Ear Infections in Children: A Parent’s Guide to Signs, Comfort and When to Get Help
Why young children get so many ear infections, how to spot one in a child who cannot tell you, how to ease the pain, the age-related warning signs, and what glue ear and grommets mean.
Part of the Complete Ear Infection Guide.
Key fact: Most children have at least one middle ear infection before they start school, and most get better within three days without antibiotics. The job at home is to treat the pain well and know the warning signs. A baby under 3 months with a temperature of 38°C or above always needs urgent medical advice, whatever the cause.
Earache Relief for Children
Access Doctor provides Otigo pain-relieving ear drops, suitable for children aged 1 and over with an intact eardrum, following a GPhC-regulated online consultation with our pharmacist independent prescribers.
See ear infection treatments →Why children get so many ear infections
The Eustachian tube, which drains the middle ear into the back of the throat, is shorter, narrower and more horizontal in young children than in adults. It blocks easily when a cold swells the lining of the nose and throat, so fluid collects behind the eardrum and can become infected. Add the number of colds a young child catches, especially at nursery, and ear infections become one of the commonest reasons for a sore, unsettled child.
The peak age is between 6 months and 2 years, and most children grow out of frequent infections by the age of 6 or 7 as the tube lengthens and their immunity matures. Middle ear infections themselves are not contagious, but the colds that trigger them are.
6–24
Months: the peak age for ear infections
3 days
Typical length, often without antibiotics
38°C
Temperature that always needs urgent advice under 3 months
How to tell if your child has an ear infection
Older children can tell you their ear hurts. Babies and toddlers cannot, so the signs are less direct and often appear during or just after a cold.
| Babies and toddlers | Older children |
|---|---|
| Pulling, rubbing or holding one ear | Earache, often worse lying down or at night |
| Crying more than usual, especially when lying flat | A blocked or muffled feeling in the ear |
| Fever | Fever |
| Poor feeding, or pulling off the breast or bottle | Not hearing as well, turning the television up |
| Restless sleep and irritability | Feeling generally unwell |
| Not responding to quiet sounds | Mild dizziness or clumsiness |
Ear pulling on its own, without fever or distress, is common and often has nothing to do with infection; teething and simple self-soothing cause it too. A sudden easing of pain followed by yellow or green fluid from the ear usually means the eardrum has burst to release pressure. That sounds alarming, but it typically heals within a few weeks; your child should still be seen.
Easing the pain at home
Pain relief is the main treatment for a middle ear infection, and giving it properly makes the biggest difference to how your child, and you, get through the next few days.
| What helps | How |
|---|---|
| Children’s paracetamol | From 2 months of age. Give the dose for your child’s age or weight on the packet, regularly rather than only when they cry |
| Children’s ibuprofen | From 3 months of age and over 5kg, with food or milk. Avoid if your child has chickenpox, is dehydrated, or has asthma that has worsened with ibuprofen before |
| Pain-relieving ear drops | Otigo ear drops can be used from 1 year of age, but only if the eardrum is intact: never if there is any discharge from the ear |
| Comfort measures | A warm or cool flannel held against the ear, extra drinks, and a slightly raised head at night |
Do not give paracetamol and ibuprofen together as a routine. If one alone is not controlling the pain, you can switch to the other before the next dose is due, but do not exceed the daily maximum of either. Do not put oil, cotton buds or anything else into your child’s ear.
Stop ear drops and get advice if fluid starts coming out of the ear. Discharge usually means the eardrum has a small hole, and drops such as Otigo must not be used when the eardrum may be perforated.
When to get help, by age
Call 999 or go to A&E if your child has a stiff neck, a rash that does not fade when a glass is pressed on it, is floppy, very drowsy or hard to wake, has a seizure, is struggling to breathe, or has a swelling behind the ear pushing the ear forward.
| Situation | What to do |
|---|---|
| Under 3 months with a temperature of 38°C or above | Urgent medical advice the same day: call your GP or NHS 111 straight away |
| 3 to 6 months with a temperature of 39°C or above | Same-day medical advice |
| Under 12 months with suspected earache | See a GP |
| Fluid, pus or blood coming from the ear | See a GP, usually within a day |
| Earache lasting more than 3 days, or getting worse | See a GP or pharmacist |
| Redness, swelling or tenderness behind the ear | Same-day assessment, as it can mean mastoiditis |
| Not drinking, very few wet nappies, or vomiting repeatedly | Same-day advice, because of the risk of dehydration |
| Hearing still reduced several weeks after the infection | See a GP about a hearing check |
The full list of warning signs for any age is in ear infection: when to worry.
Will my child need antibiotics?
Usually not. Most middle ear infections in children clear up on their own, and antibiotics shorten the illness only a little while causing diarrhoea, rashes or tummy upset in some children. A GP is more likely to prescribe them if your child is under 2 with infection in both ears, has discharge from the ear, is very unwell, is not improving after three days, or has a condition that raises the risk of complications.
You may be given a delayed prescription to collect only if your child is not getting better within a few days. If antibiotics are prescribed, amoxicillin liquid is the usual choice, for 5 to 7 days. How doctors decide is explained further in is my ear infection bacterial or viral?
Glue ear and grommets
After an ear infection, fluid often stays behind the eardrum for several weeks. When it lingers without infection, it is called glue ear, or otitis media with effusion. It is not usually painful, but it muffles hearing, and you may notice your child asking “what?” more often, speaking loudly, seeming inattentive at school, or being slow with speech.
Most glue ear clears on its own within three months, so the usual approach is to wait and arrange a hearing test if it persists. If it lasts longer and affects hearing in both ears, an ear, nose and throat specialist may suggest grommets, tiny tubes placed in the eardrum to let air in and fluid drain, or temporary hearing aids. Grommets usually fall out on their own after 6 to 12 months as the eardrum heals.
Nursery, school, swimming and flying
| Question | Answer |
|---|---|
| Should my child stay off nursery or school? | Not because of the ear infection itself, which is not contagious. Keep them at home while they are feverish or too unwell to join in |
| Can they swim? | Wait until the pain has gone. Avoid swimming if there is discharge or a burst eardrum until it has healed. With grommets, follow the advice of the ENT team; many children can swim on the surface |
| Can we fly? | Flying with an ear infection can be painful. If you must fly, give pain relief beforehand and encourage feeding, a dummy or swallowing during take-off and landing |
| Will it affect their hearing long term? | Rarely. Hearing usually returns once fluid clears, but get it checked if it seems reduced weeks later |
If your child keeps getting ear infections, the things that reduce them, from vaccinations to smoke-free homes, are covered in preventing recurring ear infections.
Need Advice About Your Child’s Earache?
Our pharmacist independent prescribers can check your child’s symptoms, recommend pain relief or Otigo ear drops where suitable, and tell you when your child needs to be seen in person.
See ear infection treatments →Frequently Asked Questions
How do I know if my baby has an ear infection?
Babies often pull, rub or hold an ear, cry more than usual especially when lying down, sleep badly, feed poorly, and may have a fever, usually during or after a cold. Ear pulling on its own without fever or distress is common and often due to teething or self-soothing. A baby under 3 months with a temperature of 38C or above needs urgent medical advice.
Do ear infections in children go away on their own?
Most do. Middle ear infections in children usually get better within three days, and sometimes take up to a week, without antibiotics. Regular children’s paracetamol or ibuprofen for the pain is the main treatment. See a GP if it lasts more than three days, gets worse, or your child is under 12 months.
What can I give my child for earache?
Children’s paracetamol from 2 months of age and children’s ibuprofen from 3 months of age, at the dose for their age or weight on the packet. Pain-relieving ear drops such as Otigo can be used from 1 year of age, but only if the eardrum is intact and there is no discharge from the ear.
Is it serious if fluid comes out of my child’s ear?
It usually means the eardrum has burst to release pressure, which often eases the pain. Most small holes heal within a few weeks, but your child should see a GP, usually within a day. Stop any ear drops, keep the ear dry, and get urgent help if your child is very unwell or has swelling behind the ear.
Can my child go to nursery with an ear infection?
Yes, once they feel well enough. Middle ear infections are not contagious, although the colds that cause them are. Keep your child at home while they have a fever or are too unwell to take part.
What is glue ear?
Glue ear is fluid that stays behind the eardrum after an infection. It is not usually painful but muffles hearing. Most cases clear on their own within three months. If it lasts longer and affects hearing, a specialist may suggest grommets, small tubes in the eardrum, or temporary hearing aids.
When should my child see a GP about an ear infection?
See a GP if your child is under 12 months, has earache lasting more than three days, has fluid coming from the ear, keeps getting ear infections, or seems to have reduced hearing afterwards. Get same-day help for a high temperature in a young baby, swelling behind the ear, or signs of dehydration, and call 999 for a stiff neck, a non-fading rash or a very drowsy child.
References
- National Institute for Health and Care Excellence. Otitis media (acute): antimicrobial prescribing (NG91). nice.org.uk
- National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management (NG143). nice.org.uk
- National Institute for Health and Care Excellence. Otitis media with effusion in under 12s: surgery (CG60). nice.org.uk
- NHS. Ear infections. nhs.uk
- NHS. Glue ear. nhs.uk
- electronic Medicines Compendium. Otigo ear drops: Summary of Product Characteristics. medicines.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Babies under 3 months with a fever, and any child who seems very unwell, need urgent medical assessment. Always follow the dosing instructions for children’s medicines, and do not use ear drops if there is discharge from the ear. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.