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Ear infections

Ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age, are usually not serious, and are not contagious. Most ear infections occur with a cold.

What causes an ear infection?

Viruses or bacteria (germs) cause middle ear infections. The Eustachian tube connects the middle ear with the back of the throat. Germs can travel from the back of the throat when the Eustachian tube is damaged, causing middle ear infections.

Who is at higher risk for ear infections?

  • Babies born prematurely.
  • Younger children because they have shorter Eustachian tubes.
  • Children who attend daycare because they tend to have more colds.
  • Children with allergies or exposed to cigarette smoke. Smoke can irritate the Eustachian tube, making ear infections more likely.
  • Children who were not breastfed. Breastmilk has antibodies that help fight infections.
  • Children who are bottle fed and who swallow milk while lying down. Milk can enter the Eustachian tube, which increases the risk of an ear infection.
  • Children with cleft palates.
  • Children of First Nations and Inuit descent.

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

Older children will complain of an earache. Younger ones might not say they have an earache, but might:

  • have an unexplained fever,
  • be fussy,
  • have trouble sleeping,
  • tug or pull at their ears, and
  • have trouble hearing quiet sounds.

Some children have fluid draining from their ear. This fluid could contain germs. The best way to prevent the spread of these germs is to wash your hands well.

Doctors diagnose ear infections by looking at the ear drum (tympanic membrane) with a special light called an otoscope.

How is an ear infection treated?

  • Doctors almost always prescribe antibiotics for children under 6 months of age or for children with other serious medical problems.
  • For older children who don’t have too much discomfort or a high fever, your doctor will likely watch for 48 – 72 hours (2-3 days) to see if the ear infection gets better on its own.
  • Your doctor might suggest acetaminophen or ibuprofen to reduce your child’s pain. Only give ibuprofen if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months without first talking to your doctor.
  • Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children under 6 years of age without first talking to your doctor. The only exceptions are drugs used to treat fever (such as ibuprofen and acetaminophen).
  • Your doctor may give a prescription for antibiotics to use if your child doesn’t feel better in 2 to 3 days or she might want to re-examine your child if he is still in pain. Most children are feeling better by then.

Children usually feel better within 1 day of starting an antibiotic. Use antibiotics only as directed. Keep giving them until they are finished, even if your child feels better. Your doctor might want to see your child again to be sure the infection has cleared up completely.

When do children need tubes in their ears?

If your child has frequent ear infections, or if he has trouble hearing because of fluid in the middle ear, an ear, nose and throat surgeon might need to insert a tube through the ear drum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps any fluid to drain.

Putting tubes in requires a short operation. Children don’t usually have to stay in the hospital overnight.

When should I call the doctor?

Call your doctor if you think your child has an ear infection AND:

  • has other serious medical problems,
  • seems ill,
  • vomits over and over,
  • is younger than 6 months,
  • is older than 6 months and has had a fever for more than 48 hours,
  • has swelling behind the ear or the ear is tender,
  • is very sleepy,
  • is very irritable
  • has a skin rash,
  • isn’t hearing well or at all,
  • remains in a lot of pain despite at least one dose of acetaminophen or ibuprofen, or
  • still has an earache after 2 days of treatment with acetaminophen or ibuprofen.

How can I prevent my child from getting an ear infection?

  • Wash your and your child’s hands often to reduce the chance of getting a cold.
  • Breastfeed your baby.
  • Avoid bottle feeding your baby when she is lying down.
  • Don’t use a pacifier (soother) too often.
  • Don’t smoke; smoking can increase the risk of ear infections.
  • Have your child vaccinated with the pneumococcal vaccine (if they are at least 2 months of age, and have not already had this shot) and with the flu shot every year. 

Reviewed by the following CPS committees:
Infectious Diseases and Immunization Committee

Last Updated: September 2009