As a parent, it is pretty common to feel worried about your little one's health and well-being. After all, as they grow and get introduced to new people and environments, so does the likelihood that they will pick up certain illnesses.
One of the common ailments they’ll experience is a middle ear infection, also known as an inner ear infection or acute otitis media. Although this infection is not explicitly contracted from others, there are external factors that contribute to your baby or toddler experiencing an ear infection.
What is a middle ear infection?
A middle ear infection is an infection that occurs when there is inflammation or infection in the middle ear behind the eardrum. It affects most kids under the age of three.
What causes ear infections in babies and toddlers?
Ear infections often occur after a child has a cold when fluid that builds up in the middle ear gets infected by a virus, a bacteria, or some combination of both.
The most common ear infection-causing virus is the rhinovirus, which is the predominant cause of the common cold. Bacteria like Streptococcus pneumoniae and Haemophilus influenzae (nontypeable) are the most common bacteria causing ear infections.
Other possible risk factors of ear infections in young children include allergies, exposure to secondhand smoke, or frequent upper respiratory infections.
Why are ear infections more common in children?
Ear infections are more common in children primarily because young children have shorter and narrower Eustachian tubes (the tube connecting the middle ear to the nose) than adults. These tubes connect the back of the nose to the middle ear, and their smaller size makes them more prone to blockage or infection.
Additionally, a child's immune system is still developing, making them less able to fight off infections caused by bacteria or viruses. Furthermore, young children often put objects in their mouths that may carry germs which can lead to an infection. All of these factors make children more vulnerable to ear infections than adults.
What are the signs and symptoms of an ear infection?
Ear infections can cause a variety of symptoms depending on the cause of the infection and the age of the child, with symptoms ranging from mild to severe. Some of the typical symptoms of an ear infection are:
- Ear pain
- Tugging at the ear
- Reduced appetite
- Crankiness or irritability
- Trouble sleeping
- Ear drainage (which may be clear, yellow, bloody, or pus-filled)
Additionally, children often have a runny nose or cough for a few days before they start to feel pain in their ear.
Are there specific infant ear infection symptoms?
Generally, it can be difficult to tell what’s causing your baby discomfort - let alone discerning if your baby has an ear infection. Are they fussy because their ears hurt? Are they teething? Are they constipated? Something else? Babies are experiencing new feelings and milestones daily while their immune systems are simultaneously being introduced to new germs; it can feel like a guessing game!
Dr. Kristen Borchetta, DO, says, "In infants, ear infection symptoms may not always be as obvious as in older children. The most common things we see are fussiness, ear pulling, fever, and poor feeding. Often, they occur during or just after cold symptoms.”
How do you diagnose an ear infection?
If you suspect your child has an ear infection, you should have them examined by a pediatrician. The doctor can diagnose an ear infection using an otoscope to examine the inner ear canal and eardrum. If an ear infection is present, they may see redness, fluid behind the eardrum, or signs of increased pressure.
If you're unable to see your child's pediatrician, using a pediatric telemedicine service like Blueberry Pediatrics can help you diagnose and treat ear infections from home. All Blueberry families receive a video otoscope, which allows parents to record and send inner ear videos to Blueberry’s board-certified pediatricians, who will review your child’s video and advise the next steps.
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How do you treat an ear infection?
Treating a viral ear infection
Most ear infections are caused by viruses and, in most cases, will resolve on their own within a few days. For milder cases, regardless of your child’s age, your physician will want to watch and wait as the infection clears. During this waiting period, you can help lessen your child's pain by applying warm compresses to their ears and giving them over-the-counter pain relief medication.
Treating a bacterial ear infection
Bacterial ear infections require antibiotic treatment to clear the infection. Your pediatrician will prescribe antibiotics if necessary; however, antibiotics are only helpful if the cause of the infection is bacterial, so doctors will oftentimes wait to write a prescription.
Whether your child is prescribed antibiotics or advised to watch and wait, it may take up to three days for the infection to clear.
What should I do if my child's ear infection doesn't improve?
If your child does not get better within a few days with or without antibiotics, a follow-up with the doctor is needed. If you notice any of the following symptoms in your child, you should act immediately and speak with a healthcare provider who will determine the best treatment:
- Swelling directly behind your child’s ear
- Excessive sleepiness
- Noticeably different behavior
- A fever of 102.2°F (39°C) or higher or fever that lasts more than 3 days
- Pus, discharge, or fluid coming from the ear
- Worsening symptoms or not improving within 2-3 days of starting antibiotics
- Ear pain that lasts for more than 2–3 days
- Hearing loss
- Dizziness, vision problems, swelling and redness about the ear, or weakness of the facial muscles
How do you prevent ear infections in babies and toddlers?
Ear infections are among the most common childhood illnesses and can be incredibly painful. Parents can help prevent and limit frequent ear infections by reducing risk factors.
- Prevent the spread of cold and other illness-causing germs. Clean your little one's hands and toys frequently - especially toys they put into their mouth, as bacteria from these objects can spread quickly.
- Breastfeed your baby, if possible. Breast milk contains antibodies that can help protect your baby against various illnesses, including ear infections.
- Avoid letting your baby lay down when bottle-feeding. Keep their heads higher than their stomachs during feeds to help prevent fluid from getting into the middle ear.
- Make sure your child is getting all their recommended vaccinations. Vaccines can help protect against many of the bacteria that cause ear infections.
- Avoid secondhand smoke exposure. Cigarette smoke can increase your child's risk of developing ear infections. Studies have shown children exposed to smoke get more ear infections than those who are not exposed.
If my child has an ear infection, should I limit their activities?
If your child has an ear infection, it is best to let them rest and recover until the symptoms improve. They should stay home from school or daycare until fever free for at least 24 hours.
Dr. Borchetta adds, "Swimming is safe with a middle ear infection (not to be confused with Swimmer’s Ear), but diving can increase pressure, so it should be avoided. Similarly, flying on an airplane may make pain worse due to cabin pressure and can increase the chance of the eardrum rupturing, so it is best to avoid flying if possible during the first few days of treatment."
Once your child's ears feel better and they are fever free, you can return to normal activities!
Can ear infections cause other complications?
Untreated, persistent ear infections can cause long-term challenges for younger children. As the infection progresses, it can lead to dangerous complications such as hearing loss, speech delay, and meningitis. If left untreated, an ear infection can also rarely cause balance problems and facial paralysis.
Additionally, recurrent ear infections can cause a buildup of fluid in the ears that may require surgery to drain. Babies and toddlers are especially at risk for complications because their smaller bodies are more susceptible to infection-related issues like hearing loss and other developmental delays.
While parents don't need to rush to the urgent care or emergency room if their child shows signs of an ear infection, it is important for parents to consult with a doctor, as early treatment (when indicated) can help reduce the risk of any long-term complications.
What happens if my child keeps getting ear infections?
Despite your best preventive efforts, your child may experience recurrent ear infections. If so, your pediatrician may refer you to an ear, nose, and throat (ENT) specialist. They can help evaluate your child’s condition and provide the appropriate treatments to reduce the likelihood of recurrent ear infections.
In some cases, the ENT may recommend having your child undergo a tympanostomy tube insertion procedure. This involves surgically inserting small tubes into your child’s eardrums to prevent fluid buildup and improve airflow in the middle ear.
Your baby's ear infection
80-90% of children develop ear infections by the time they're three years old, with the highest incidences occurring between 6 and 18 months. While parents can take preventive measures to reduce their occurrence, they can also prepare for future infections by joining Blueberry Pediatrics.
Blueberry offers text, phone, or video care from board-certified pediatricians 24/7. One of the most common conditions our board-certified pediatricians advise is ear infections.
All Blueberry families receive a three-piece medical kit, including a video otoscope that records inner ear videos for our doctors to review and provide guidance and treatment depending on your child's needs.
The best part? An entire year of Blueberry membership costs less than the typical copay of a single urgent care visit, and one membership covers all children in your household! It's like having a doctor's office in your house. Sign up here.