Acute Otitis Media with Infection (Child)

Image showing a cross-section of the external, middle, and inner ear, including the ear canal, eardrum, and eustachian tube.

Your child has a middle ear infection (acute otitis media). It's caused by bacteria or viruses. The middle ear is the space behind the eardrum. The eustachian tube connects the ear to the nasal passage. The eustachian tubes help drain fluid from the ears. They also keep the air pressure equal inside and outside the ears. These tubes are shorter and more horizontal in children. This makes it more likely for the tubes to become blocked. A blockage lets fluid and pressure build up in the middle ear. Bacteria or fungi can grow in this fluid and cause an ear infection. This infection is commonly known as an earache.

The main symptom of an ear infection is ear pain. Other symptoms may include pulling at the ear, being more fussy than usual, fever, decreased appetite, and vomiting or diarrhea. Your child’s hearing may also be affected. Your child may have had a respiratory infection first.

An ear infection may clear up on its own. Or your child may need to take medicine. After the infection goes away, your child may still have fluid in the middle ear. It may take weeks or months for this fluid to go away. During that time, your child may have temporary hearing loss. But all other symptoms of the earache should be gone.

Home care

Follow these guidelines when caring for your child at home:

  • The healthcare provider will likely prescribe medicines for pain. The provider may also prescribe antibiotics to treat the infection. These may be liquid medicines to give by mouth. Or they may be ear drops. Follow the provider’s instructions for giving these medicines to your child. Don't give your child any other medicine without first asking your child's healthcare provider, especially the first time.

  • Because ear infections can clear up on their own, the provider may suggest waiting for a few days before giving your child medicines for infection.

  • To reduce pain, have your child rest in an upright position. Hot or cold compresses held against the ear may help ease pain.

  • Don't smoke in the house or around your child. Keep your child away from secondhand smoke.

To help prevent future infections:

  • Don't smoke near your child. Secondhand smoke raises the risk for ear infections in children.

  • Make sure your child gets all appropriate vaccines.

  • Don't bottle-feed while your baby is lying on his or her back. (This position can cause middle ear infections because it allows milk to run into the eustachian tubes.)    

  • If you breastfeed, continue until your child is 6 to 12 months of age.

To apply ear drops:

  1. Put the bottle in warm water if the medicine is kept in the refrigerator. Cold drops in the ear are uncomfortable.

  2. Have your child lie down on a flat surface. Gently hold your child’s head to one side.

  3. Remove any drainage from the ear with a clean tissue or cotton swab. Clean only the outer ear. Don’t put the cotton swab into the ear canal.

  4. Straighten the ear canal by gently pulling the earlobe up and back.

  5. Keep the dropper a half-inch above the ear canal. This will keep the dropper from becoming contaminated. Put the drops against the side of the ear canal.

  6. Have your child stay lying down for 2 to 3 minutes. This gives time for the medicine to enter the ear canal. If your child doesn’t have pain, gently massage the outer ear near the opening.

  7. Wipe any extra medicine away from the outer ear with a clean cotton ball.

Follow-up care

Follow up with your child’s healthcare provider as directed. Your child will need to have the ear rechecked to make sure the infection has gone away. Check with the healthcare provider to see when they want to see your child.

Special note to parents

If your child continues to get earaches, he or she may need ear tubes. The provider will put small tubes in your child’s eardrum to help keep fluid from building up. This procedure is a simple and works well.

When to seek medical advice

Call your child's healthcare provider for any of the following:

  • Fever (see Fever and children, below)

  • New symptoms, especially swelling around the ear or weakness of face muscles

  • Severe pain

  • Infection seems to get worse, not better 

  • Neck pain

  • Your child acts very sick or not himself or herself

  • Fever or pain don't improve with antibiotics after 48 hours

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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