Dr. Mona's Mom Blog

How to know if your kid has an ear infection

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Not all ear infections need treatment. Read on to learn about signs and symptoms and management.

Are you often confused if your child has an ear infection? Or confused if an ear infection needs treatment? Does tugging at the ear automatically mean infection? Are tubes needed? There can be a lot of confusion when it comes to ear infections. Let’s clear some of that up!

Let’s look at the anatomy of the ear

When we look at the ear we’re looking at the outside structures. When we use an otoscope, we can see the ear canal and the eardrum. If the ear canal or the outside of the ear is red this is commonly referred to as an outer ear infection (swimmer’s ear or otitis externa). If we look inside the ear and we see that the eardrum is red and/or bulging, this is a sign of a middle ear infection or otitis media. These are commonly caused by congestion or inflammation in the middle ear. Viruses are one of the most common reasons we see ear infections.

Why children are more prone to ear infections

Children’s ear canals and ear anatomy are narrow, shorter and more horizontal than adults. This can mean that fluid can build up in their ear canal and also subsequently lead to more inflammation (and possibly bacteria), developing into an ear infection. Also, children are just more likely to get viruses – you know this if your child goes to daycare or is school age! They are more prone to picking up these germs and viruses which can subsequently lead to an ear infection. Lastly, their immune systems are still developing.

When to seek medical attention vs. when to monitor at home

Ear pain can commonly be caused by teething and is a common reason babies and young children can tug their ears. Not all ear infections need antibiotics so use the following information to determine the best course of action to take.

  • Your child is complaining of ear pain. If they are verbal and are telling you, “Mommy, my ear hurts,” if they are non-verbal or pre-verbal, and you see them tugging and holding their ears repetitively, consider seeking medical attention.
    • Tugging alone is not always a sign of an ear infection, though. For babies this is very common because it’s something new for them, they have ears and hands and now they can explore their body. Combine tugging, a fever and irritability and that’s a different story.
  • If your child just generally seems like they are in a lot of pain, give them Motrin or Tylenol or a pain medicine that’s age appropriate.
    • If after giving medicine and an hour or an hour and a half goes by and they’re still in pain, you’re going to want to seek medical attention. At this point, we are concerned that there is an ear infection and there is something that we need to evaluate inside that ear.
  • If they are crying more than usual (especially when lying down and especially for babies), consider alerting your child’s clinician. Commonly, when we lay down, fluid can build up in the ears, which can lead to inflammation, which can lead to an infection.
  • If your child has persistent fever without pain (especially approaching five days), we want to evaluate your child even if they’re not in discomfort.
  • If you see any fluid coming from your child’s ears, you’re going to want to get them evaluated.

What about swimming and plane rides with ear infections?

Parents commonly ask if they can take their child swimming or on an airplane if they have a middle ear infection. If they’re acutely febrile then maybe you want to hold on any of those activities because of contact and exposure. But if they’re otherwise well and pain is well managed, you can go on that flight or you can go swimming. If flying, you can have them drink something at takeoff or landing. If they’re younger, use a pacifier to help with ear pressure.

Tell me about ear tubes!

Ear tubes are sometimes recommended for children who have recurrent ear infections or recurrent fluid in the ears that might be impacting their hearing. These tubes are small tubes that are surgically placed into your child’s eardrum by an ear, nose and throat surgeon (ENT). The tubes are usually made of plastic or metal and are placed to help drain fluid out of the middle ear – the place between the eardrum and the inner ear that can cause ear infections. Tubes may be recommended if your child is having three or more ear infections in a six month period and more importantly if they are having fluid accumulation that’s impacting their hearing.

We use the criteria of “three or more in a six month period” or concerns with hearing loss to determine if a child needs tubes. If your child does need tubes, then the benefit likely outweighs the risk. Check out the podcast below for more!

Listen to episode 76 of The PedsDocTalk Podcast where I interview an ENT and we discuss tubes!

Ear infections are not contagious

Ear infections themselves are not contagious. I remember hearing this all the time from my child’s daycare! “Well, someone has an ear infection so ear infections are going around!” You can’t catch an ear infection. What you can catch is the virus that is going around that subsequently caused some children to develop ear infections. Some children get ear infections due to the anatomy in their ear as well as their immune system, so 10 kids could get exposed to a virus but maybe two or three will develop an ear infection.

How to prevent ear infections

So much of it is out of our control! A lot of it has to do with the anatomy of the child’s ear. Normal hand hygiene can go such a long way. This will help reduce the spread of illnesses so your child is less likely to get sick and subsequently less likely to develop an ear infection. Also, avoid second-hand smoke. We know that second-hand smoke can cause a lot of illnesses in our children and this includes ear infections. But remember that your child’s propensity to ear infections is NOT your fault. Some kids are truly more prone to them and a lot of it has to do with anatomy/head shape and exposure to viruses.


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All information presented on this blog, my Instagram, and my podcast is for educational purposes and should not be taken as personal medical advice. These platforms are to educate and should not replace the medical judgment of a licensed healthcare provider who is evaluating a patient.

It is the responsibility of the guardian to seek appropriate medical attention when they are concerned about their child.

All opinions are my own and do not reflect the opinions of my employer or hospitals I may be affiliated with.