Did you know that about 25% of infants have had at least one ear infection by one year of age? An ear infection is a diagnosis we make as pediatricians, but as a concerned parent, you might be curious about what is really causing your child’s ear pain. Let’s explore the reasons.

What causes an ear infection?

Ear infections occur after a child has a cold when the fluid built up in the middle ear gets infected by a bacteria, a virus, or some combination of both. Kids will often have a runny nose, cough or a fever a few days before their ear pain starts.

How can we know if it's an ear infection?

In kids that are too young to tell us what hurts, we can learn a lot from any change in their normal behavior – are they pulling at their ear or refusing to lie down calmly? Moving their ear or changing position will often relieve an earache.  Older kids usually know the drill and can almost diagnose it themselves if they have a lot of experience with them.

So, you suspect an ear infection, now what?

You will need to speak to a doctor and figure out the best plan for your child. Is it antibiotics? Is it observation? Since most ear infections are viral, it is very common that for children over the year of two, your physician will want to "watch and wait." Remember, antibiotics are only useful if the cause of the infection is bacterial, so doctor's will oftentimes not hand out a prescription right away. You can give your child acetaminophen (Tylenol) or ibuprofen (Motrin) to relieve his or her discomfort in the meantime.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 swelling directly behind your child’s ear, excessive sleepiness, or if something just seems off about your child’s behavior, you should act immediately and speak with a doctor or go to the emergency room.What about an ear infection and flying on an airplane?Kids may have more pain, specifically during descent. This is due to the pressure changes of the plane without the ear being able to equilibrate pressure also due to congestion. The best advice for this is to have them chew gum or food if they are older. If they are younger, breastfeeding or bottle feeding may help.So, next time your little one has a cold, you will be aware of the possibility of developing an ear infection, and confidently watch for the signs!