An ear infection in a baby is caused by fluid that builds up in the middle ear. This causes the eardrum to bulge and become red and inflamed.
Ear Infections in Babies and Toddlers
Ear infections in babies and toddlers are very common. Five out of six kids will be treated for an ear infection before their third birthday. Thankfully, most ear infections go away on their own and don’t cause any lasting harm to your child.
So what causes babies to have ear infections?
Ear Infection Causes
Often, the initial cause of an ear infection is a viral infection. The virus causes inflammation in the middle ear and Eustachian tube which makes it impossible for fluid to drain out of the middle ear. This fluid sits in there and can become infected by bacteria.
Young children have 10 to 12 viral illnesses per year. This averages to about one cold per month. Viral infections don’t always lead to an ear infection, but definitely increase the odds.
When I am examining the ears of a young baby, I look at the eardrum to see if it is red and bulging. I am also looking for evidence that there is fluid behind the ear drum. A baby’s anatomy makes them more susceptible to an ear infection.
The Eustachian tubes are small tubes that connect the inner ear with the back of the throat. They are smaller in diameter and sit more horizontally in the head of babies than they do in adult ears. This allows for them to become blocked more easily by inflammation and therefore lead to build up of fluid in the middle ear.
As your child grows, their eustachian tube grows as well. Additionally, the eustachian tube becomes more vertical in orientation which allows the ear to drain more easily. This decreases their odds of having ear infections. Often, kids have fewer ear infections after their third birthday.
Ear Infection Signs
Since babies and young toddlers can’t verbally tell you when their ear hurts, these are some signs that they may have an ear infection. If your child is having these symptoms for a couple of days, it is time for them to be seen by your pediatrician.
- tugging at the ear
- difficulty sleeping or laying down
- ear drainage
- crying more than usual
- difficulty hearing
- fever
Treating Ear Infections in Babies
So if most ear infections go away on their own, why do we treat them with antibiotics?
Under 6 months
Ear infection guidelines state that all babies under six months of age should receive antibiotics for their ear infection. Children at this age are not completely vaccinated against the common bacteria that cause these infections.
Additionally, complications from ear infections can become more serious if they occur in younger babies. In this age group, we also worry that bacteria behind the ear drum could spread to the blood and other parts of the body. Even though this is a rare complication, it is something that we keep in mind when deciding on treating a baby’s ear infection.
6 months to 2 years
For children between the ages of 6 months and 2 years, the American Academy of Pediatrics (AAP) recommends shared decision-making between parents and their trusted pediatrician. If the ear infection is not severe or your child has minimal symptoms, you can safely observe for a couple of days. Antibiotics can be prescribed after this waiting period if your child’s symptoms are worsening. However, this observation period does not apply to your child if they are in lots of pain from their ear infection or are having other concerning symptoms. We treat these kids with antibiotics right away.
Over 2 years
Often, in children over the age of 2 years, ear infections will clear on their own with the help of your child’s immune system. In this case, antibiotics are not necessary. If your child has an ear infection that isn’t causing any discomfort, you can feel good about observing it without antibiotics. However, if his symptoms aren’t going away or are getting worse, it is best to take your child to the pediatrician for an exam. Additionally, if over the counter pain medications are not relieving your child’s ear pain, it is time to consult your child’s pediatrician for an antibiotic prescription.
Unfortunately, some children experience recurring ear infections, even up to five or six times per year. If this is the case, your child may benefit from a surgical procedure to place tiny tubes in their eardrums that will give them the ability to drain fluid. This will allow your child’s ears to have a way to drain and therefore decrease their risk for more middle ear infections. These little tubes are placed by an Ear, Nose and Throat surgeon and typically stay in place for 6 months to 2 years.
Ways to prevent ear infections in babies
While not all ear infections can be prevented, there are several things that you can do to help prevent your child from having an infection.
- Vaccinate your child on time per the CDC schedule
- Wash your hands frequently to prevent illness
- Breastfeed
- Avoid putting your child to bed with a bottle
- Prevent smoke exposure
Should I Take My Baby to the Doctor?
If you think that your baby has an ear infection, it is best to consult their pediatrician.
At 127 Pediatrics, we maintain a small patient panel so that we can see your child quickly. You also have our direct cell phone number, so you never have to worry about trying to get a hold of someone for help. Find out how to become a member of 127 Pediatrics by filling out a contact form on our website.
© 127 Pediatrics; October 2022, updated October 2023
This article is for informational purposes only and should not be construed as medical advice.
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls-only concierge pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.
