Ear Infections in Children: Causes, Treatment, and When to Call the Doctor
Ear infections are one of the most common reasons parents bring young children to the pediatrician — and one of the most frequently misunderstood. Not every ear pain is an infection, and not every ear infection requires antibiotics. Here’s what you need to know.
Types of Ear Infections
Acute Otitis Media (Middle Ear Infection)
This is the most common type. Fluid collects behind the eardrum and becomes infected, most often following a cold or upper respiratory illness. It causes pain and fever, and may cause the eardrum to bulge or rupture (which can cause temporary relief of pain and some drainage from the ear — not dangerous, but worth notifying your provider).
Otitis Media with Effusion (“Fluid in the Ear” or “Glue Ear”)
Fluid behind the eardrum without active infection. Often follows an acute ear infection. This type causes muffled hearing but not pain or fever, and often resolves on its own. Long-standing fluid can affect speech and language development in young children and may warrant further evaluation.
Swimmer’s Ear (Outer Ear Infection)
An infection of the outer ear canal, typically from water exposure. Pain worsens when you pull on the outer ear — this distinguishes it from middle ear infections. Treatment is antibiotic ear drops, not oral antibiotics.
Symptoms to Watch For
- Ear pulling or tugging — common in infants and toddlers who can’t verbalize pain
- Fussiness and sleep disruption — ear pain often worsens when lying down
- Fever — especially following a cold
- Temporary hearing difficulty
- Ear drainage — clear, yellow, or slightly bloody discharge
Treatment: Not Always Antibiotics
Current guidelines recommend a “watchful waiting” approach for many ear infections in children over 2 years with mild-to-moderate symptoms — many resolve on their own within 2-3 days. For children under 2, those with severe symptoms, or those with persistent or recurrent infections, antibiotic treatment is recommended.
Pain management — acetaminophen or ibuprofen at appropriate doses — should be used regardless of whether antibiotics are prescribed.
Recurrent Ear Infections
If your child has 3 or more ear infections in 6 months, or 4 or more in a year, discuss a referral to an ENT specialist to evaluate for ear tubes (tympanostomy tubes), which can significantly reduce recurrence.Ear pain? We offer same-day sick visits and telehealth appointments. Call (702) 457-5437 or visit our walk-in clinic page.
