How can middle ear infections in children be prevented?

Photo of a crying baby

Parents might wonder what they can do to help prevent painful middle ear infections, especially if their children have them again and again. There are a few things you can do that will probably lower the risk a little.

Babies' and toddlers' immune systems are still maturing – it will still take some time before they are better at fighting off disease. So colds and middle ear infections are a normal part of a child's development. If a child has a middle ear , it's important to give the child a lot of care and attention, but also to relieve the symptoms and to watch for possible complications.

There are various things that are recommended for the prevention of middle ear infections.

Smoke-free environment

Passive smoking increases the risk of infections in the airways and in the upper throat. It also weakens the child's . This means that it is especially important to make sure that children grow up in an environment that is as smoke-free as possible.

Use pacifiers less often

Babies and toddlers who regularly use a pacifier (dummy) are a little more likely to develop middle ear infections. One possible explanation for this is that sucking on a pacifier changes the pressure in the throat and ears. Infections can also be spread through the use of pacifiers. So it's worth trying to let your child use a pacifier less frequently – for example, only to help them get to sleep.

Pneumococcal vaccination

Babies who are vaccinated against pneumococcal are somewhat less likely to have a middle ear . This will only offer protection from infections that were caused by pneumococcus . But middle ear infections can also be caused by other bacteria or viruses. The pneumococcal is recommended by the German Standing Committee on Vaccination (STIKO). They advise parents to have their children vaccinated three times between the ages of 2 and 14 months.

Vaccination probably can't prevent middle ear infections in children who have already had it several times.

Flu vaccinations

Flu vaccinations can prevent infections caused by flu viruses. They may also lower the risk of middle ear infections. Researchers have also observed that children who have had flu vaccinations are less likely to need . But the German Standing Committee on Vaccination only recommends an annual flu shot for children who have a higher risk of developing serious flu complications – for instance, children who have respiratory, heart or metabolic disease.

Xylitol gum

Xylitol is a naturally occurring sweetener found in foods like strawberries, raspberries and plums. It is used in sugar-free chewing gum. Xylitol can slow the growth of some types of , including those that can cause middle ear infections. Research suggests that children who go to daycare will develop fewer middle ear infections if they regularly chew xylitol gum or take syrup containing xylitol. Chewing gum is more effective than syrup.

But the chewing gum only had a preventive effect if it was chewed five times a day for several months. The gum had no effect if the children only chewed it three times a day. It is not clear whether this is a practical option because younger children often have trouble with chewing gum.


The trace element zinc is vital for the to function optimally and successfully fight off infections. A typical diet will usually supply your body with all the zinc it needs. Pharmacies and drugstores also offer zinc in the form of dietary supplements, some of which are meant to strengthen the .

Studies found no that zinc supplements can prevent middle ear infections in children who eat a balanced diet. But zinc can help prevent middle ear infections in children who have severe malnutrition, for example in developing countries.

Adenoid surgery and the use of ear tubes

Enlarged adenoids can prevent the flow of air to and from the middle ear and increase the chances of a middle ear developing. Some studies looked at whether adenoidectomy (surgery to remove the adenoids) or the use of ear tubes could prevent middle ear infections. These two procedures were sometimes done together.

Although adenoidectomy on its own probably can't prevent middle ear infections, the use of ear tubes may lower the risk of developing another middle ear . This may also depend on whether the child has chronic glue ear.

When deciding whether or not to have surgery, it's important to consider that the procedure can have side effects. Middle ear infections become less common as children grow older anyway.

Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016; (8): CD007095.

De Sevaux JL, Venekamp RP, Lutje V et al. Pneumococcal conjugate vaccines for preventing acute otitis media in children. Cochrane Database Syst Rev 2020; (11): CD001480.

Gulani A, Sachdev HS. Zinc supplements for preventing otitis media. Cochrane Database Syst Rev 2014; (6): CD006639.

Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2017; (10): CD010089.

Steele D, Adam GP, Di M et al. Tympanostomy Tubes in Children with Otitis Media. (AHRQ Comparative Effectiveness Reviews; No. 185). 2017.

Venekamp RP, Mick P, Schilder AG et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018; (5): CD012017.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on December 22, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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