How and Why Kids Get Ear Infections

Understanding ear infections in children

Your baby’s adorable little shell-like ears are made for more than just listening to lullabies. They are sophisticated and delicate organs that make it possible to hear, maintain balance, and connect with the world. But when a child gets an ear infection, the pain and discomfort can affect the whole family.

Ear infections are a common ailment for many children. Jasmin Makar, MD, a pediatrician at Stanford Medicine Children’s Health — Pediatrics in San Francisco, explains why kids are more prone to ear infections and discusses practical ways to ease their discomfort and prevent future bouts.

Why do kids get ear infections?

Young children are more prone to ear infections simply because their ears are so small. Tiny tubes called Eustachian tubes connect the middle ear to the back of the throat. These tubes help regulate air pressure and drain fluids. However, they are shorter and more horizontal in children, which means they can get infected more easily. Additionally, young children are generally more prone to infections because their immune systems are still developing.

“For younger kids, it can be an especially difficult and challenging issue. The frequent ear infections have a lot to do with the anatomy of their ears and the overall immaturity of their immune system,” Dr. Makar said. “They can’t equalize the pressure in their ears as easily as older kids and adults.”

Some ear infections happen spontaneously because of a bacteria or virus in the Eustachian tubes. However, Dr. Makar shared, they are often caused when a cold, flu, or other respiratory illness triggers inflammation and infection in those tubes.

“Ear infections often follow a viral respiratory infection. It starts as a typical cold, and then over several days those cold symptoms continue instead of getting better like a typical virus, causing the kids to present with fever and ear pain,” she said. “If there was fever at the start of the viral illness, and then it goes away for more than a day or so and then comes back, that can be a sign of secondary bacterial infection in the ear. Or if there wasn’t fever early in the course of the viral illness, and then suddenly on day four, five, or six they develop a fever, then I would want to have a look at their ears.”

Ear infection symptoms

Age can play a big role in identifying an ear infection in your child. Older kids may be able to complain about pain in their ears, but younger children might not be able to tell you what is wrong. Dr. Makar suggests watching out for these signs:

Ear pain or tugging

Irritability and poor sleep

Difficulty hearing

Fever

Treating ear infections

If you think your child has an ear infection, Dr. Makar advised that it’s OK to treat with over-the-counter pain relievers, but still make an appointment with your child’s pediatrician to make sure it’s not serious. For most kids, ear infections resolve on their own in a few days.

“It’s a spectrum, and the decision to treat is based on a child’s age, how certain we are about the diagnosis, and how severe the illness is. So, if a younger child has both ears infected and a fever, we’re going to be more likely to want to start antibiotics,” she said. “For an older child who doesn’t have a fever, who might only have fluid behind one ear, we may take a watch-and-wait type of approach, where we say, let’s see how this plays out.”

In the past, most ear infections were treated with antibiotics right away. But Dr. Makar explained that doctors now have increased awareness of the impact of antibiotics on children.

“In the past few years, we have been taking more of a watch-and-wait approach for a lot of kids. This is because we’re much more aware of antibiotic stewardship,” she shared. “We’re much more aware that antibiotics have their own potential for side effects. And unnecessary treatment can lead to unnecessary risks. So, we’ve developed this plan, and it’s different than what we were used to when we were kids.”

For more advice from Dr. Makar, check out “Health Care Issues Facing Families Today.” Or, read more about ear infections: “Otitis Media (Middle Ear Infection).”