Ear infections in babies and children

What is an ear infection?

Ear infections are very common in babies and young children, especially between the ages of 6 and 18 months. Most ear infections are not serious, but they can be very painful. Often, they go away on their own within a few days.

The 2 main types of ear infections seen in children:

• middle ear infections (otitis media) — develop in the middle of your child’s ear, behind their eardrum
• outer ear infections (otitis externa) — develop in your child’s outer ear canal, between the outside of their ear and the eardrum

Middle ear infections are the most common.

Most children outgrow middle ear problems, including glue ear, and have normal hearing when they get older.

Read more about ears and ear problems.

What are the symptoms of ear infections?

Middle ear infection may cause:

• pain in the ears
• hearing loss
• headache
• irritability
• fever
• loss of balance

Outer ear infection may cause:

• tenderness and pain in the outer ear, especially with jaw movement
• muffled hearing
• feeling pressure or fullness in the ear
• redness or swelling of the ear
• clear or yellow fluid coming out of the ear
• swishing or squelching sounds in the ear with movement

Pressure and pain in your child’s ear are caused by the fluid buildup inside the ear. This fluid usually drains by itself in a few days.

Since younger children can’t tell you if they are experiencing ear pain, it’s important to pay attention to their behaviour. Your child pulling at or poking their ear may be a sign of an ear infection or another ear problem.

Read about fevers in babies.

Read about how to tell if your child is sick.

What causes ear infections?

Middle ear infections

Middle ear infections can be caused by viruses, bacteria or both at once.

It’s common for a cold or illness to come before an ear infection. During a cold or illness, fluid filled with germs can enter your child’s ear via the auditory (Eustachian) tubes — which connect the middle ear to the back of the throat. Children usually have shorter and narrower Eustachian tubes. This makes it more difficult for fluid to drain from the ears, so it can build up and cause an infection.

Outer ear infection

Outer ear infections can occur when fluid becomes trapped between the outer ear and the eardrum. If the fluid contains bacteria, an infection can develop. This commonly occurs while swimming — for this reason, outer ear infections are also called ‘swimmer’s ear’.

Outer ear infections can also be caused when the ear canal is damaged, which may happen if your child scratches their ears or cleans them with cotton buds.

When should I take my child to see a doctor?

You should see a doctor if:

• you suspect your child has an ear infection
• your child’s pain hasn’t improved after 1 – 2 days
• there is redness, swelling and pain behind your child’s ear
• you are worried about your child’s hearing or speech and language development
• you plan for your child to travel by aeroplane within one week of an ear infection

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How are ear infections diagnosed?

Your doctor will ask about your child’s symptoms and medical history. Your child’s doctor can diagnose an ear infection by examining the ear, including checking the eardrum with an otoscope.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

How are ear infections treated?

Treatment will depend on the type of infection and how severe it is.

Treatment of middle ear infections can include:

• pain relief — pain relief medicines, such as paracetamol and ibuprofen or numbing ear drops, should be used as directed
• antibiotics — may be prescribed if your child has severe symptoms
• referral to an ear, nose and throat (ENT) specialist — if your child has severe or recurring infections

Treatment of outer ear infections usually involves antibiotic ear drops prescribed by your doctor. In cases of severe infection, your doctor may also place a gauze in the ear canal to help the medicine stay where it is needed.

Your child should avoid swimming or touching the inside of the ear until the infection has resolved.

For both middle and outer ear infections:

• Your child should rest.
• Your child should not fly on an aeroplane unless your doctor has approved it.
• Do not put anything, including cotton buds, in your child’s ears, especially if there is pus or blood. This may damage their eardrum.

Always ask your doctor or pharmacist before giving your child ear drops. Your child should feel much better within a week. Remember, most ear infections resolve within a few days without any treatment.

If your child’s symptoms do not improve, you should take them back to their doctor.

If your child has frequent or severe infections, their doctor may refer them to an ear, nose and throat (ENT) specialist who may recommend treatment options, such as:

• grommets — these are small tubes put in your child’s eardrum to help drain fluid
• antibiotics

Read about medicines for babies and children.

What complications are caused by ear infections?

Complication of middle ear infections can include:

• glue ear
• ruptured eardrum

Glue ear

Glue ear is when the fluid in the middle ear becomes thick and sticky, like glue. When the fluid becomes too thick, it cannot drain easily through the Eustachian tubes and may build up in your child’s middle ear. This can affect your child’s hearing.

In younger children, hearing difficulties can delay or stop their language development.

If glue ear is not bothering your child or affecting their speech or language development, no treatment is needed. It usually goes away by itself over time.

Ruptured eardrum

Your child’s ear drum is a sheet of tissue that separates their middle ear from their outer ear. If your child has a severe ear infection, pressure can build up in the middle ear from the trapped fluid and cause the ear drum to burst.

This will relieve the pain immediately, and yellow fluid may drain from their ear. The eardrum usually heals by itself without special treatment.

While recovering, your child should avoid swimming and getting their ear wet in the bath or shower.

Can ear infections be prevented?

Here’s how you can reduce the chance of your baby developing an ear infection:

• Avoid putting them to sleep with a bottle in their cot or bassinet.
• Hold your baby upright when feeding them a bottle, to reduce the chance of fluid getting into their ears.
• If you choose to breastfeed, breastfeed for as long as you can.

Here’s how you can reduce the chance of your child developing an ear infection:

• Avoid smoking near your children, including in your home, backyard or car.
• Gently clean your child’s outer ear with a damp cloth instead of cotton buds.
• Encourage your child to wear earplugs when swimming.

Resources and support

Talk to your doctor or child health nurse if you have questions about ear infections in babies and children.

Read more about ear infections and glue ear in children on the Sydney Children’s Hospitals Network website.

The Royal Children’s Hospital Melbourne has a fact sheet on ear infections and glue ear.

Learn about healthy hearing in children at Children’s Health Queensland.

Do you prefer to read in languages other than English?

Visit Children’s Health Queensland for resources about middle ear infections (acute otitis media) in a variety of community languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

The Care for Kids’ Ears program helps families, educators and health professionals recognise and prevent ear disease in Aboriginal and/or Torres Strait Islander people.