Ear infections are one of the most common reasons young children are brought to a pediatrician. Most follow a cold, most are in children under five, and — this surprises many parents — a good number resolve without antibiotics.
Signs of an ear infection
- Ear pain, often worse lying down, which is why it so often starts at bedtime
- Tugging or pulling at the ear — worth noting, but on its own a poor indicator; plenty of well babies pull at their ears
- Fever
- Unusual irritability, or waking in the night when they had been sleeping
- Fluid draining from the ear
- Not responding to quiet sounds, or seeming not to hear
- Loss of appetite, or pain when sucking or chewing
Why young children get so many
The eustachian tube connects the middle ear to the back of the throat. In small children it is shorter, narrower and more horizontal than in adults, so fluid drains less easily and bacteria travel more readily from the nose and throat. Children typically grow out of frequent ear infections as those tubes lengthen and tilt — which is why they become much less common after about age five.
Does my child need antibiotics?
Not always, and this is worth understanding before you come in. Many ear infections are viral or clear on their own, and current practice for a mild infection in an older child may be observation for 48 to 72 hours with good pain control, antibiotics held in reserve if things do not improve.
Antibiotics are more clearly indicated for younger infants, for severe pain or high fever, and when both ears are affected in a very young child. Which applies to your child is a judgement made after looking in the ear — it is not something to decide from a website, including this one.
If antibiotics are prescribed, finish the whole course even once your child seems better.
Managing the pain
Pain relief is not an afterthought — it is often the main treatment. Acetaminophen, or ibuprofen for children over 6 months, usually settles things; see our guidance on fever and medication dosing. A warm compress against the ear can help. Do not put oil, drops or anything else into the ear canal unless we have told you to, and never if there is any chance the eardrum has perforated.
Is it contagious?
The ear infection itself is not. The cold or virus that led to it is, which is why ear infections seem to travel around a nursery.
Recurrent infections and ear tubes
If your child has repeated infections, or persistent middle-ear fluid that is affecting hearing and speech, we will assess whether a referral for ear tubes (tympanostomy) is worth considering. Keep a note of each episode — dates and which ear — because that history is exactly what the decision turns on.
When to call us
- Ear pain that is not settling with pain relief
- Fluid, pus or blood draining from the ear
- Fever — and any fever in a baby under 3 months, which needs same-day attention
- Symptoms not improving after 2 to 3 days, or getting worse at any point
- Swelling, redness or tenderness of the bone behind the ear, or the ear being pushed outward — this needs urgent assessment
- You are concerned your child is not hearing properly
Ear infections in MetroWest, Orlando
We keep time for same-day sick visits, because ear pain rarely waits politely for a routine appointment. Primary Care Pediatrics is at 1507 S Hiawassee Rd, Suite 105, Orlando, FL 32835, Monday to Friday, 9:00 AM – 5:00 PM. Call (407) 445-9224.
