Ear infections

Ear infection usually refers to middle ear infections (otitis media) or glue ear. This occurs when bacteria and viruses get into the fluid in the middle of the ear, behind the eardrum, causing pain and discomfort.

Key points:

  1. Ear infections are common in young children.
  2. Treatment is not always needed but the child should be seen by a doctor.
  3. If pus is present the eardrum may burst and discharge pus.
  4. Fluid can also remain in the middle ear after an ear infection or can occur on its own. This is commonly called ‘glue ear’. Glue ear can take weeks to resolve and reduce hearing.
  5. Children with a suspected ear infection, or who have difficulty hearing, should see a doctor.

If you feel your child is not improving or seems unwell, you should take the child back to the doctor. If you are unsure what to do, you can phone Healthline on freephone 0800 611 116 for advice.

How did my child get an ear infection?

Ear infections are caused by bacteria or viruses entering the ear. In children, the tube that joins the back of the nose to the middle of the ear (called the eustachian tube) is shorter than in adults. This means that bacteria and viruses can find their way deep into the ear much more easily.

Usually children get ear infections up to the age of about seven years. Ear infections are more common in autumn and winter and after a child has had a cold. Children are more likely to get ear infections if they:

  • live in houses that are crowded
  • live with someone who smokes
  • go to daycare
  • arebottlefed
    • feeding babies lying down or putting them to bed with a bottle can make it easier for bacteria to get into the ear
    • breastfed babies are less likely to get ear infections, as breastfeeding helps strengthen the baby's immune system
  • have a lot of colds, infected tonsils, swollen adenoids or other infections
  • have brothers and sisters with ear infections (or other viral illness).

How do I know if my child has an ear infection?

  • Very young children with ear infections usually get irritable, fussy, cry and rub their ears. They may not hear, eat or sleep well.
  • Older children will complain of earache, a feeling that the ear is 'full', or that they can't hear well. They may have a fever, runny nose or a cough.
  • If the infection is severe, the eardrum may burst and you may notice pus leaking out of the ear.

How are ear infections diagnosed?

If you think your child has an ear infection, take them to your doctor for a check up. Your doctor will ask how your child has been feeling and behaving, and will look inside their ears with a special instrument (called an otoscope), for signs of infection.

Based on their observation, your doctor will be able to tell you if your child has an ear infection and how serious it is, whether or not treatment is needed, and what you can do to make your child more comfortable. 

What can I do to ease discomfort caused by ear infection?

  • Regular pain relief, such as paracetamol can help ease pain and discomfort.
    • Discuss with your pharmacist or doctor what pain relief is best for your child (do not give aspirin to children).
    • Measure children's doses accurately and follow product directions.
  • Gentle heat may help.
    • Soak a flannel in warm water, squeeze it out and place over the ear, taking care not to burn the delicate skin.
  • Prop older children up on pillows to sleep. It may feel better if they lie with the sore ear on the pillow.
  • Keep your child's ears dry and clean.
  • Keep background noise in the home down. Loud noises can upset children with sore ears and make it harder for them to hear normal conversation.

Are antibiotics needed for ear infections?

Antibiotics may be needed, but they do not always help. Your doctor will decide whether antibiotics should be given, based on:

  • how old your child is
  • how bad the infection is
  • how often your child has ear infections
  • whether your child has other medical conditions
  • whether there have been complications from any previous ear infections.

If the ear is always getting infected, and it is not getting better with antibiotics, your doctor may suggest small tubes (grommets) are put in the ear so air can get into the middle ear to ventilate it. You will need to visit an ear, nose, throat (ENT) specialist for this type of treatment.

What happens if an ear infection is not treated?

Many children will get better without any treatment. Some, however, will go on to have one infection after another.

If an infection is very bad, the eardrum can burst. It may heal without any damage, but if it happens too often, it may form a scar and hearing will be affected. An operation to fix the damaged part of the ear may be needed. Children who can't hear well can have trouble learning to talk and have problems at school later on.

If you feel your child has any problems with hearing, see your family doctor.

Learn more

Glue ear Kidshealth and Paediatric Society of New Zealand and Starship Foundation, 2013 
Otitis media: a common childhood illness Best Practice Journal, BPAC

Credits: Editorial team. Last reviewed: 29 Feb 2016