A Parent's Guide to Ear Infections

Odds are that your child will develop at least one ear infection before she is 6 years old. Three out of four children in the United States do. And many children suffer from recurring ear infections, which may require intensive treatment.

Parents can reduce their worry - and their child's distress by learning the signs and symptoms of an ear infection and knowing what steps to take to reduce their little one's pain.

Ear Infection Basics

At What age are ear infections common?

Ear infections typically affect babies and young children between 3 months and 3 years of age. But older children sometimes get them, too.

There are two reasons young children get them:

Their immature immune systems have trouble fighting off infections.
The shape and small size of a child's eustachian tubes makes it easier for fluid to build up in the middle ear.

What usually causes ear infections in children?

When doctors talk about children's ear infections, they are usually referring to acute otitis media, or an infection of the middle ear. Ear infections usually occur when children have colds or allergies.

The congestion or swelling that accompanies these conditions can cause a tiny tube in the ear—called the eustachian tube—to become blocked. This, in turn, may cause fluid to temporarily build up in the middle ear.

Fluid in the ear is not usually, in itself, problematic. But if a bacteria or virus infects this fluid, then an ear infection can develop.

How can I tell if my child has an ear infection?

The most telling sign of an ear infection is ear pain. But many children with ear infections are too young to say, “My ear hurts.” Clues that a baby or toddler is in pain include irritability, crying, tugging at one or both ears, loss of appetite, and trouble sleeping.

Other symptoms of an ear infection include:

a temperature between 100 and 104 degrees Fahrenheit
yellow or white fluid draining from the ear
loss of balance
hearing problems, which may become apparent when a child consistently talks softly, does not respond to sounds, or turns up the television.

Call your child's doctor if you suspect an ear infection. An untreated ear infection can sometimes cause serious problems, including permanent hearing loss.

It's especially important to watch for telling symptoms during or after a cold since this is usually when ear infections develop.

How are ear infections usually treated?

Your doctor may prescribe an antibiotic if your child's earache is caused by a bacterial infection. If a virus or other cause is the problem, your doctor may recommend self-care strategies.

Most ear infections clear up in a few days with treatment. If ear pain or a fever persists after two days, talk to your child's doctor.

What self-care strategies can help ease my child's pain during and ear infection?

The following measures can help relieve an earache:

Try an over-the-counter painkiller that's safe for children, such as acetaminophen. But never give children aspirin; it has been linked to Reye's syndrome, which affects the brain and liver.
Put warm compresses against your child's ear—but ask your doctor before doing this for a young baby.
Keep your child sitting up as much as possible during the day.
Give your child sugarless gum to chew if she is old enough not to swallow it.
Use an extra pillow to keep your child's head raised in bed—but never put pillows in a baby's crib. It will not help to give your child a decongestant or antihistamine. Research shows that these do not help prevent or clear up ear infections.

What if my child's earache went away but she still has a slight hearing problem?

Once an ear infection clears up, fluid can persist in the middle ear for about three months. This painless condition, called otitis media with effusion, usually disappears on its own. The only symptom may be some loss of hearing.

However, fluid in the ears that doesn't clear up can set the stage for repeated ear infections. For this reason, your child's doctor may want to recheck your child's ears after an ear infection. Parents also should stay attuned to their child's condition to make sure hearing returns to normal.

When Children Keep Getting Ear Infections

How many ear infections is it "normal" for a child to get?

Don't worry if your child has had two or three ear infections. This is fairly typical. It's not even a cause of concern if your child gets two ear infections within a few months.

However, if your child keeps getting one ear infection after another, she may suffer from recurrent ear infections, which require special treatment.

How are recurrent ear infections usually treated?

You should talk to your child's doctor about the pros and cons of various treatment options. Available treatments include the following:

Preventive antibiotics over a long period of time. This can lower the number of ear infections your child gets. However, it also may contribute to the spread of germs that are resistant to antibiotics.
A tube that is surgically inserted into your child's eardrum. This common procedure allows fluid to drain, reducing middle ear pressure. The ear tubes usually fall out by themselves within six to 18 months.
Removal of adenoids. Research suggests that taking out the adenoids can reduce the number of ear infections a child has, but only if she is age 4 or older.

Why do some children get more ear infections than others?

The following factors increase a child's risk of getting frequent ear infections:

Exposure to cigarette smoke
Allergies
Frequent colds
Exposure to a lot of germs from siblings and other young children
A history of ear infections as a young baby
Unrestricted pacifier use after 6 months of age
Not being breastfed or being breastfed for less than three months

Many of these risk factors are out of a parent's control. But there are some measures you can take to lower your child's risk. See “Can You Prevent Ear Infections?”

Can You Prevent Ear Infections?

There is no surefire way to prevent ear infections. However, you may be able to reduce the number of ear infections a child gets with the following strategies:

Ask your doctor about the pneumococcal vaccine that protects against pneumonia and other serious diseases. Some research suggests this vaccine may help reduce the number of ear infections children get.
If you are expecting a baby, consider breastfeeding for at least three months. If your baby drinks from a bottle, hold his or her head above the level of her stomach. And don't give a bottle to a baby in bed.
Keep secondhand smoke away from small children.
Keep your child away from other sick children as much as possible. Since this can be difficult, teach your child the importance of frequent hand-washing.
Restrict your baby's pacifier use after she is 6 months old to the moments when she is falling asleep. Then, at 10 months of age, try to discontinue using a pacifier altogether. In one study, children who followed this routine had 33% fewer ear infections than children who frequently used a pacifier.
If your child has allergies, take steps to remove any allergens from your home that cause trouble.