Middle ear infection in babies and young children

If a few days after getting a cold, for example, your child is crying more than usual, is running a fever, and is possibly rubbing his or her ear, a middle ear infection might be the cause. It is quite common in young children, but will almost always heal within two or three days even without special treatment. This video will explain how you can help your child during this time.

We can only give you general information. Do not hesitate to go to your doctor early on if you have questions. In most cases he or she will tell you not to worry, and possibly prescribe a painkiller suitable for children.

Antibiotics are usually not needed to treat an acute middle ear infection. We will explain why this is so, and give you some other information.

An acute middle ear infection is one of the most common illnesses affecting babies and young children: about 1 out of 10 children gets a middle ear infection in their first three months of life. A middle ear infection usually develops after a cold, sore throat or sinus infection.

The following symptoms may be signs that a young child has an acute middle ear infection:

  • Earache, made noticeable by the child rubbing and pulling the ears, or frequently shaking his or her head.
  • Fever several days after a cold or sore throat has started.
  • No response to speaking or sounds of normal volume level that the child would typically react to.
  • Irritability, frustration, restless sleep.
  • More frequent and more intense crying than usual.
  • Loss of appetite or vomiting.

Many of these symptoms are linked to the pain that a middle ear infection can cause. This pain mostly comes from the eardrum.

The middle ear is connected to the nose and throat area by what is called the auditory tube. The auditory tube in young children is still very small and short, making it easier for germs to enter the middle ear from the nose and throat area.

During an infection the middle ear produces more fluid than it does otherwise. At the same time, the mucous membranes of the auditory tube may also swell up and block the canal. This results in the fluid not being able to drain. It then collects in the middle ear and leads to a so-called tympanic effusion.

This high pressure in the middle ear can cause the eardrum to become so tightly stretched that children will experience pain. And his or here hearing will be affected.

Sometimes, if the pressure in the middle ear is very high, the eardrum can also burst. The resulting rip in the eardrum usually closes on its own again, but fluid may continue to leak from the ear for several more weeks.

Usually, an acute middle ear infection will heal on its own. In about 9 out of 10 children, symptoms get better after two or three days at the latest. But it usually lasts a bit longer until their hearing returns to normal again. Complications of a middle ear infection occur extremely rarely in industrialized countries.

You can help your child the most by relieving the pain quickly. Many parents try to do this by using home remedies – for example, small bags of cut onions that are placed on the ear that is hurting or with infrared light to warm up the affected ear. Other parents turn to homeopathic medicine (for example Pulsatilla). There is, however, no scientific proof of the effectiveness of these home remedies.

It is proven, though, that some painkillers do help, and that they can also lower fever. Your doctor can tell you which painkillers are suitable for children. It is often enough to have taken steps against the pain and fever.
Antibiotics usually have no benefit because they can hardly speed up recovery from a simple middle ear infection for most children. This is due to the fact that middle ear infections are mostly caused by viruses. And antibiotics are not effective against viruses.

Yet for some children it may make sense to use antibiotics, however. According to scientific research, this is the case when:

  • A child under the age of two years has an infection in both ears, or
  • A child has pus leaking from the ear.
These symptoms indicate that the infection has been caused by bacteria, which antibiotics are effective against.
  • And if symptoms do not improve after a few days, if they get worse, or if new symptoms start, antibiotics are also a good idea.

Even if you are understandably worried because your child has a middle ear infection, remember: children will usually be able to deal with the infection on their own. A visit to the doctor’s may be a good idea anyway, to be sure that the middle ear infection is actually free of complications. And: a middle ear infection may indeed lead to some sleepless nights when your child will need a lot of care and attention. But it is usually over in a few days.

Photos: Thinkstock: www.thinkstockphotos.de
The images of people on our website are used solely for illustration purposes. The people shown are models.

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Updated on December 17, 2019

Next planned update: 2021


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

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