Middle ear infections in children: how to spot them and respond correctly
Middle ear infection is a very common health issue among children. 80% of children under five will experience at least one episode of an ear infection. While it's usually a temporary and harmless condition, it can cause the child significant discomfort and a lot of worry for parents.
What can an ear infection look like?
Recognising an ear infection isn’t always straightforward, especially in young children whose vocabulary doesn’t yet let them describe pain precisely. Symptoms can be fairly general and resemble a cold or other viral illness. Ear pain, however, is one of the most common signs — it can be sharp or throbbing and tends to worsen at night. Many children become more irritable, sleep poorly, lose their appetite, or may even vomit.
Ear discharge, fever, and temporary hearing loss are also common, especially when the infection is more extensive. Since all of these symptoms can also occur with other illnesses, a definite diagnosis is still a job for a doctor.
First aid at home
If a child complains of ear pain or is especially restless at night, parents can help quite a lot at home. The most important thing is to keep the child comfortable and ease the pain.
Initial home remedies include:
- Painkillers (paracetamol or ibuprofen), which relieve pain and fever.
- Numbing ear drops, which can provide short-term relief.
- Nasal spray or saline solution, which helps reduce nasal congestion and, in turn, improve Eustachian tube function.
If the child’s condition hasn’t improved within 48 hours, or the fever rises above 38.5°C, it’s advisable to see a doctor.
Is an antibiotic always necessary?
Antibiotics are no longer the first-line treatment for ear infections today. Most ear infections resolve on their own, and antibiotic treatment doesn’t speed up that process. In certain cases, though, antibacterial treatment may still be indicated.
Antibiotic treatment is recommended when:
- there’s (purulent) discharge from the ear
- the child is under six months old and an ear infection is suspected
- a child under 2 has an infection in both ears
- severe pain doesn’t resolve within 48 hours
- fever is above 38.5°C
Recurrent ear infections
If a child has three middle ear infections within six months, or four within a year, a doctor may recommend ear tube surgery (tympanostomy). In this procedure, performed under general anaesthesia, tiny tubes are placed in the eardrum to help ventilate the middle ear space and reduce the risk of further infections. This also makes it possible to use antibacterial ear drops if an infection develops, avoiding the need for oral antibiotics. Contrary to a widespread misconception, swimming with tubes in place has actually been permitted since 2012, and the ears don’t need special protection for it. Tube placement is often combined with removal of the adenoid (the nasopharyngeal tonsil) in children. In most cases, the tubes fall out of the eardrum on their own within 1–2 years.
Can ear infections be prevented?
While ear infections can’t be completely avoided, the risk of developing one can be significantly reduced. Good hand hygiene and avoiding the spread of illness are important everyday measures. Certain vaccines and the child’s living environment also play a role.
More effective preventive measures include:
- regular handwashing
- the flu and pneumococcal vaccines
- parents quitting smoking and avoiding tobacco smoke around the child
These simple steps can significantly reduce the occurrence of upper respiratory viral infections, which are often the root cause of ear infections.
When should you definitely see a doctor?
Ear pain often starts at night, but emergency care usually isn’t needed. If the child is still clearly struggling by morning, it’s worth contacting a doctor. You should act more quickly if purulent discharge appears, fever persists for several days, or the child becomes lethargic and their overall condition worsens.
An ear examination is a completely painless and safe procedure that gives the doctor the clearest picture of the child’s condition, helping determine whether home care remains sufficient or whether the child needs further treatment.
Sources:
- Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngol Head Neck Surg. 2022 Feb;166(1_suppl):S1-S55.
- NICE Guideline: National Institute for Health and Care Excellence. (2022). Otitis media (acute): antimicrobial prescribing (NG91).
- Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99.
