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Paediatr Child Health. 2009 September; 14(7): 465–466.
PMCID: PMC2786955

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.

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 not working well, 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 bottlefed and who swallow milk while lying down. Milk can enter the eustachian tube, which increases the risk for an ear infection.
  • Children of First Nations and Inuit descent.
  • Children with cleft palates.

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, or
  • 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?

  • Usually, doctors give antibiotics to children under 6 months of age.
  • For older children who don’t have too much discomfort or a high fever, your doctor will likely watch for 48 h to 72 h (2 to 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 younger than 6 months of age without first talking to your doctor.
  • Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children younger than 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 the doctor might want to re-examine your child if he or she is still in pain. Most children feel 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 or she 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:

  • is less than 6 months old and has a fever,
  • is older than 6 months and has had a fever for more than 72 h,
  • has swelling behind the ear or the ear is tender,
  • isn’t hearing well or at all,
  • is very sleepy,
  • has a skin rash,
  • has other serious medical problems, 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 hands 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.
  • Do not use a pacifier (soother) too often.
  • Do not smoke; smoking can increase the risk of ear infections.
  • Have your child vaccinated with the pneumococcal vaccine (if the child is at least 2 months of age, and has not already had this shot) and with the flu shot every year.

For more information


This information should not be used as a substitute for the medical care and advice of your physician.

All Canadian Paediatric Society documents are reviewed, revised or retired as needed on a regular basis.

Please consult the Caring for Kids Web site ( for the most current version.

May be reproduced without permission and shared with patients and their families.

Articles from Paediatrics & Child Health are provided here courtesy of Pulsus Group