Ear Infections in Babies: Basic 7 Signs and Symptoms

ear infections

It is very common for babies and toddlers to have ear infections. One study was said that five out of six children will experience an ear infection before their third birthday [1]. Many children are concerned that an ear infection will affect their child’s hearing irreversibly or that the ear infection will go undetected and untreated. But, there is good news too. Most ear infections go away on their own and those that do not are typically easy to treat. Usually, your child will start to feel better in a period of few days after visiting the doctor.

If several days have passed and you still think that your baby is not okay, then visit your doctor as soon as possible. Maybe, your child will need other antibiotics. When the infection clears, the fluid may still remain in the middle ear, but it usually disappears in a period of 3 – 6 weeks. One of the best ways to prevent ear infections is to reduce the risk factors which are associated with them. You need to avoid smoking around your baby. [2]

It is known that babies who are around smokers have more ear infections [2,3]. Also, you need to wash your hands frequently, so this can help to prevent the spread of germs and it can help to keep your child from catching a cold or the flu. You should never put your baby down for a nap or for the night with a bottle. You should not allow your child to spend time with another sick child, so chances of getting ear infections will be reduced.

Ear infection in babies

Childhood Ear Infections:

Ear infections happen when there is inflammation. It is usually caused by trapped bacteria. It happens in the middle ear, which is the part of the ear that connects to the back of the nose and throat. Otitis media is the most common type of ear infection. It happens when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.

If your child has an upper respiratory infection, cold, or a sore throat, then bacteria can spread to the middle ear through the Eustachian tubes (these are channels that connect the middle ear to the throat). [4] In response to the infection, the fluid builds up behind the eardrum. Usually, children are more likely to suffer from ear infections compared to adults for two reasons:


  • Eustachian tubes of children are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear
  • The immune system of children is underdeveloped and it is less equipped to fight off infections

In some children, fluid can remain trapped in the middle ear for a long time or returns repeatedly, even when there is no infection.

Signs and Symptoms:

Pain in and around the ear is a telltale sign of an ear infection. Many young children develop an ear infection before they are old enough to talk. This means that parents are guessing why their children are not feeling well. But, there are some signs and symptoms which can tell you that your children have an ear infection, such as

  • A loss of balance
  • A fever, especially in younger children
  • Difficulty hearing or responding to auditory cues
  • Fluid draining from the ear
  • Difficulty sleeping
  • Crying and irritability
  • Tugging or pulling the ear

Some signs that need immediate attention include bloody or pus-like discharge from the ears, severe pain, and high fever. If you want to prevent the ear infection from coming back, then you can limit some of the factors that might put your child at a risk, such as not being around people who smoke and not going out to bed with a bottle. But, in some cases, even parents take precautions, children may continue to have middle ear infections, sometimes as many as five or six a year. The doctor might want to see if the infection will get better on its own.

But, if the infection keeps coming back and antibiotics do not help, then your doctor may recommend a surgical procedure that places a small ventilation tube in the eardrum to improve the airflow and prevent the fluid backup in the middle ear. The most commonly used tubes stay in a place for 6 – 9 months and they need follow–up visits until they fall out. If the placement on the tubes still does not prevent the infections, then a doctor may consider removing the adenoids to prevent infection from spreading to the Eustachian tubes.


Usually, bacteria is a cause of an ear infection [4]. It often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper infection is caused by bacteria, these same bacteria may spread to the middle ear. If the upper respiratory infection is caused by a virus, such as a cold, then bacteria may be drawn to the microbe–friendly environment and move into the middle ear as a cold, secondary infection. Due to the infection, the fluid builds up behind the eardrum.

We know that ears have 3 big parts – the outer ear, the middle ear, and the inner ear. The outer ear is known as the pinna. This part of the ear includes everything we see on the outside (the curved flap of the ear leading down to the earlobe), but it also includes the ear canal, which begins at the opening to the ear and it expands to the eardrum. As we know, the eardrum is a membrane that separates the outer ear from the middle ear. The location of our middle ear is between the eardrum and the inner ear. In the middle ear infections happen.

In the middle ear, there are three tiny bones which are known as malleus, incus, and stapes which transmit sound vibrations from the eardrum to the inner ear. The bones which are part of the middle ear are surrounded by air. The inner ear has a labyrinth, which is helping us to keep our balance. The cochlea is a part of the labyrinth. It is a snail-shaped organ, which converts sound vibrations from the middle ear into electrical signals. The auditory nerve is carrying these signals from the cochlea to the brain.

Also, other nearby parts of the ear can be involved in ear infections. The Eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. The job of the Eustachian tube is to supply fresh air to the middle ear, drain fluid and keep the air pressure at a steady level between the nose and the ear. Adenoids are small pads of the tissue which are located behind the back of the nose, above the throat, and near the Eustachian tube. Mostly, adenoids are made up of immune system cells. They fight against infections by trapping bacteria that enter through the mouth.

Types of an Ear Infection:

It is known that there are three main types of ear infections. Each type of ear infection has a different combination of symptoms.

  • AOM (acute otitis media): This is the most common type of ear infection in children. Part of the middle ear is infected and swollen. The fluid is trapped behind the eardrum. This leads to pain in the ear, which is known as an earache. Also, your children might get a fever.
  • OME (otitis media with effusion): This condition sometimes happens after an ear infection that has run its course and fluid stays trapped behind the eardrum. Children who have this type of ear infection may have no symptoms. But, the doctor will be able to see the fluid behind the eardrum with a special instrument.
  • COME (chronic otitis media with effusion): It happens when the fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. This type of ear infection makes it harder for children to fight new infections and also can affect their hearing.

Reasons why children have more chances of getting ear infections compared to adults:

There are different reasons why children have more chances to get ear infections compared to adults. They have smaller Eustachian tubes and there are more levels compared to the adults. This is making it more difficult for the fluid to drain out of the ear, even under normal conditions. If the Eustachian tubes are blocked with mucus due to a cold or other respiratory illness or if they are swollen, then fluid may not be able to drain. [5]

The immune system of a child is not as effective as the immune system of an adult, because it is still developing. This is making it harder for children to fight against infections. The adenoids respond to bacteria passing through the nose and mouth as a part of the immune system. In some cases, the bacteria get trapped in the adenoids, which is causing a chronic infection that can be passed on the Eustachian tubes and the middle ear. [6]


[1] National Institute on Deafness and Other Communication Disorders. Ear infections in children. Retrieved from www.nidcd.nih.gov/health/ear-infections-children

[2] Harvard School of Public Health. Secondhand smoke laws may reduce childhood ear infections, study suggests. Science Daily. 2011. Retrieved from www.sciencedaily.com/releases/2011/01/110127090620.htm

[3] Amani S, Yarmohammadi P. Study of effect of household parental smoking on development of acute otitis media in children under 12 years. Global Journal of Health Science. 2016;8(5):81–8. doi:10.5539/gjhs.v8n5p81

[4] Getaneh A, Ayalew G, Belete D, et al. Bacterial etiologies of ear infection and their antimicrobial susceptibility pattern at the university of gondar comprehensive specialized hospital, gondar, northwest ethiopia: a six-year retrospective study. Infection and Drug Resistance. 2021;14:4313-22.

[5] National Library Medicine. Ear infections. Paediatrics Child Health. 2009;14(7):465–6.

[6] Kisembo P, Mugwanya F, Atumanya P, et al. Prevalence of ear infections in first year children of primary schools in a western ugandan community. African Journal of Biomedical Research. 2018;21(2):117–22.


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