sleep.
A warm (not hot) cloth held over the ear can be soothing.
What not to do
Do not put cotton buds, oils, garlic, breast milk or any home remedy into the ear.
Do not use ear candles. They do not work and can burn the ear canal.
Do not use ear drops if fluid is coming out of the ear unless a doctor has examined it.
Do not give cough and cold syrups, decongestants or antihistamines for an ear infection. They do not help ear symptoms.
Do not let your child swim with a burst eardrum or discharge from the ear until a doctor confirms it has healed.
What about flying and glue ear?
Most children can fly once the pain has settled, but muffled hearing that lingers after an ear infection should be checked, as glue ear can affect speech.
Can my child fly with an ear infection?
Changes in cabin pressure during take-off and landing can make an infected ear much more painful. If your child has active ear pain within a day or two of a flight, see your doctor before travelling. During any flight, feeding a baby or giving an older child a drink or something to chew during descent helps the ears equalise.
What is glue ear, and can it affect speech?
After an ear infection, fluid can stay behind the eardrum for weeks. Most glue ear clears within three months. If it lingers, your child may seem to have selective hearing, turn the television up, or have speech that is slower to develop. If you notice these signs, ask for a hearing check. Persistent glue ear sometimes needs an ENT review.
When to see a doctor, and when not to worry
Most ear infections can be managed at home with pain relief, but some signs mean your child needs to be seen soon or the same day.
Usually fine to watch at home
A child over six months with mild ear pain during a cold who is drinking well and still playing between doses of pain relief
Ear pulling in a happy baby with no fever and normal feeding
Mild fever that responds to paracetamol, with the child improving by day two or three
Book an appointment soon
Ear pain that is not starting to improve after two to three days
Pus, yellow fluid or blood coming from the ear
Three or more ear infections in six months, or four in a year
Hearing that still seems reduced six to eight weeks after an infection
Speech that seems to have stalled, or a child who often does not respond when called
See a doctor the same day
Any baby under three months with a temperature of 38°C or higher
A baby under six months with suspected ear pain or fever
A child who is very drowsy, floppy, hard to wake or unusually irritable
Redness, swelling or tenderness behind the ear, or the ear being pushed forwards
A stiff neck, severe headache, dislike of bright light, or a rash that does not fade when pressed
Weakness or drooping of one side of the face
Signs of dehydration: very few wet nappies, dry mouth, no tears
From Dr Nisa's clinic: In clinic, I often meet parents who have had a very long night with a toddler who will not settle and keeps grabbing one ear. The worry is understandable. What I look for is the whole picture: is the child drinking, are they playing between doses of pain relief, and is the eardrum red and bulging? Many children need only good pain relief and a clear plan for what to watch. The ones I want to see quickly are the very young, the very unwell, and those with a discharging ear.
Worried about your child's ears?
I am Dr Nisa Khalil, a consultant paediatrician with more than 18 years of experience, and I see children at ParkCity Medical Centre in Desa ParkCity, Kuala Lumpur. If your child has repeated ear infections, ongoing ear pain, or you are concerned about their hearing or speech, I can examine them and talk you through the options.
Book an appointment or, if you would like advice first, use the online eConsult.
You may also find these helpful:
Frequently asked questions
How long does an ear infection last in a child?
A middle ear infection usually lasts about three days and can last up to a week. Most children start to feel better within three days, with or without antibiotics. Muffled hearing can continue for a few weeks while fluid drains from behind the eardrum. If pain is not improving after three days, see your doctor again.
Can an ear infection go away on its own?
Yes. Most ear infections in children clear up on their own, which is why doctors often recommend pain relief and watchful waiting for children over two who are not very unwell. Babies under six months, children with infection in both ears under two, and children with discharge from the ear are more likely to need antibiotics, so they should always be examined.
Why is my child's ear pain worse at night?
Ear pain often feels worse at night because lying flat changes the pressure in the middle ear and reduces drainage through the Eustachian tube. Giving pain relief before bed and letting your child sleep with the head slightly raised on an extra pillow, for children over one, can help. Babies should still sleep flat on their backs.
Is it safe to fly with a child who has an ear infection?
Flying with an active ear infection can be very painful because of pressure changes during take-off and landing. It is usually best to see your doctor first if your child has ear pain within a day or two of a flight. Once the infection has settled, flying is fine. Feeding or giving a drink during descent helps the ears equalise.
Can teething cause ear pain?
Teething can cause babies to rub their ears and cheeks, because the nerves of the jaw and ear are close together. Teething does not cause a high fever or fluid coming from the ear. If your baby has ear rubbing with a fever, a cold and poor sleep, an ear infection is more likely, and it is worth having the eardrum checked.
When should my child see an ENT specialist for ear infections?
A referral to an ear, nose and throat specialist is usually considered if a child has very frequent infections, such as three in six months or four in a year, glue ear with reduced hearing lasting three months or more, or speech and learning concerns linked to hearing. Your paediatrician can arrange a hearing test and decide whether referral is needed.
Medically reviewed by Dr Nisa Khalil on 19 October 2026. This article is general information and does not replace a consultation with your own doctor.
References
Worried about your child?
Book an appointment with Dr Nisa Khalil for calm, evidence-based paediatric care when your child is unwell.
Book an appointment