Baby Ear Infection Symptoms: What to Do
Ear tugging alone does not prove an ear infection. Ear tugging with pain or fever needs a clinician’s advice.
SUMMARY
- If your baby is under 12 months and you suspect an ear infection, arrange a medical examination. If your baby is under 12 months and has pain in both ears, contact a clinician right away for urgent medical advice.
- For a baby younger than 3 months, a temperature of 38°C (100.4°F) or higher needs medical advice right away.
- A clinician must check the eardrum to confirm a middle ear infection.
For caregivers of babies in their first year, the immediate decision is whether to observe ordinary ear touching or arrange an examination. The treatment table also explains the age bands used for older children.
Ear touching: what else is happening?
Between 4 and 12 months, ear touching without fever, crying or pain is often ordinary exploration.
Possible signs include ear pain, unusual fussiness, disturbed sleep, fever, reduced feeding, drainage or a change in hearing. Sucking and swallowing may make ear pain more noticeable during feeds.
If no urgent signs are present, contact a clinician within 24 hours when ear pulling comes with apparent pain, crying, new waking from sleep, fever or cold symptoms.
Why an ear examination matters
Middle ear infections affect the space behind the eardrum and can follow a cold; bacteria or viruses can be involved. Children’s smaller, more horizontal eustachian tubes—the passages between the middle ear and the back of the throat—make fluid harder to drain.
Teething, a sore throat or irritation in the outer ear canal—the passage leading to the eardrum—can also cause ear pain. A clinician must check the eardrum to confirm a middle ear infection.
When to call, and when to act now
For a baby younger than 3 months, a temperature of 38°C (100.4°F) or higher needs medical advice right away. Contact a clinician right away for ear drainage or a temperature of 39°C (102.2°F) or higher.
Urgent signs
If your baby is under 12 months and has pain in both ears, contact a clinician right away for urgent medical advice. If your baby has ear infection symptoms with a change in hearing or new hearing loss, contact a clinician right away for urgent medical advice. Get urgent medical help for pain, redness or swelling behind the ear, especially if the ear starts sticking out. Call your local emergency number if your baby struggles to breathe, has blue or grey lips, or is difficult to wake.
Seek medical care if symptoms worsen or last longer than 2–3 days.
Observation or antibiotics?
For a mild infection, a clinician may recommend 2–3 days of watchful waiting before deciding whether antibiotics are needed.
The table describes US eligibility. Agree the observation and follow-up plan with the clinician who examines your child.
| Age group | US observation criteria after examination |
|---|---|
| 6–23 months | Under this US approach, children aged 6–23 months may qualify for observation when only one ear is infected, ear pain is mild and has lasted less than 48 hours, and temperature is below 39°C (102.2°F). |
| 2 years and older | From age 2 years, this US observation approach allows one or both ears to be affected, with mild ear pain lasting less than 48 hours and temperature below 39°C (102.2°F). |
This observation approach requires reliable follow-up and a separate treatment plan for ear drainage, an eardrum hole, ear tubes, cochlear implants, immune or ear-anatomy problems, or recent or resistant ear infections.
A severe infection or one that does not improve during observation may need prompt antibiotics. If observation is advised and your child is not improving or still has ear pain after 2–3 days, call the clinician about reassessment or antibiotics.
If antibiotics are prescribed, give them exactly as directed for the prescribed duration, even if your child seems better. Antibiotics can cause side effects such as diarrhea or a rash, so they are used when needed.
Before leaving the visit, ask about pain relief, when to return and whom to contact if symptoms worsen.
Relieve pain without putting things in the ear
Pain relief can help whether or not antibiotics are used; ask a clinician which medicine and dose fit your baby’s age and size. Under US guidance, do not give ibuprofen to a baby younger than 6 months unless the baby’s doctor tells you to. Do not give ibuprofen if your child is dehydrated or has chickenpox; with asthma, use it only if a doctor recommends it.
Never give aspirin to a baby or child.
If your baby has a fever and is breastfed, continue breastfeeding as usual. If feeding is poor and you are worried, or nappies are less wet than usual, contact a clinician right away for urgent medical advice.
Do not insert cotton swabs, fingers or other objects into the ear canal. Do not use home ear drops with ear drainage, a hole in the eardrum or an ear tube—a small ventilation tube placed through the eardrum. Decongestants and antihistamines have no demonstrated benefit for ear infections.
Everyday steps that lower the risk
Keep recommended vaccinations up to date, including flu and pneumococcal vaccines when age-appropriate. Clean hands and avoiding secondhand smoke help reduce ear infection risk.
Never put a baby to bed with a bottle. Breastfeeding offers some protection against ear infections. Ear infections cannot always be prevented.
After the pain settles
Fluid may remain behind the eardrum after an infection and temporarily affect hearing for several weeks. Arrange follow-up for hearing concerns, repeated infections or concerns about speech development.
Questions that come up at home
Can it still be an ear infection without fever?
An ear infection can occur without a fever.
The ear started draining and the baby seems happier. Is it over?
Pain may ease when fluid drains from the ear, but that does not confirm recovery and the ear still needs examination.
Can a sibling catch the middle ear infection?
A middle ear infection itself is not contagious, but the cold viruses that can lead to it can spread.