Ear infection in children
- Mr Nicholas Clifton, Consultant Ear, Nose and Throat Surgeon
A middle ear infection (otitis media) is when your child’s ear gets infected, swollen and painful. This happens when fluid gets trapped behind the eardrum. Middle ear infections often clear up on their own. You don’t usually need to treat them with antibiotics.
About middle ear infections
Middle ear infections are very common in children, especially toddlers and babies. More than four out of five children will get a middle ear infection at least once before their second birthday.
The middle ear is the space behind the eardrum. It’s normally filled with air but can get filled with fluid after an infection, such as a cold or sore throat. This happens because the Eustachian tube (which connects the middle ear to the back of the throat) gets swollen or blocked and the fluid can’t drain away. The fluid in the middle ear then becomes infected with bacteria or viruses, which travel up the Eustachian tube from the nose or throat. Pus builds up and causes pain.
Some children keep getting middle ear infections. Around one in every two children will have three middle ear infections before they reach the age of two years. See our causes of middle ear infections section for more information on what could be increasing your child’s risk.
Middle ear infections are less common in adults than in children. This is because children’s Eustachian tubes are still quite short and horizontal, so fluid and mucus can build up inside the middle ear more easily than in adults.
An outer ear infection (otitis externa) is another common type of ear infection. This may be caused by a bacterial or fungal infection, allergy, swimming or having too little earwax. You may also be more prone to outer ear infections if you have dry, flaky skin in your ear canal. This may be caused by eczema or psoriasis.
Causes of middle ear infection
Most middle ear infections are caused by bacteria or viruses (or both) – for example, those that cause a cold. Other things that can increase the chance of your child getting a middle ear infection include:
- sucking on a dummy
- formula feeding rather than breastfeeding, especially if your child lies down when they feed
- passive smoking
- lots of contact with other children, such as older brothers or sisters or at nursery or playgroup
- your child was born with a cleft lip or palate or with Down’s syndrome
Boys tend to get more middle ear infections than girls. Middle ear infections are more common in winter than in summer. Your child is less likely to get a middle ear infection as they get older.
Symptoms of middle ear infection
A middle ear infection can develop soon after your child gets a cough or a runny nose. Other symptoms and signs of an ear infection in children can include:
- earache (young children may rub or tug at their ear)
- a fever
- irritability and crying
- restlessness
- seeming generally unwell
- not feeding or eating well
- being sick
Older children may tell you:
- they can’t hear properly
- their ear feels blocked
In some children, the eardrum bursts (perforates) because of the pressure. If this happens, you may see fluid or pus coming out of their ear. Although a burst eardrum sounds nasty, your child will probably feel better after it happens because they won’t be in so much pain.
The symptoms of a middle ear infection usually clear up on their own within three days. If you’re concerned about your child’s symptoms or they get worse, contact your GP.
Diagnosis of middle ear infection
Your local pharmacist may be able to diagnose an ear infection and give you advice on how to ease any pain. The pharmacist will ask about your child’s symptoms and any other illnesses they’ve had. They may look at your child’s eardrum using an instrument called an otoscope. This is a small, handheld device that has a magnifying glass and a light. If the ear infection is severe, your pharmacist will recommend you contact your GP.
Your GP will usually be able to diagnose a middle ear infection using an otoscope, without any further tests. But if your child is under three months, the GP may advise you take them to hospital for further checks.
Your GP may also recommend further tests or may refer your child to a specialist if they don’t get better as expected. They may, for example, want to check if your child has developed glue ear. This is when the middle ear remains blocked with fluid, which stops your child hearing properly.
Under 18 GP Appointments
We now offer GP appointments for children under 18 via our remote video service (UK wide) and face to face appointments at selected centres. Please note that these appointments cannot be booked online so please call 0330 822 3072 for more information or to book. Lines are open Monday to Friday 8am to 8pm, Saturday and Sunday 9am to 5pm. We may record and monitor our calls. Available from £49.
To book or to make an enquiry, call us on 0343 253 8381∧
Self-help for middle ear infection
It’s upsetting to see your child in pain with a middle ear infection. But try not to worry because they’ll usually get better in a few days without any ear infection treatment. In the meantime, there are some things you can do to help.
Often, the best treatment is to relieve your child’s symptoms with painkillers until the inflammation has cleared up. You can buy paracetamol or ibuprofen for children at a pharmacy. These will also help to bring down their temperature. Don’t give aspirin to your child if they’re under 16.
If painkillers aren’t working, and your child is aged between 1 and 18 years, speak to your local pharmacist. They may be able to prescribe some pain-relieving ear drops containing phenazone and lidocaine. These ear drops may be suitable if your child isn’t prescribed antibiotics and doesn’t have any complications, such as pus or fluid coming from their ear. Your GP will be able to prescribe these ear drops too.
There’s no evidence that decongestants or antihistamines will help.
It may help to reduce pain if you soak a flannel in warm water, wring it out, and hold it gently over your child’s ear.
Always read the patient information leaflet that comes with your child’s medicine. If you have any questions, ask your pharmacist. If your child’s condition doesn’t clear up after three days or it gets worse, see your child's GP.
Treatment of middle ear infection
Antibiotics
Most children don’t need to take antibiotics for a middle ear infection. The infection will clear up on its own within three days. Your GP will explain that antibiotics probably won’t help your child’s ear infection symptoms and may instead cause side-effects, such as diarrhoea or feeling sick.
Sometimes, your GP may give you a delayed or back-up prescription. You should only use this prescription if your child’s symptoms last longer than three days or get much worse at any point.
Your GP may prescribe antibiotics straight away if your child:
- has a very severe infection
- has already had symptoms for three days and doesn’t seem to be getting better
- is under two years and the infection affects both of their ears
- has a perforated eardrum (a hole or tear in their eardrum)
If your child is prescribed antibiotics, it’s important to complete the whole pack even if their symptoms get better. Read the patient information leaflet that comes with your child’s medicine carefully. If you have any questions about the medicine or how to take it, ask your pharmacist.
If your child is under three months and has a raised temperature, your GP may refer them to a hospital for further treatment.
Surgery
- Most children don’t need surgery for middle ear infections. But if your child develops complications or the infection doesn’t clear up with antibiotics, your doctor may recommend one of two procedures. A myringotomy will help to drain the fluid in your child’s ear. Your doctor will make a small cut in your child’s eardrum. The hole in the eardrum will heal naturally within a few days or weeks. Sometimes, a surgeon will put in small ventilation tubes called grommets.
- A tympanocentesis will relieve pain and pressure in the middle ear. Your doctor will insert a needle through your child’s ear to draw out the fluid from the middle ear. They’ll send this to a lab to see what’s caused the infection.
If your doctor recommends surgery, they’ll explain exactly what will happen and what the benefits might be.
Complications of middle ear infection
Most children with middle ear infections get better without any lasting problems. But some children can develop complications.
Recurrent ear infections
Some children get ear infections regularly. If your child gets more than three infections in six months, or more than four infections in a year, this is called having recurrent ear infections. Their GP will discuss what may be increasing their risk of infections – see our Causes of middle ear infection for more information. Your child may be prescribed antibiotics every time they have a new middle ear infection. Or your GP may refer your child to an ear, nose and throat (ENT) specialist, who may prescribe a longer course of antibiotics.
Glue ear
Glue ear is when fluid stays inside the middle ear after the infection clears up. Your child’s hearing may be affected. Glue ear often doesn’t need any specific treatment – it will usually go away on its own within about three months.
Burst eardrum
Sometimes, a middle ear infection can cause the eardrum to burst (perforate). This is due to the pressure of fluid building up behind your eardrum. You may notice pus or fluid coming from your child’s ear. Fortunately, the eardrum usually heals quickly. Sometimes a perforation leads to a long-term infection of the ear. If your GP thinks your child may have a long-term infection, they may refer them to an ear, nose and throat (ENT) specialist for treatment.
Mastoiditis
Very rarely, the infection can spread from the middle ear to surrounding tissues. An infection in the bone behind the ear is called mastoiditis. You may notice a soft, red lump behind your child’s ear, which hurts when you touch it. Your child will need to have antibiotics through a drip (intravenously) in hospital. They may also have grommets (small tubes) put in to drain any fluid or pus in the middle ear. Sometimes, they may need to have an operation called a mastoidectomy to remove the infected cells from the bone behind the ear.
Prevention of middle ear infection
- You probably won’t be able to stop your child getting a middle ear infection at some point. But there are some things you can do to reduce their chances. Breastfeed your baby for three months or more, if possible. Breast milk contains nutrients and antibodies that will help your baby to fight infection.
- Keep your baby’s head up when they feed, rather than let them lie flat.
- Make sure that all your child’s vaccinations are up to date.
- Don’t expose your child to tobacco smoke.
- Consider limiting or not using dummies.
It’s usually impractical to stop your child mixing with children who have coughs and colds. But if they’re old enough, teach your child about good basic hygiene and regular hand washing.
Older children may complain of earache. Younger children who aren’t talking yet may rub or tug at their ear. They may also have a fever and be irritable and restless. For more information, see our symptoms of middle ear infection section.
The symptoms of a middle ear infection usually clear up on their own within three days. If you’re concerned about your child’s symptoms or they get worse, contact your GP. For more information, see our treatment of middle ear infection section.
The best treatment is often to just ease your child’s symptoms with painkillers until the infection clears up. If this doesn’t help, a pharmacist or GP may prescribe some pain-relieving ear drops. Most children don’t need antibiotics. For more information, see our self-help for middle ear infection section.
Fever in children
If your child’s temperature is 38°C (100.4°F) or above, then it means they have a fever.
Glue ear
Over-the-counter painkillers
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- Victoria Goldman, Freelance Health Editor
