Recurrent ear infections in children are one of the most common reasons for a visit to a pediatrician and for antibiotic treatment in early childhood. Acute otitis media is an infection of the space behind the eardrum, and it usually appears a few days after a cold, with ear pain, fever, crying and restlessness at night. Most children have at least one infection by the age of three, and this is a normal part of the development of the immune system. When the infections come back three times in six months or four times in a year, when fluid stays in the ear for weeks after each infection, or when there is concern about hearing and speech, it is worth seeing a pediatric specialist to build an orderly plan instead of treating each episode on its own.
Why young children get ear infections
The middle ear is connected to the back of the nose through a narrow tube called the Eustachian tube. Its job is to ventilate the middle ear and drain fluid from it. In babies and young children the tube is shorter, narrower and more horizontal than in adults, so it blocks easily with every runny nose, and fluid that collects behind the eardrum becomes a comfortable breeding ground for bacteria and viruses.
A young child’s immune system is still getting to know the common viruses, which is why children in daycare catch many colds every winter, and every cold is an opportunity for an ear infection. The adenoids, lymphatic tissue at the back of the nose, are also relatively large at this age and can press on the opening of the tube. With growth the tube lengthens and becomes more upright, and in most children the infections fade by school age.
What raises the risk of recurrent infections
- Attending a setting with many children, which increases exposure to viruses.
- Exposure to cigarette smoke at home or in the car.
- Using a pacifier beyond the age of one, especially during sleep.
- Bottle feeding while lying flat.
- Nasal allergy that causes a chronic runny nose and swelling around the opening of the tube.
- Enlarged adenoids.
- A first infection at a very young age, before six months.
- A family history of recurrent ear infections in the parents or siblings.
- Autumn and winter, the seasons of respiratory viruses.
Breastfeeding in the first months and the routine vaccines against pneumococcus and influenza reduce the number of infections, so it is important to keep to the vaccination schedule.
How to recognise an ear infection in a child who cannot yet talk
An older child will complain of ear pain. In babies and toddlers the signs are indirect: sudden crying, mainly when lying down, waking at night, pulling or rubbing the ear, fever, refusing to eat because swallowing and sucking hurt, and general restlessness after a few days of a runny nose. Sometimes there is a discharge from the ear, a sign that the eardrum has torn slightly to release the pressure. This tear relieves the pain immediately and usually closes on its own within days, but it needs to be checked by a doctor.
Ear pulling on its own, without fever and without a runny nose, is usually a habit or a sign of teething, not an infection. The diagnosis is made only by examining the eardrum with a dedicated instrument, so antibiotics should not be started on the basis of symptoms alone.
When antibiotics are needed and when waiting is enough
A considerable share of ear infections is caused by viruses or clears on its own even when the cause is bacterial, so not every infection needs antibiotics. In children over the age of two with a mild infection on one side, without a high fever and without discharge, the doctor may suggest waiting two or three days with treatment for pain and fever, and starting antibiotics only if there is no improvement. This approach reduces unnecessary exposure to antibiotics, which cause diarrhoea, rashes and bacterial resistance.
Antibiotics are given straight away when the child is under six months, when there is a high fever and marked pain, when both ears are infected in a young child, when there is discharge from the ear, or when the child looks very unwell. In every case it is important to complete the full course that was prescribed even when the child feels well after two days, and to return for a check if there is no improvement within two or three days of starting treatment.
Pain relief is part of the treatment, not an extra: children’s painkillers dosed according to the child’s body mass, as directed by the doctor, allow sleep and eating and ease the first days.
When to see a pediatric specialist
It is worth booking a visit with the private pediatric specialists in Modi’in in these situations:
- Three or more ear infections in six months, or four or more in a year, with the latest in the past six months.
- Fluid that stays behind the eardrum for more than three months after an infection, or persistent fluid in both ears.
- Concern about reduced hearing: the child turns the television up, does not respond to their name, asks for things to be repeated or their speech is delayed.
- Infections that do not respond to antibiotics or come back as soon as the treatment ends.
- Discharge from the ear that lasts more than a week or keeps returning.
- Ear infections alongside regular snoring, mouth breathing and restless sleep, which hint at enlarged adenoids.
- A first ear infection before the age of six months, or frequent infections in a child with an underlying condition.
- Parents who feel they are chasing the episodes without a clear plan.
A high fever with a stiff neck, extreme drowsiness, swelling and pain behind the ear that pushes it forward, or sudden weakness on one side of the face are emergencies that need an immediate visit to the emergency room.
What the pediatric specialist checks
The visit begins with an orderly mapping: how many infections there have been, at what age they began, which antibiotics were given, how the child responded, what the childcare setting is, whether there is smoking at home, allergy, snoring or delayed speech. The doctor examines the eardrums, the nose and the throat, checks the child’s response to sounds and assesses the development of speech and language relative to age.
As needed, the doctor refers the child for a hearing test and for a test that measures the movement of the eardrum and the fluid behind it, for an allergy work-up when there is a chronic runny nose, and in suitable cases to an ENT specialist to assess the adenoids and discuss ventilation tubes. The advantage of a specialist lies in the view of the whole picture: not another treatment for the current infection, but an understanding of what causes the recurrence and what can be changed.
How to reduce the number of infections
- Keep cigarette smoke completely out of the home and the car.
- Wean off the pacifier gradually after the age of one, at least during sleep.
- Bottle feed in a semi-upright position.
- Keep to the routine vaccines and an annual influenza vaccine.
- Treat allergic rhinitis when it is present, as directed by the doctor.
- Teach hand washing and reduce exposure to sick children in winter as far as possible.
- Consider, together with the doctor, a change of setting or group when infections are very frequent in the first year.
When these steps are not enough and the fluid remains persistent with reduced hearing, a mechanical solution such as ventilation tubes comes up for discussion, and sometimes removal of the adenoids. You can read more in our article on glue ear and grommets in children.
At EliteMed in the Ayala 360 complex in Modi’in you can book a visit with a pediatric specialist without a referral, and the consultation can be held in English. The information here is general and does not replace an examination and advice from a doctor.
Frequently asked questions
How many ear infections a year are too many?
Recurrent infections are usually defined as three or more in six months, or four or more in a year with one of them in the past six months. In that situation it is worth having an orderly work-up with a pediatric specialist to find the factors that can be changed and decide on a plan, instead of treating each infection on its own.
Does every ear infection need antibiotics?
No. A considerable share of infections clears on its own, and in children over the age of two with a mild infection on one side the doctor may suggest waiting two or three days with pain relief. Antibiotics are given straight away to young babies, for a high fever and marked pain, for infection in both ears in a young child, for discharge from the ear or when the child looks very unwell.
Do recurrent ear infections damage hearing in the long term?
During the infection and in the weeks after it, when there is fluid in the middle ear, hearing is temporarily reduced. In most children it returns to normal when the fluid is absorbed. Lasting damage is rare, but fluid that stays for months in both ears at the age when language is acquired can delay speech, so in that situation hearing is tested and treatment is considered.
What should I do if there is discharge from the ear?
Discharge usually means a small tear in the eardrum that releases the pressure and the pain. The tear usually closes on its own within days, but it is important to see a doctor for examination and treatment, to keep water out of the ear until the doctor allows it, and not to use drops without a doctor’s instruction.
Does a child with recurrent infections have to have ventilation tubes?
No. Ventilation tubes come up for discussion mainly when there is persistent fluid behind the eardrums for months with reduced hearing, or when infections are very frequent despite prevention and treatment. In many children the infections fade with age without any procedure, and the decision is made after a work-up and a hearing assessment.