Ear Infection in Toddlers: Causes, Signs to Look Out For & Treatment

An ear infection is an infection affecting the middle, outer or, less commonly, inner ear. In babies and toddlers, middle ear infections are especially common and often develop after a cold.

Because younger children may be unable to explain where it hurts, recognising an ear infection in toddlers often means looking for changes in their behaviour alongside physical symptoms, such as fever or ear discharge.

Key Points

• Ear infections are very common in babies and toddlers, particularly after a cold.
• Young children may pull at their ear, cry more, sleep poorly, refuse food, or seem unusually irritable.
• An ear infection can occur without a fever, so behaviour and other symptoms are important.
• Most acute middle ear infections improve within around 3 days without antibiotics, although symptoms can last up to a week.
• Children aged 1–17 with suspected acute otitis media can be assessed by a pharmacist, while babies under 12 months should see a GP.

What Causes Ear Infections in Toddlers?

The most common type in young children is acute otitis media, which affects the middle ear behind the eardrum. It often develops when fluid becomes trapped in the middle ear, allowing viruses or bacteria to cause an infection.

Why Are Toddlers More Prone to Ear Infections?

Several features of early childhood make ear infections particularly common:

• Eustachian tube anatomy: The Eustachian tubes connect the middle ear to the back of the throat and help fluid drain away. In toddlers, they are shorter, narrower, and more horizontal than in adults, so fluid does not drain as easily and can build up behind the eardrum.
• Developing immune system: A toddler's immune system is still maturing, which can make it harder to fight off the viruses and bacteria that may contribute to an ear infection.
• Larger adenoids: Children's adenoids are relatively large and sit close to the Eustachian tubes. If they become swollen, they can interfere with drainage and contribute to fluid building up in the middle ear.

What Can Increase the Risk of an Ear Infection?

Certain illnesses, exposures and everyday factors can make middle ear infections more likely:

• Colds and respiratory infections: Colds, flu, and other respiratory infections can cause inflammation and mucus that block the Eustachian tubes. This is why an ear infection often develops during or shortly after a cold.
• Exposure to tobacco smoke: Second-hand smoke can irritate the airways and increase a child's risk of developing middle ear infections.
• Group childcare: Regular contact with other children can increase exposure to the respiratory infections that often precede an ear infection.
• Dummy use: Regular dummy use, particularly after 6 months of age, has been associated with an increased risk of middle ear infections.
• Family history: Some children may be more susceptible to recurrent ear infections because of inherited differences in their immune response or ear anatomy.

If your child's earache develops during or after a respiratory illness, learn which common cold symptoms need closer attention.

How Do I Tell If My Non-Verbal Child Has an Ear Infection? Signs & Symptoms

A toddler cannot always tell you that their ear hurts. Instead, watch for a combination of physical symptoms and changes in their usual behaviour. Signs and symptoms of an ear infection in toddlers can include:

• Pulling, rubbing, or tugging at an ear
• Increased crying, irritability, or restlessness
• Difficulty sleeping
• Ear pain or distress that appears worse when lying down
• A high temperature
• Reduced appetite or difficulty feeding
• Fluid or discharge from the ear
• Difficulty hearing or not responding to quieter sounds
• Problems with balance or unusual clumsiness
• Pressure or fullness in the ear, if the child is able to describe it

What Are the Treatments for Ear Infection in Babies and Toddlers?

Treatment depends on which part of the ear is affected, the cause, your child's age, and the severity of their symptoms.

Most ear infections improve without specific treatment, while others may require medicines, such as ear drops or antibiotics.

Here are the main treatment options that may be recommended for babies and toddlers:

1. Pain Relief

Managing pain is an important part of treatment. Children's paracetamol or ibuprofen can be given when appropriate, using the correct dose for your child's age or weight. Children under 16 should never be given aspirin.

By the way, explore Weldricks’ pain relief options and always check that your chosen medicine is suitable for your child’s age.

2. Ear Drops

Depending on the type of infection and symptoms, a healthcare professional may recommend pain-relieving, antibiotic, antifungal, or steroid ear drops.

For acute middle ear infections, ear drops containing a local anaesthetic and painkiller may sometimes be recommended to relieve pain, particularly when immediate oral antibiotics are not needed. However, these drops should not be used if your child has a perforated eardrum or discharge from the ear.

Never put drops, oil, or other products into a young child's ear unless they are suitable for them and you have been advised to do so.

You can browse ear drops at Weldricks, but always check age restrictions and speak to a pharmacist if you're unsure.

Read also: Are Ear Drops or Oral Antibiotics Better For Ear Infections?

3. Antibiotics

Antibiotics are not routinely needed for every childhood ear infection. Most children with acute otitis media improve without them, and antibiotics make little difference to pain during the first 24 hours.

When antibiotics are appropriate, amoxicillin is commonly used as the first-choice oral antibiotic for acute otitis media in children. The medicine, dose, and treatment duration must be determined by a healthcare professional according to factors including the child's age and clinical assessment.

Immediate antibiotics may be appropriate when:

• Your child is very unwell.
• Your child is at increased risk of complications.
• A child under 2 has acute otitis media in both ears.
• There is ear discharge due to a perforated eardrum.

A healthcare professional will assess your child's symptoms and individual risk before deciding whether antibiotics are appropriate.

What Can You Do at Home?

While your child recovers:

• Give suitable paracetamol or ibuprofen for pain.
• Gently wipe away discharge from the outside of the ear with cotton wool.
• Keep water and shampoo out of the affected ear.
• Avoid swimming until the infection has cleared.
• Never put cotton buds, fingers, or other objects inside the ear.
• Do not use decongestants or antihistamines to treat the infection, as evidence does not show they help.

When Should I Take My Child to the Doctor for an Ear Infection?

The appropriate next step depends partly on your child's age.

See a GP if your baby is under 12 months and you suspect an ear infection. For children aged 1–17, a pharmacist can assess suspected acute otitis media and, when clinically appropriate, provide treatment through NHS Pharmacy First.

Seek urgent GP advice or contact NHS 111 if your child has an ear infection and:

• Seems generally unwell
• Has a very high temperature or feels hot, cold, or shivery
• Develops swelling around the ear
• Has a change in hearing
• Has fluid or discharge coming from the ear
• Is vomiting, dizzy, or has a severe sore throat
• Is under 12 months and has earache in both ears
• Has a weakened immune system or certain long-term health conditions (e.g., heart, lung, or neurological condition)

How Can You Help Prevent Ear Infections in Toddlers?

Not every ear infection can be prevented, particularly those associated with colds. However, you can reduce some risk factors by:

• Keeping your child's routine vaccinations up to date
• Keeping them away from cigarette smoke and smoky environments
• Avoiding dummies after 6 months where possible
• Never putting cotton buds or fingers into their ears
• Keeping water out of the ears when an infection is present

Ear Infection in Toddlers — Conclusion

Ear infections are common in toddlers and usually improve quickly, but recognising them can be harder when your child cannot describe their pain. Watch for ear pulling alongside changes in sleep, feeding, hearing, and behaviour, and seek help when symptoms persist or become more severe.

If your child is aged 1–17 and may have an ear infection, visit Weldricks Pharmacy for professional assessment and appropriate ear infection treatment!