Baby & Pregnancy

Understanding Baby’s Ear Infections

Understanding Baby’s Ear Infections
Written by Sarah


The easiest way to tell whether your baby has an ear infection (also known as acute otitis media) — or any other illness, for that matter — is a change in her mood. If she turns fussy, or starts crying more than usual, you should be on the lookout for a problem. If she develops a fever (whether slight or high) you have another big clue. Ear infections tend to strike after a common cold or sinus infection, so keep that in mind too. You may also notice the following symptoms:


  • Your baby pulls, grabs or tugs at her ears. This is a sign she’s in pain.
  • Diarrhea. The virus that causes ear infections can also affect the gastrointestinal tract.
  • Reduced appetite. Ear infections can cause gastrointestinal upset. They can also make it painful for your baby to swallow and chew. You may notice your baby pull away from the breast or bottle after she takes the first few sips.
  • A yellow or whitish fluid draining from the ear. This doesn’t happen to all babies, but it’s a sure sign of infection. It also signals that a small hole has developed in the eardrum. Don’t worry — this will heal on its own once the infection is treated.A foul odor emanating from the ear
  • What causes ear infections?


An ear infection results when fluid and bacteria build up in the area around your baby’s eardrum. Normally any fluid that enters this area leaves pretty quickly through the Eustachian tube (which connects the middle ear to the back of the nose and throat) when your baby yawns or swallows. But if the Eustachian tube is blocked — common during colds, sinus infections, even allergy season — it traps the fluid in the middle ear. Bacteria like to grow in dark, warm, wet places, so a fluid-filled ear becomes the perfect breeding ground. As the infection worsens, so does the swelling in and around the eardrum, and, as a result, the pain. Fever develops as your baby’s body attempts to fight the infection.

Babies are particularly susceptible to ear infections because their Eustachian tubes are short (about 1/2 an inch) and horizontal. As they grow to adulthood, the tube triples in length to 1 1/2 inches and become more vertical, so fluid can drain more easily. Ear infections are one of the most common childhood illnesses. While there are no statistics on how many babies get them, the American Academy of Pediatrics expects that most children will have gotten at least one ear infection by the time they turn 3.

When should I call the doctor?

Call the doctor at the first sign of an ear infection. He’ll ask you to come in so he can take a look in your baby’s ear with an instrument called an otoscope. An eardrum that’s red, bulging and possibly draining is likely infected. He may also look to see whether the eardrum is moving using a pneumatic otoscope, which releases a brief puff of air into the ear. If it’s not moving, you have one more clue that fluid is collecting in the middle ear and it may be infected.

How will the doctor treat my baby’s ear infection?

Though recent research shows that many ear infections eventually clear up on their own without any treatment, when it comes to babies, doctors will always reach for an antibiotic. “With infants it’s better to err on the side of caution and prescribe something,” says Robert Ruben, an otolaryngologist (ear, nose and throat doctor) at Montefiore Medical Center in New York. The antibiotic of choice is amoxycillin, which parents refer to as “the pink stuff.” In addition, your doctor may recommend that you give your baby children’s acetaminophen or ibuprofen to help relieve any pain caused by the infection.

Make sure you give your baby her entire prescription of antibiotic and follow up with an ear re-check a few weeks later so the doctor can gauge whether the medicine did its job. Don’t hesitate to call your doctor if your baby seems to be getting worse or hasn’t improved significantly after a few days on the antibiotic. He may want to switch the antibiotic or examine your child again.

What can I do to prevent ear infections in the future?
Babies who attend day care or playgroups with other children are more prone to getting ear infections because they are exposed to more germs. That doesn’t mean you should keep your baby home all the time. That’s not fun or practical and even if you managed to do it, your baby would still catch an illness here or there. Instead, wash your hands (and your baby’s hands) often, and try these prevention ideas:

  • Keep your baby up to date on her vaccines. They help prevent certain illnesses that can lead to an ear infection. For example, the Hib vaccine has helped tremendously in reducing the number of ear infections in babies, and the new pneumococcal vaccine can help prevent them as well. If your baby has suffered repeated ear infections, especially after bouts with the flu, you may want to consider an annual flu vaccine, but talk to your doctor first. Only children over 6 months old can get a flu shot.
  • Breastfeed your baby for a minimum of six months. A recent study from the Centers for Disease Control and Prevention and the Food and Drug Administration, which appeared in the journal Pediatrics, showed that children who are breastfed for the first six months of life are less likely to develop ear infections. In fact, the risk of ear infections was 70 percent greater in formula-fed babies. Practitioners such as Ruben believe that mothers transfer certain immune-building antibodies to their babies through breast milk. However, those antibodies seem to decrease after the six-month mark.
  • Limit your baby’s exposure to tobacco smoke. Even a weekend spent in a house with a smoker can significantly harm a baby and increase her chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your baby to fight off infection.

My baby gets repeated ear infections. Can ear tubes help?

Babies with multiple ear infections — which, for many children, is actually one ear infection that lingers on for months despite antibiotic treatment — may be good candidates for ear tubes. This procedure, known as tympanostomy, is the most common surgery performed in North America on children under 4, according to a study in the Canadian Medical Association Journal. In the United States alone doctors perform roughly one million ear-tube insertions each year.

During the procedure, which is done under general anesthesia, an otolaryngologist makes a tiny incision in the child’s eardrum and inserts a millimeters-long tube into the slit. These tubes act as a vent, letting air in and fluid out so bacteria can’t flourish. “It helps the Eustachian tube work better,” says Ruben.

Your pediatrician may suggest this surgical solution because a baby with persistent fluid in his ears (or otitis media with effusion) is not only a prime candidate for repeated ear infections, but also for hearing loss. Babies who have trouble hearing may suffer delays in language development.

Still, the procedure is considered controversial and there is little consensus among doctors on whether it’s really necessary. Studies have shown that some babies who’ve had recurrent ear infections are a little behind when it comes to school readiness. But somewhere between 2 and 5 the connection between chronic ear infections and decreased school readiness disappears, argues Joanne E. Roberts, a senior scientist at the Frank Porter Graham Child Development Center at the University of North Carolina in Chapel Hill. Children with chronic ear infections eventually perform on par with their peers who didn’t battle ear troubles in the first few years.

What should you do? Talk to your doctor and weigh the pros and cons for you and your baby. Unfortunately, there’s no definitive answer to the ear tube question yet.

Are ear infections ever serious?

They can be. A severe or untreated infection can break your baby’s eardrum and flood her ear canal. It doesn’t happen very often, but it’s one of the reasons it’s so important to have a doctor examine your baby’s ear if you think she may have an infection. Repeated ear infections can also lead to hearing loss and scarring. In very rare cases, untreated ear infections can lead to an infection of the skull behind the ear (mastoiditis), or meningitis.

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