From Symptoms to Solutions: Navigating Infant Ear Infections

Ever seen your baby or child being miserable and pulling at their ears? That’s because one of the most common infections in children between six months and three years is a middle-ear infection called otitis media. Read on below to learn how to recognise ear infection signs in newborns and babies, how to manage them, and help your little one feel comfortable and healthy again. The information in this article is general in nature and should not replace medical advice from your own doctor.  

What are ear infections?

Ear infections are common in young babies and children. They can be broadly divided into two types – outer (otitis externa) and middle ear (otitis media).

Otitis externa, also known as swimmer’s ear, is an infection anywhere from the outside of the ear, in the ear canal – all the way to the ear drum. Excessive moisture in the ear (eg. from swimming), an injury to the ear canal or bacterial exposure can lead to outer ear infections.

Otitis media is an infection in the middle ear – anywhere behind the ear drum. This is the most common type of ear infection in children. While your baby may be irritable for a few days, middle-ear infections are usually not serious and resolve themselves with minimal intervention. 

Ear infection in newborn symptoms

There can be several signs and symptoms indicating your baby might have an ear infection. Some of the symptoms listed below may also be an indication something else is wrong so it’s never safe to self-diagnose. Make sure you get advice from your GP. 

• Redness, swelling and tenderness around the ear canal – these are usually signs of an otitis externa infection (outer ear infection)
• Tugging at the ear – If your baby is pulling or tugging at their ear it can be a sign of ear trouble, but not always. They would be irritable as well.
• Flu-like symptoms – If your baby has a fever or a cold and is restless in their sleep, they may be suffering from an ear infection. In some cases, appetite might also decrease.
• Fluid discharge – In some cases a thick yellow fluid may drip from the ear. This occurs when the ear drums swells and tears, often referred to as a burst ear drum. Although it sounds scary, children often feel better once this happens (as built up pressure is released) and the eardrum normally heals itself without treatment.

Infants or babies with an ear infection may also have other symptoms such as:

• Be unusually irritable or fussy
• Have trouble sleeping (younger infants)
• Cry more than usual, especially when lying down (younger infants)
• Have fever (particularly in younger children)
• Experience hearing difficulties or not responding to quiet sounds
• Show balance problems or clumsiness
• Have decreased appetite or difficulty with feeding
• Develop headaches (in older children who can communicate this)

Glue ear and infant ear infections

Every time a middle ear infection happens, fluid builds up behind the ear drum and causes pain and discomfort. This is usually reabsorbed by the body and cleared as part of recovery from the infection.

However, if fluid from the infection remains for an extended period of time (weeks to months), it can cause a condition known as glue ear – which can cause problems with hearing and balance and may also temporarily affect speech and language development. Glue ear is not an infection in and of itself, but a description of a potential complication after an infection.

What causes infant ear infections? 

Different types of infant ear infections have different causes. In infants, otitis media is often more common than otitis externa.

Causes of middle ear infections in infants

Otitis media happens when the area behind the eardrum (the middle ear) becomes inflamed and infected. The accumulation of fluid may cause a pressure build up, swelling and pain.

These infections often follow colds, sinus infections, or allergies when bacteria or viruses from the throat and nose travel up the Eustachian tube and into the middle ear. In babies and young children, these tubes are shorter, more horizontal, and less developed than in adults, making them more vulnerable to infections. Babies’ immune systems are still developing, which also makes them more susceptible to ear infections.

Causes of outer ear infections in infants

Otitis externa, also known as swimmer’s ear, is an infection anywhere from the outside of the ear, in the ear canal – all the way to the ear drum. Excessive moisture in the ear (eg. residual water from baths), an injury to the ear canal from scratching or using cotton buds, or bacterial exposure can lead to outer ear infections.

Preventing ear infections in infants

As the main cause of ear infections are usually a harmless cold, they can be hard to avoid! So while you can't prevent all ear infections, you can reduce your child's risk by:

• practicing good hand hygiene, washing your hands well and coughing into your elbow;
• limiting the use of dummies after the age of six months;
• managing allergens like dust or pet dander;
• keeping your child away from cigarette smoke to prevent respiratory irritation; and
• ensuring vaccinations are up to date (especially pneumococcal and influenza immunisations) can also help.

Where possible, breastfeeding a child up to 6 months and beyond can provide some protection against infections. Breast milk contains antibodies from mum which are passed to the infant to help protect against many childhood infections or illnesses. 

Infant ear infection treatment

A middle ear infection often resolves itself after 48 to 72 hours with no treatment. Even a burst ear drum will heal over time, often without medication. Antibiotics generally aren’t required for most ear infections.

Using over-the-counter pain relief such as paracetamol or ibuprofen can be helpful to relieve pain and/or fever. Be sure to use only the dosages listed on the label.

It is also important to keep your baby’s nose and throat as clear as possible when your baby has a cold. Using saline (salty water) to clear the nasal passages as well as drinking plenty of fluid are also great ideas.

If a middle ear infection continues beyond 2-3 days or if your baby’s ear infection becomes recurrent, speak with your doctor again to ensure they’re getting the right care and treatment. Antibiotics may be considered for severe infections, infections in babies under 6 months, or when symptoms don't improve with observation.

If your child has recurrent middle ear infections or glue ear, seek medical advice as there may be further tests such as hearing tests or other procedures (grommets) that may need to be performed.

Otitis externa infections (outer ear infections) are often treated with ear drops that help to reduce swelling and infection.

Using cotton buds or cotton wool to assist with ear infections is not recommended for infants and babies. They may cause harm to the ear because they can cause damage or irritation to the ear canal, which in turn may worsen the infection. Additionally, home-made infant ear infection remedies and concoctions to clean the ear are not recommended.

When to take my infant with an ear infection to the doctor?

Most of the time, ear infections are self-resolving and do not require a doctor’s visit. However, if your child has an ear infection and has any of the following symptoms, you may want to seek medical advice or evaluation:

• Has ear pain that doesn't improve with over-the-counter pain relief
• Has persistent discharge from the ear
• Shows symptoms of an ear infection that last more than 2-3 days
• Seems unusually lethargic or irritable
• Has swelling behind the ear or the ear sticks out at an unusual angle

Frequently asked questions about infant ear infections

How do I know if my infant has an ear infection?

You might suspect your infant has an ear infection if they become unusually fussy, especially during feeds or when lying down, and frequently tug or pull at their ears. Many babies with ear infections may develop a fever, have trouble sleeping, cry more than usual, or show signs of hearing difficulties like not responding to sounds as they typically would. You might notice your baby has become clumsier or has balance issues when sitting or standing. Some babies with ear infections also have diarrhoea, reduced appetite, or fluid draining from the ear.

Since babies can't verbalise where it hurts, watch for these behavioural changes, particularly if they've recently had a cold, as ear infections often follow respiratory illnesses. Remember that ear-pulling alone isn't a definitive sign of an infection, as babies explore their ears normally or may pull at them during teething as well.

Do I need to take my baby to the doctor for an ear infection?

Most ear infections resolve without treatment. However, if you are concerned, getting professional advice and someone to examine your baby's ears, as well as to check if there is fluid buildup behind the eardrum is warranted. It's especially important to seek medical attention if your baby has a high fever, seems to be in severe pain, has discharge from the ear, shows signs of hearing difficulties, or if symptoms don't improve within 48-72 hours. Early treatment can prevent complications and provide your little one with faster relief from discomfort.

Can you treat a baby ear infection at home?

You can help to manage an ear infection at home via appropriate doses of infant paracetamol or ibuprofen to help reduce pain and fever, always following package instructions or your doctor's guidance for proper dosing.

Keep your baby hydrated and offer frequent feedings in an upright position to help drain the Eustachian tubes. Elevating your baby's head slightly during sleep can also reduce pressure on the ear, though always follow safe sleep guidelines. Remember that home treatments should complement medical care rather than replace it, especially for very young infants or if symptoms are severe.

Will an infant ear infection go away on its own?

Many ear infections in babies will indeed clear up on their own without antibiotic treatment (within 2-3 days), particularly those caused by viruses. Those with severe symptoms, high fevers, recurrent infections, or those who appear very unwell may need antibiotic treatment.

How to tell if baby is teething or ear infection?

Distinguishing between teething and an ear infection can be challenging since both can cause irritability, fussiness, and ear-pulling in babies. With teething, you'll typically notice increased drooling, a desire to chew on objects, swollen or red gums, and sometimes a low-grade fever. Teething discomfort tends to come and go, often worsening in the evening, and is usually accompanied by visible signs in the mouth like a tooth breaking through the gum.

In contrast, ear infections frequently follow a cold or respiratory illness, cause more persistent pain (especially when lying down), and often involve higher fevers, difficulty sleeping, apparent hearing problems, and sometimes fluid draining from the ear. Babies with ear infections may also refuse to eat due to the pressure changes during swallowing. If you're unsure, or if symptoms persist or worsen, it's best to consult your doctor, who can examine your baby's ears and provide a definitive diagnosis.