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Ears: Ear infections - brief version


Disclaimer: This fact sheet is for educational use only. Please consult your doctor or other health professional to make sure this information is right for your child.

Key points to remember about ear infections

  • ear infections are very common in young children
  • they can cause pain, and often fever
  • antibiotics are not always needed
  • pain relief is important
  • there may be some fluid in the space behind the ear drum (middle ear) for several weeks or months after the infection. This is normal, and usually clears up on its own
  • most children outgrow ear infections and have perfect and undamaged ears and normal hearing
  • if you think your child has an ear infection, take them to your family doctor

For a more detailed version of this fact sheet, including photos and diagrams, see:


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What are the signs and symptoms of an ear infection?

Older children will complain of significant ear pain and may have a fever. They may also feel unwell and complain of reduced hearing in the affected ear.
 
In babies and younger children, sometimes the only sign of an ear infection is a fever.
 
Younger children may also:
  • cry and become very upset / distressed / irritable and hard to deal with
  • have very disturbed sleep at the beginning of the infection
  • be harder to settle to sleep
  • vomit, lose interest in eating, seem to have no energy
  • become “clingy” and “grizzly”
Sometimes pus will burst through the eardrum. The pus looks like snot coming out of the ear. When the ear drum bursts, children often feel better as the pressure causing the pain is suddenly released. The burst eardrum usually heals without treatment or future problems. See When should I seek help?
 

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How long does an ear infection last?

The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours. After an ear infection, your child may have fluid behind their ear drum (effusion) which can last several weeks to months. This may cause your child to have an ongoing feeling of discomfort in their ears. It is more a dull, abnormal feeling than a nasty, sharp pain. The fluid also causes a short-term decrease in hearing in that ear. See the fact sheet on glue ear (detailed version or brief version).
 

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What is the treatment for an ear infection?

Pain relief
Regular pain relief is important to help your child feel more comfortable. Paracetamol and / or ibuprofen can help reduce pain, and also lower fever which can make your child feel better. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose. Your family doctor or pharmacist can advise you on the right dose of pain relief medicine for your child.
 
Antibiotics
Your doctor may either:
  • wait to see whether the infection will clear up by itself, or
  • recommend treatment with antibiotics, if your child is unwell and feverish

Your child's doctor will be happy to discuss your child's treatment with you so that you can be involved in the treatment decisions. The decision about whether or not to use antibiotics may depend on some of the following factors:

  • how severe the infection is
  • how old your child is
  • how often your child has had middle ear infections before
  • how long your child has had this infection
  • whether your child has ever had complications from ear infections before
  • whether your child has any other medical conditions
  • your views on how to manage your child's ear problems

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How can I care for my child at home?

  • pain relief is important (see What is the treatment for an ear infection?)
  • propping your child's head up with a pillow in bed may help reduce the pain
  • your child may need rest and lots of comforting / cuddles
  • keep your child home from child care or school while they are unwell or have a fever
There is no evidence that decongestant medicines (including nose sprays) and antihistamines are of any benefit in the treatment of ear infections and they can have unwanted side-effects so they should not be used.
 

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Can I do anything to prevent ear infections in my child?

Children grow out of the tendency to have ear infections as they get older. It is not easy to prevent ear infections, but the following may help reduce the risk
  • keeping your child smoke-free
  • breastfeeding your baby for three to six months is thought to be protective against the early development of ear infections. This may be because breast feeding boosts the immune system (the body's defence against potentially harmful germs)

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When should I seek help?

The symptoms of ear infections also occur in other illnesses; for this reason, if you suspect your child has an ear infection, take them to your family doctor. Your doctor will examine your child to see if an ear infection (or another problem) is the cause of your child's symptoms.
 
Once an ear infection is diagnosed, your child should start to improve within 24 to 48 hours. If the symptoms are no better or are getting worse, or you are worried about your child, take them back to your family doctor.
 
You should should always take your child to your family doctor to have their ears reviewed after any ear infection, to make sure the ear fluid has gone. This recheck usually happens around four to six weeks after the infection.
 
You should also take your child to your family doctor if:
  • your child's ear starts to discharge
  • your child has a fever which doesn't go away after 24 – 48 hours
  • you are worried about the continuing unwellness of your child

You need to take your child to a doctor immediately if your child:

  • has any swelling, redness or tenderness in or around the ear
  • is feeding poorly
  • has any change in consciousness
  • has a stiff neck
  • has sensitivity to light
If your child keeps getting frequent ear infections, they may need to see an ENT (ear, nose and throat) specialist to consider grommets (tympanostomy or ventilation tubes). See Grommets (tympanostomy or ventilation tubes), including the section When might my child need grommets?
 

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Acknowledgements

Procare logoStarship Foundation and the Paediatric Society of New Zealand acknowledge the co-operation of Procare Health Ltd in the development of this fact sheet. Procare Health Ltd provides GP (general practice) services in the greater Auckland area.
 

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Endorsement

This fact sheet was endorsed by PSNZ - 04/02/2009

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2010


The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
http://www.starship.org.nz