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The Ins and Outs of Ear Infections in Children

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What is an ear infection?

The National Institute on Deafness and Other Communication Diseases defines an ear infection as “an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum ... Three out of four children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to a doctor.” (2) The technical term for an ear infection is otitis media.

“Ear infections peak at age 6 months to 2 years. They are a common problem until age 8 [and] 90% of children will have at least 1 ear infection.” (5) There are two possible reasons for why so many children are affected.

First, a child’s eustachian tubes are shorter, more horizontal, narrower and less stiff than those of adults, which means bacteria and viruses can find their way into the middle ear more easily, and they are more prone to blockage. (1)

Second, children have larger adenoids, gland-like structures located in the back of the upper throat near the eustachian tubes, which can interfere with the opening of the eustachian tubes. (1)

The American Academy of Pediatrics (AAP) states that middle ear infections in children start either from a viral infection (such as a common cold), against which antibiotics don’t work, or from unhealthy bacterial growth.

What are the symptoms of ear infections in children?

There are three main types of ear infections — acute otitis media (AOM), otitis media with effusion (OME) and chronic otitis media with effusion (COME). The symptoms for each of these types can vary.

Acute otitis media is the most common type of ear infection where parts of the middle ear become infected and swollen when fluid is trapped behind the eardrum. Children with AOM can experience:

• Ear pain – the area may be red, swollen, hot and painful to the touch

• Fever

• Fluid draining from the ear

• Difficulty with hearing/tracking sounds or with keeping balance

OME is known to occur after an ear infection has cleared up, but when there is fluid still trapped behind the eardrum. There may be no symptoms with OME, but the doctor will be able to see the fluid with his instruments.

COME is when fluid in the middle ear lingers for a long time or returns from time to time. “COME makes it harder for children to fight new infections and also can affect their hearing.” (2)

How are ear infections in children treated?

“Not all forms of otitis need to be treated with antibiotics.” (1)

In fact, “common ear infections rarely require any other action, except when severe or in young infants” (3) and fewer doctors are relying on antibiotics, which may not actually speed recovery anyway.

Many pediatricians take a wait-and-see approach for the first 48 to 72 hours. Numbing drops are available by prescription, or parents may wish to use ibuprofen or acetaminophen to manage the pain and fever symptoms.

Some mothers swear by the use of the garlic oil or coconut oil for their children’s ear infections, however it is best to check with your doctor about using these remedies to rule out whether or not there is already damage to the eardrum.

Other treatment options may include:

• Ear tubes to drain the fluid when fluid continues to build up despite medication, although tubes don’t actually stop ear infections

• Antibiotics, such as Amoxicillin, in low doses if the infections are recurring or your child has had four or more ear infections within a 12-month period, and at least one within the last six months

• Removal of the adenoids if they are blocking the eustachian tubes. (4)

The AAP has actually revised its recommendations for treatment of ear infections. You can read more about these changes in this article.


1) Middle Ear Infections. KidsHealth.org. Web. Oct 7, 2013.

2) Ear Infections in Children. National Institute on Deafness and Other Communication Disorders (NIDCD). Web. Oct 7, 2013)

3) When is it an Ear Infection. American Academy of Pediatrics. Web. Oct 7, 2013.

4) Your Child and Ear Infections. American Academy of Pediatrics. Web. Oct 7, 2013.

5) Ear Infection Questions. American Academy of Pediatrics. Web. Oct 7, 2013.

6) Kids’ Ear Infections: New Guidelines for Treatment. Gordon, Serena. WebMD. Web. Oct 7, 2013.

Reviewed October 7, 2013
by Michele Blacksberg RN
Edited by Jody Smith



Description: The National Institute on Deafness and Other Communication Diseases defines an ear infection as “an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum….

Page Title: The Ins and Outs of Ear Infections in Children

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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