What Is the Best Treatment for an Ear Infection for Children?

Ear infections can be caused by either bacteria or a virus, often following a cold. The common cold can cause the middle ear to become inflamed and fluid to build up behind the eardrum. The Eustachian tube, which connects the ears, nose and throat, can also become swollen and blocked. 

Children are especially prone to ear infections, explains Jennae Lee, MD, a pediatrician at Scripps Coastal Medical Center Oceanside. 

“Children are more susceptible to ear infections than adults because they have shorter and narrower Eustachian tubes, so it is easier for bacteria or viruses to reach the middle ear and for fluid to get trapped there,” Dr. Lee says. “Babies and children also have less developed immune systems, so their bodies aren’t able to fight an infection as effectively as adults do.” 

Not every earache means an infection. The American Academy of Pediatrics (AAP) emphasizes that a true middle ear infection must be accurately diagnosed before treatment begins. 

Doctors look for key signs, such as bulging of the tympanic membrane and fluid in the middle ear (also called middle ear effusion). These findings confirm that the infection is located in the middle ear, not the outer ear or ear canal. 

During an exam, the pediatrician will often use an otoscope to check the child's ear. They look for redness, swelling or fluid behind the eardrum.

Getting an accurate diagnosis makes sure your child gets the right care and can avoid any unnecessary use of antibiotics. 

Understanding the type of ear infection helps guide the right treatment plan.

• Acute otitis media (AOM): Infection in the middle ear with infected fluid and inflammation, often following a cold; causes ear pain, fever and irritability 
• Otitis media with effusion (OME): Noninfected fluid trapped in the middle ear that may follow AOM or appear alone; may affect hearing but usually not painful 
• Otitis externa (swimmer’s ear): Infection of the outer ear or ear canal caused by moisture or irritation; results in redness, itching and tenderness when the ear is touched 

Because symptoms can overlap, only a pediatric exam can determine the exact type of ear infection. 

Not every ear infection needs antibiotics. Many infections get better on their own as the immune system fights them off. If you think your child has an ear infection, talk to your pediatrician. They can confirm the diagnosis and recommend the best treatment approach. 

Dr. Lee explains that antibiotics are not always the first line of care. “Some ear infections do not require antibiotics. If the infection is mild, the body’s immune system can often fight off the infection on its own,” she says. 

“Also, some ear infections are caused by viruses which won’t respond antibiotics,” she adds. “A good number of ear infections will resolve on their own within a week.” 

 For mild cases, your doctor might recommend watchful waiting to give your child’s immune system time to fight off the infection before turning to antibiotics. 

When to observe:

• Mild symptoms, no fever, child over 2 years old 
• One ear affected 
• First or occasional infection 

When to treat with antibiotics: 

• Severe pain or fever over 102°F 
• Both ears infected in children under 2 
• No drainage or rupture 
• Recurrent or persistent infection 

Even when antibiotics are prescribed, they can take a day or two to begin easing symptoms. In the meantime, you can help your child at home. You can comfort them, reduce swelling in the middle ear and support their healing. 

Over-the-counter medications can help reduce pain and fever. Use the right dose based on your child’s age and weight. When in doubt, check with your pediatrician. “It’s very important to follow instructions and give the appropriate dosage according to your child’s weight and age,” says Dr. Lee. “Giving too much or too little medicine can make it less effective or even unsafe.” 

For children younger than 6 months, give only acetaminophen (Tylenol). For those older than 6 months, ibuprofen (Advil, Motrin) may also be used. Never give aspirin to children — it can cause Reye’s syndrome, a rare but serious illness that affects the liver and brain.  

Infants under 3 months old with a fever need medical help right away even if they seem fine and show no other signs of illness. 

Gentle warmth or coolness can ease pain in a child’s ear affected by an infection. 

A warm compress helps blood flow behind the eardrum. It also relieves pressure and helps drain fluid. A cold compress can numb sharp pain and reduce swelling. Try alternating between the two to find what feels better.

Always check the temperature before using. You can use compress therapy several times a day. It is especially helpful before naps or bedtime when ear pressure may feel worse. 

Encourage your child to drink lots of fluids. Staying hydrated helps thin mucus and fluid in the middle ear. This makes it easier for the fluid to drain through the Eustachian tube. 

Swallowing helps open this tube slightly, improving fluid drainage. Offer water, diluted juice or warm soups throughout the day. For infants, continue regular breast or formula feedings. 

Raising your child's head can reduce pressure behind the eardrum. It also helps fluid in the middle ear drain naturally. 

“Keeping the head slightly elevated, especially during sleep, can make a big difference,” Dr. Lee notes. “It’s a simple step that helps reduce discomfort from pressure changes inside the ear.” 

For children over age 2, you can elevate the upper body slightly by placing a small pillow under the mattress. Never place pillows directly in a crib. 

If your child’s eardrum ruptures, you may see fluid draining or pus from the ear canal. While it might look alarming, this usually relieves pain and allows the infected fluid to escape. 

Gently wipe any discharge with a clean tissue or gauze pad — never insert cotton swabs or anything into the ear. Keep the ear canal dry and avoid swimming until your pediatrician says it’s safe. 

Certain factors increase a child’s risk of ear infections, including: 

• Frequent daycare exposure (increased cold viruses) 
• Pacifier use beyond 6 months 
• Family history of allergies or asthma 
• Secondhand smoke exposure 
• Feeding while lying flat 

To help prevent recurrence: 

• Keep immunizations up to date (flu and pneumococcal vaccines) 
• Manage allergies to reduce nasal swelling 
• Limit pacifier use 
• Keep your child upright during feeding 
• Encourage breastfeeding when possible 

Call your child’s pediatrician if: 

• Fever lasts more than two days on antibiotics 
• Ear pain becomes severe or persistent 
• Ear discharge continues after three days of treatment 
• Your child appears unusually irritable, tired or off-balance 

If you plan to fly while your child has a middle ear infection, check with your pediatrician first. Cabin pressure may worsen pain or raise the risk of a ruptured eardrum, and your doctor can advise on safe travel. 

If flying can’t be avoided, you can help ease your child’s discomfort by giving a child-appropriate pain reliever before takeoff, keeping them awake during ascent and descent, encouraging frequent swallowing or sipping water and using a doctor-approved nasal spray to reduce congestion.

Ear infections in children are common and usually clear up quickly with proper care. Stay alert to symptoms, keep your child comfortable and follow your pediatrician’s advice for the best recovery. 

“Most ear infections in children improve within a few days,” says Dr. Lee. “The key is keeping your child comfortable and checking in with your doctor if symptoms don’t get better.”