Ear Infection in Babies: Signs, Treatment and When to Worry

An ear infection in a baby or toddler is usually a middle ear infection (acute otitis media), where fluid and germs build up behind the eardrum, often after a cold. Signs include ear pain, fever, crying more than usual (especially lying down), poor feeding and sleep, and sometimes pulling at the ear. The NHS notes most ear infections clear within about 3 days, though symptoms can last up to a week. Babies under 1 should see a doctor, and any child with swelling behind the ear, a stiff neck, drowsiness or a high fever needs urgent care.

Here’s how to spot an ear infection, what treatment usually involves, and how to reduce your child’s chances of getting another.

Why babies get so many ear infections

A small tube (the Eustachian tube) connects the middle ear to the back of the nose. In babies and toddlers it is shorter and more horizontal than in adults, so it blocks easily when the nose is congested. Fluid then collects behind the eardrum, and bacteria or viruses can multiply there.

That’s why ear infections so often follow a cold, and why they peak in the infant care and preschool years, when children catch one cold after another. Our guide to baby cough and cold remedies covers why colds are so frequent, and our bronchiolitis guide explains when a cold spreads to the chest.

Signs of an ear infection

Older children can say their ear hurts. Babies can’t, so look for a combination of signs:

Fever
Crying more than usual, especially when lying down, which raises pressure in the ear
Waking at night more than usual
Rubbing or pulling at one ear
Fussiness during feeds, as sucking and swallowing can hurt
Not reacting to some sounds, or seeming off-balance
Fluid or pus draining from the ear

Ear pulling on its own is not a reliable sign. The American Academy of Pediatrics points out that many babies tug their ears to self-soothe or when teething. If your baby is happy, feeding well and has no fever, ear pulling alone usually isn’t a worry. Our teething guide explains other teething signs.

Middle ear or outer ear?

An outer ear infection (otitis externa, or “swimmer’s ear”) affects the ear canal and is more common in older children who swim often. The ear is usually painful when the outer ear is touched or moved. A doctor can tell the two apart by looking into the ear.

Does my child need antibiotics?

Not always. Many middle ear infections are viral, or clear up on their own. The American Academy of Pediatrics notes that about 80% of ear infections get better without antibiotics, and that doctors may sometimes wait 48 to 72 hours to see if symptoms improve before prescribing.

Situation	What doctors often do
Young babies, especially under 6 months	Usually examine promptly and are more likely to treat, as infections in young babies need closer attention
Older babies and toddlers with mild symptoms	May suggest pain relief and watchful waiting for 2 to 3 days, sometimes with a “just in case” prescription
Severe pain, high fever, both ears affected or ear discharge	More likely to prescribe antibiotics
Not improving or getting worse after 2 to 3 days	Re-examine and consider antibiotics or a change of medicine

The right approach depends on your child’s age, symptoms and history, so follow your doctor’s advice. If antibiotics are prescribed, give the full course, even when your child seems better.

Caring for your child at home

Pain relief comes first. Paracetamol can ease pain and fever. Your doctor may also suggest ibuprofen for babies old enough to have it. Follow the label or your doctor’s or pharmacist’s advice for your child’s age and weight. Never give aspirin.
Offer frequent feeds and fluids, even if your baby takes less at each feed.
Clear a blocked nose with saline drops before feeds and sleep.
Keep your baby on their back to sleep on a flat surface, even if they seem more comfortable upright. Our safe sleep guide explains why.
Don’t put anything in the ear: no cotton buds, oils or home-made drops. Use ear drops only if a doctor prescribes them.
Keep the ear dry and skip swimming lessons until a doctor says it’s fine, especially if there is discharge.

The NHS also says decongestants and antihistamines don’t help ear infections, and cough and cold medicines aren’t recommended for young children.

What if the ear starts draining?

Sometimes pressure behind the eardrum causes a small tear, and pus or fluid drains out. The pain often eases quickly when this happens. These small tears usually heal on their own, but your child should see a doctor. Gently wipe the outside of the ear only.

When to see a doctor

See your GP, polyclinic or paediatrician if:

Your baby is under 1 and you think they have an ear infection
Earache lasts more than 2 to 3 days, or is getting worse
There is fluid or pus coming from the ear
Your child keeps getting ear infections
You notice hearing problems after the infection has settled

See our baby fever guide for temperature thresholds by age.

Glue ear and repeated infections

After an infection, fluid can stay behind the eardrum for weeks. When it lingers, it’s called glue ear. It often causes muffled hearing rather than pain. The NHS says glue ear usually clears within about 3 months.

Watch for signs your child isn’t hearing well: not responding to their name, turning the TV up, speaking loudly or late talking. Hearing matters for speech, so mention concerns to your doctor; see our baby speech milestones guide. Your child may be referred to an ENT (ear, nose and throat) specialist for a hearing test.

For children with persistent glue ear and hearing loss, or very frequent infections, a specialist may suggest grommets: tiny tubes placed in the eardrum to let air in. The NHS notes they usually fall out by themselves within 6 to 12 months.

Lowering the risk of ear infections

Keep up with vaccinations. The pneumococcal vaccine in the National Childhood Immunisation Schedule protects against a common cause, and the flu vaccine can help too.
Breastfeed if you can. Breast milk offers some protection against infections.
Don’t prop bottles or feed your baby lying flat; hold them semi-upright for feeds.
Keep your home and car smoke-free, including vapes.
Wash hands often to cut down on colds, especially in infant care.

The bottom line

Ear infections are common after colds; look for fever, ear pain, night waking and fussy feeds
Many clear in about 3 days; antibiotics aren’t always needed, so follow your doctor’s advice
Pain relief, fluids and saline for the nose help most
Babies under 1 should see a doctor; swelling behind the ear, stiff neck or drowsiness needs urgent care
Watch hearing after repeated infections, and ask about an ENT referral if worried

Read more on the NHS ear infections page, or browse our baby health hub.

How do I know if my baby has an ear infection?

Look for fever, crying more when lying down, waking at night, fussy feeds and sometimes ear pulling or discharge. Ear pulling on its own, in a happy baby without fever, is often just self-soothing. A doctor can confirm an infection by looking at the eardrum.

Do ear infections need antibiotics?

Not always. Many clear on their own within a few days. Doctors are more likely to prescribe antibiotics for young babies, severe symptoms, both ears affected, discharge, or infections that don’t improve after 2 to 3 days.

Can my baby fly with an ear infection?

Pressure changes can make ear pain worse. Ask your doctor before flying. If you do fly, feeding or offering a dummy during take-off and landing can help ease pressure.

Are ear infections contagious?

The ear infection itself isn’t, but the cold that often triggers it is. Good handwashing helps reduce colds in the family.