Learn the telltale signs of a baby ear infection to look out for, plus why ear infections are more common in young children.
Ear infections are most common in babies and toddlers who are between 3 months and 3 years of age. As the NIH reports, 5 out of 6 children will have an ear infection before they reach the age of 3, and ear infections are the most common reason families take their young child to the doctor. But how do you know if your baby has an ear infection? Today, we’ll cover the telltale signs to look out for, plus why ear infections are more common in young children.
What causes a baby ear infection?
An ear infection (otitis media) is an infection in the middle ear, which is the space directly behind the eardrum where the small bones of the ear are located. It is usually caused by bacteria in the middle ear. When someone has an ear infection, fluid builds up behind the eardrum, and their middle ear area becomes swollen from inflammation.
Colds/respiratory infections and ear infections
Often, an ear infection will begin after your child has a cold, a sore throat, the flu, or another respiratory infection. If bacteria causes that respiratory infection, the bacteria may spread to the middle ear and cause the ear infection. If a virus causes the respiratory infection, this may encourage bacteria to build up in the middle of the ear as a separate infection. This can cause fluid to build up in the ear, and cause the ear to become infected.
Bacteria or viruses sometimes cause swelling of the eustachian tube. This is the tube that connects the upper throat to the middle ear, and that helps drain fluid out of the middle ear. If the tube is swollen, though, it’s much harder for the fluid to drain out. This may lead to an ear infection.
Allergies and ear infections
The congestion and inflammation from allergies --- environmental or food allergies --- can also cause an ear infection.
Allergies affect the adenoids, the small pads of tissue above the throat and behind the nose that help fight against bacteria.
Allergies may cause your child’s adenoids to swell up. The enlarged adenoids may block fluids from draining out of the ear, making an ear infection more likely.
(Similarly, colds and other respiratory infections can cause the adenoids to swell up, block fluids from draining out of the ear, and increase the chances of an ear infection.)
Why are ear infections more common in babies and toddlers?
Ear infections are more common in young children than in adults because young children don’t have fully developed immune systems. It’s harder for babies’ bodies to fight off the colds and respiratory illnesses that lead to ear infections. It’s also harder for babies’ immune systems to fight off the ear infections themselves.
The second reason ear infections are more common in babies involves the eustachian tube.
In babies and toddlers, the eustachian tube is smaller and more level (less sloped) than in adults. So, it’s harder for fluid to drain out of babies’ ears even if they don’t have a respiratory infection. If the tube swells up due to a cold, other respiratory infection, or allergy, then it’s even harder for fluid to drain out of the tube. This may lead to an ear infection.
Babies also have larger adenoids than older children and adults. This means that if baby develops a respiratory infection or suffers from allergies, it’s more likely that swollen adenoids will block fluids from draining out of the middle ear, and lead to an ear infection.
Dr. Anton Milo, director of the Ear, Nose and Throat Center at Akron Children's Hospital, gives more details on why ear infections are more common in babies and toddlers:
Telltale signs that baby has an ear infection
Ear infections cause ear pain, but baby can’t directly tell you that their ear is hurting. So, how can you tell if baby has an ear infection? Be on the lookout for these symptoms:
- Tugging, holding or rubbing the ears: Baby may rub, hold, or tug their ears to try to relieve the pain of an ear infection.
- Trouble sleeping: When baby is lying down, this may increase the pressure on their ear and make the infection’s pain worse.
- Fussiness/irritability: If baby won’t stop crying, or is more irritable than usual, this may be a sign of an ear infection. Look for other symptoms, though, as baby could be fussy for any number of reasons.
- Fever: Around half of the children who have an ear infection develop a fever. And fever with ear infections is especially common in babies and young children. Your little one could develop a temperature between 100° F and 104° F when they have an ear infection.
- Loss of appetite: Since pressure in the ear changes when your little one swallows, an ear infection may cause pain when baby eats (especially if they take a bottle). This means your baby may be less inclined to eat.
- Difficulty hearing: Baby may have trouble hearing and responding to sounds when they have an ear infection, especially quieter sounds. This is because the small bones in the middle ear connect to nerves that send sound signals to the brain, but too much fluid in the ear slows down the movement of those signals.
- Fluid leaking from the ear: This fluid may be brown, yellow or white. It’s different from earwax.
- Balance problems: Fluid in the inner ear can cause baby to have trouble balancing, so baby’s clumsiness may be a sign that they have an ear infection
If baby shows any of these symptoms, take them to your doctor. Your doctor will check to see if baby has an ear infection, and prescribe a treatment if needed.
How do doctors diagnose ear infections?
If you visit because you think your baby has an ear infection, your doctor will first ask if your baby has shown any signs of an ear infection. So, be ready to report any possible symptoms, including pulling at the ear or trouble sleeping. Your doctor will also ask if your baby has had a cold or other infection recently, or if they’ve shown signs of allergies.
If they think your baby has an ear infection, your doctor will look inside baby’s ear with an instrument called an otoscope. They will see if baby’s eardrum is bulging, red, inflamed, or swollen --- signs that your baby likely has an ear infection.
They might also use a pneumatic otoscope, a slightly different instrument, to blow a little air into baby’s ear. If there is too much fluid in the ear (a sign of a possible infection), the eardrum won’t move easily.
In addition to the ear tests, your doctor might check baby’s throat and nose, and listen to baby’s breathing. This is to check for a possible respiratory infection.
How do doctors treat ear infections?
Often, your doctor will prescribe an antibiotic to treat baby’s ear infection, if they think bacteria are causing the infection.
Be sure to give baby the antibiotic exactly as your doctor instructs, even if baby seems to be feeling better before your doctor recommends you stop giving the antibiotic. This way, you can ensure the infection completely leaves baby’s ear. In fact, the infection could return and get worse if you stop giving the antibiotic too soon.
But if your doctor can’t definitively diagnose an ear infection, and baby doesn’t have fever or show signs of ear pain, they may ask you to wait and monitor baby’s symptoms for a day or two. This is because the AAP recommends waiting 1 to 2 days to prescribe antibiotics to babies and toddlers (ages 6 months to 2 years) who can’t be definitively diagnosed with antibiotics. Some ear infections may go away on their own, and this approach encourages a more cautious use of antibiotics so bacteria doesn’t become resistant to antibiotics.
Your doctor may also prescribe acetaminophen (children’s Tylenol) or ibuprofen (children’s Motrin) to treat the earache or fever that comes with an ear infection. If they do, follow your doctor’s exact instructions for how much medicine to give at once, and how often.
Your baby should feel better a few days after they start the treatment. If they still show signs of an ear infection after a few days, and the symptoms haven’t lessened, call your doctor.
Reducing the risk of an ear infection
Even though babies are more susceptible to ear infections, there are ways to help reduce the risk of an ear infection:
- Make sure baby gets their flu vaccine when they’re old enough (6 months or older).
- Reduce the risk of the colds and respiratory infections that can lead to ear infections. Avoid sharing toys, bottles, utensils, and food, wash your hands often, and stay away from people who are sick.
- Keep your baby’s allergy symptoms under control.
- If you bottle feed, keep baby in an upright position while feeding. This way, the formula or breastmilk won’t flow into baby’s level eustachian tubes and get trapped in the middle ear.
- Don’t put baby to sleep with a bottle. (Putting baby to sleep with a bottle doesn’t just increase ear infection risk. It also makes baby more likely to develop tooth decay, and can increase their choking risk.)
- Keep baby away from cigarette smoke, as studies show secondhand smoke increases children’s ear infection risk.
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