Ear infections are very common in children, especially after a cold. They can cause sudden ear pain, fever, poor sleep, crying, reduced hearing and sometimes fluid leaking from the ear. Most children improve within a few days with pain relief and simple care, but some need medical advice — and a smaller number need antibiotics.
Ear pain can be miserable for a child and worrying for a parent. It often appears at the worst possible time: late evening, after a few days of a runny nose, when your child is tired, tearful and unable to settle. Babies may not be able to point to the pain, so the first clues may be crying, feeding less, rubbing or pulling the ear, waking more than usual, or seeming unusually irritable.
The good news is that most ear infections in children are not dangerous. Many are linked to viral infections and get better without antibiotics. The main treatment in the first few days is good pain relief, fluids, comfort and watching for signs that your child is getting worse.
But ear infections can sometimes need medical assessment, especially in young babies, children with fluid or pus coming from the ear, children who are very unwell, or symptoms that do not improve. This guide explains what ear infections look like, what you can do at home, when antibiotics may be needed, and when to contact your GP, NHS 111, or emergency services.
You can also find more parent-friendly guides in our Children’s Health section.
What is an ear infection?
When parents talk about an ear infection, they usually mean a middle ear infection, also called acute otitis media. The middle ear is the small air-filled space behind the eardrum. It is connected to the back of the nose by a narrow tube called the Eustachian tube.
After a cold, the lining of the nose and throat can become swollen and full of mucus. In children, the Eustachian tube is shorter and narrower than in adults, so it can block more easily. Fluid then builds up behind the eardrum, causing pressure, pain and sometimes infection.
Ear infections can be caused by viruses or bacteria. This matters because antibiotics only work against bacteria, not viruses. NICE, the organisation that produces clinical guidance for England, explains that acute otitis media usually lasts about a week and that most children get better within 3 days without antibiotics. Serious complications are rare. You can read the NICE overview of acute otitis media antimicrobial prescribing.
Why children get ear infections so often
Children are more prone to ear infections because their immune systems are still developing and because their Eustachian tubes block more easily. Ear infections are especially common in younger children and often follow a cough, cold, sore throat or other respiratory infection.
They are also more common in children who attend nursery or school, simply because they are exposed to more viruses. Smoke exposure can increase the risk of ear problems and make respiratory infections worse. Some children are more prone because of allergies, enlarged adenoids, craniofacial conditions, or a history of repeated infections.
An ear infection itself is not usually “caught” from another child, but the cold or virus that came before it can spread. If your child’s ear pain started after a runny nose or cough, our guide to coughs and colds in children may also be useful.
Signs of an ear infection in children
Older children may tell you their ear hurts, feels blocked or sounds muffled. They may say their ear is popping, buzzing or full. Younger children and babies may be harder to read.
Common signs include ear pain, crying, irritability, poor sleep, rubbing or pulling the ear, reduced hearing, fever, loss of appetite, being off balance, and sometimes vomiting. A child with an ear infection may seem worse when lying down because pressure in the ear can feel more uncomfortable at night.
Sometimes fluid or pus leaks from the ear. This can happen if pressure builds up behind the eardrum and the eardrum perforates, meaning a small hole opens. Although this sounds frightening, the pain may suddenly improve once the pressure is released. However, discharge from the ear should be assessed by a healthcare professional.
The NHS has a helpful overview of ear infection symptoms and treatment, including when to see a GP.
Earache does not always mean infection
Not every earache is a middle ear infection. Children can have ear pain from wax build-up, a sore throat, tonsillitis, teething, jaw pain, sinus congestion, dental problems, water trapped in the ear canal, or an outer ear infection.
Outer ear infection, sometimes called otitis externa or “swimmer’s ear”, affects the ear canal rather than the space behind the eardrum. It may cause pain when the outer ear is touched or pulled, itchiness, discharge, swelling or a blocked feeling. It is more likely after swimming or if the ear canal has been irritated by cotton buds, scratching, earphones or soap.
Because different ear problems need different treatment, it is worth getting advice if symptoms are severe, persistent, recurrent, or there is fluid coming from the ear.
How to help ear pain at home
Ear infections can be painful, so pain relief matters. Children’s paracetamol or ibuprofen can help reduce pain and fever. Use the correct product for your child’s age and weight, follow the label carefully, and use the measuring syringe or spoon provided.
If your child is drinking less because they feel unwell, offer small, regular drinks. Babies may want shorter, more frequent feeds. Do not worry too much if your child eats less for a day or two, but drinking and passing urine are important.
Some children find a warm flannel held gently against the ear comforting. Do not put cotton buds, oil, drops or anything else into the ear unless advised by a pharmacist, GP or nurse. If the eardrum has perforated, some drops may not be suitable.
If your child has a fever as well as ear pain, you may also want to read our guide to fever in children.
Do children need antibiotics for ear infections?
Many children with ear infections do not need antibiotics. This can feel surprising because ear infections can be very painful, but pain does not always mean bacteria are the cause. Viral infections can cause significant ear pain too.
NICE guidance says that most children with acute otitis media get better within 3 days without antibiotics, and antibiotics only make a small difference to symptoms for many children. Antibiotics can also cause side effects such as diarrhoea, rash and nausea, and unnecessary use contributes to antibiotic resistance.
Instead of immediate antibiotics, a GP may recommend pain relief and observation, sometimes called a “no antibiotic” or “delayed antibiotic” approach. A delayed prescription means you only use the antibiotic if symptoms do not improve or get worse after a set period.
Antibiotics are more likely to be considered if your child is under 6 months, is very unwell, has symptoms in both ears and is under 2, has fluid or pus coming from the ear, has a high risk of complications, or symptoms are not improving. Healthier Together’s earache guidance for under-5s explains this parent-facing approach clearly.
When to contact a GP or NHS 111
Contact your GP or call NHS 111 if your child has ear pain and is under 6 months old, has a high fever, seems very unwell, has fluid or pus leaking from the ear, has swelling or redness around the ear, has symptoms in both ears and is under 2, or has ear pain that is not improving after 2 to 3 days.
You should also seek advice if your child has repeated ear infections, hearing problems, dizziness, severe headache, vomiting, a stiff neck, a rash, or you are worried. Children with weakened immune systems, complex medical conditions or cochlear implants should be assessed more cautiously.
Call 999 or go to A&E if your child is very difficult to wake, floppy, confused, has blue lips, is struggling to breathe, has a seizure, has a stiff neck, has a rash that does not fade when pressed with a glass, or seems seriously unwell.
Trust your instincts
If your child looks seriously unwell, seek help. You do not need to be certain that the ear is the cause before contacting NHS 111, your GP or emergency services.
Fever and ear infections
A fever can happen with an ear infection, especially in younger children. Fever is a sign that the immune system is responding to infection, but the temperature number is only one part of the picture.
Babies under 3 months with a temperature of 38°C or above need urgent medical advice. Children aged 3 to 6 months with a temperature of 39°C or above should also be assessed. In older children, seek advice if the fever lasts 5 days or more, your child is getting worse, or there are red flags such as severe drowsiness, dehydration, breathing difficulty or a non-blanching rash.
For detailed advice, read Fever in Children: When to Worry and What to Do.
Fluid behind the ear and temporary hearing loss
After an ear infection, some children have fluid behind the eardrum for several weeks. This can cause temporary hearing loss or a blocked feeling. Your child may turn the TV up, ask you to repeat things, seem less responsive, or struggle in noisy rooms.
In many cases, this improves naturally as the fluid clears. However, hearing is important for speech, learning and behaviour. If your child’s hearing does not return to normal, they have repeated ear infections, or you are concerned about speech or school progress, contact your GP or health visitor.
Persistent fluid behind the eardrum is sometimes called glue ear. Some children need monitoring, hearing tests or specialist referral, especially if it affects development or quality of life.
What if the eardrum bursts?
A burst or perforated eardrum can happen when pressure builds up behind the eardrum during a middle ear infection. Parents may notice fluid, mucus, blood-stained fluid or pus coming from the ear. The child’s pain may suddenly reduce because the pressure has been released.
Most small perforations heal on their own, but ear discharge should be assessed. Your child may need specific treatment, and some ear drops are not suitable if the eardrum is not intact.
Keep the ear dry until you have had advice. Avoid swimming and do not put cotton wool, cotton buds or drops into the ear unless a healthcare professional recommends it.
Can ear infections cause vomiting or diarrhoea?
Some children feel sick, vomit or have a reduced appetite when they have an ear infection, especially if they also have a fever or viral illness. Younger children may show pain in general ways rather than pointing to the ear.
However, repeated vomiting, diarrhoea, dehydration, severe tummy pain or a child who is becoming drowsy needs careful attention. If stomach symptoms are a major part of the illness, our guide to vomiting and diarrhoea in children may help you decide what to watch for.
Can my child go to school or nursery with an ear infection?
An ear infection itself is not usually a reason to keep a child away from school or nursery if they are otherwise well. However, many ear infections follow coughs, colds or other infections, and your child may need to stay home if they have a fever, are too unwell to take part, are very tired, or need regular pain relief.
If your child has a high temperature, keep them at home until the fever has settled and they feel well enough to return. If they have vomiting or diarrhoea, they should stay away until 48 hours after the last episode.
UK Health Security Agency guidance for schools and childcare settings is useful for infectious illness exclusion periods, although ear infection alone is not usually listed as a separate exclusion condition.
How to reduce the risk of ear infections
You cannot prevent every ear infection. Many are linked to ordinary childhood viruses. But some steps may reduce the risk or help protect ear health.
Keep your child away from cigarette smoke and vaping aerosols. Smoke irritates the airways and is linked with more respiratory and ear problems. Keep routine vaccinations up to date, including vaccines that reduce infections linked with ear disease.
Avoid putting cotton buds into your child’s ears. They can irritate the ear canal, push wax further in and sometimes cause injury. Earwax is usually normal and often clears by itself.
If your child gets ear pain after swimming or has repeated outer ear infections, ask a pharmacist or GP for advice. Keeping ears dry and avoiding irritation may help in some cases.
Recurrent ear infections
Some children have repeated ear infections. This can be exhausting for families, especially when infections affect sleep, hearing, speech, nursery attendance or school.
If your child has frequent ear infections, ongoing hearing problems, speech delay, balance issues, persistent fluid behind the eardrum, or repeated courses of antibiotics, speak to your GP. They may recommend monitoring, hearing assessment or referral to an ear, nose and throat specialist.
Treatment depends on the pattern and cause. Some children simply grow out of recurrent infections as their Eustachian tubes mature. Others may need further assessment for glue ear, enlarged adenoids, allergies or other contributing factors.
What not to do
Do not put cotton buds, fingers or other objects into your child’s ear. Do not use leftover ear drops or antibiotics. Do not put oil, herbal remedies or home mixtures into the ear, especially if there is discharge or you are not sure whether the eardrum is intact.
Do not assume antibiotics are always needed. Pain relief is often the most useful first treatment, and many ear infections settle on their own. Equally, do not ignore ear discharge, severe pain, swelling around the ear, a very unwell child or symptoms that are getting worse.
Do not send your child to school or nursery if they have a fever or feel too unwell to cope with the day.
A simple home monitoring plan
If your child is well enough to stay at home, keep a simple note of symptoms. Write down when the ear pain started, whether one or both ears are affected, the temperature, medicines given, fluid intake, wet nappies or toilet trips, and whether hearing seems reduced.
Watch the direction of travel. A child who is drinking, sleeping better, needing less pain relief and becoming brighter is usually improving. A child who is more distressed, more sleepy, feverish for longer, leaking fluid from the ear or developing new symptoms should be assessed.
Key takeaways
Ear infections are common in children and often follow coughs and colds. They can be painful, but many improve within a few days without antibiotics. Pain relief, fluids and comfort are usually the most important first steps.
Contact your GP or NHS 111 if your child is under 6 months, very unwell, has fluid or pus coming from the ear, has swelling around the ear, has symptoms that are worsening or not improving after 2 to 3 days, or you are worried.
Call 999 for serious symptoms such as breathing difficulty, blue lips, severe drowsiness, confusion, seizure, stiff neck, a non-blanching rash, or a child who seems seriously unwell.
Medical disclaimer: This guide is for general information only and does not replace medical advice. If you are worried about your child, contact your GP, pharmacist, NHS 111, or call 999 in an emergency.
FAQs about ear infections in children
What are the signs of an ear infection in a child?
Common signs include ear pain, crying, poor sleep, rubbing or pulling the ear, fever, reduced hearing, irritability, reduced appetite and sometimes fluid or pus coming from the ear.
How do I know if my baby has an ear infection?
Babies may cry more than usual, feed less, wake frequently, rub or pull the ear, have a fever, seem unsettled when lying down, or have fluid coming from the ear. Babies under 6 months with suspected ear infection should be discussed with a healthcare professional.
Do children always need antibiotics for ear infections?
No. Many ear infections improve without antibiotics. Antibiotics may be considered for younger children, very unwell children, discharge from the ear, symptoms in both ears in children under 2, or symptoms that are worsening or not improving.
How long does an ear infection last in children?
Many children start to improve within 2 to 3 days, although symptoms can last around a week. Temporary hearing changes or fluid behind the ear can last longer.
What can I give my child for ear pain?
Children’s paracetamol or ibuprofen can help with pain and fever if suitable for your child. Follow the dosing instructions carefully. A warm flannel against the ear may also comfort some children.
Can I use ear drops for my child?
Ask a pharmacist, GP or nurse before using ear drops, especially if there is discharge from the ear or you suspect the eardrum may have perforated. Some drops are not suitable in that situation.
Is fluid coming from the ear serious?
Fluid, mucus or pus from the ear should be assessed by a healthcare professional. It can happen when an eardrum perforates during infection, and treatment advice depends on the cause.
Can an ear infection affect hearing?
Yes. Fluid behind the eardrum can cause temporary hearing loss or a blocked feeling. This often improves, but ongoing hearing problems should be discussed with your GP or health visitor.
Can my child go to school with an ear infection?
They can usually go if they are otherwise well, do not have a fever and feel able to take part. Keep them home if they are feverish, very tired, in significant pain or too unwell for normal activities.
Are ear infections contagious?
The ear infection itself is not usually contagious, but the cold or virus that often comes before it can spread to others.
Why is ear pain worse at night?
Lying down can increase pressure in the middle ear, making pain feel worse. Children may also notice pain more when the house is quiet and they are trying to sleep.
When should I call NHS 111?
Call NHS 111 if your child is under 6 months, has severe pain, has ear discharge, has a high fever, is getting worse, is not improving after 2 to 3 days, or you are unsure what to do.
When should I call 999?
Call 999 if your child is very difficult to wake, floppy, confused, struggling to breathe, has blue lips, has a seizure, has a stiff neck, has a rash that does not fade under pressure, or seems seriously unwell.
Can ear infections come back?
Yes. Some children have recurrent ear infections, especially when they are young. Speak to your GP if infections are frequent, hearing is affected, or there are concerns about speech, balance or school progress.
Should I clean my child’s ears with cotton buds?
No. Cotton buds can irritate the ear canal, push wax deeper and sometimes cause injury. Earwax is usually normal and often clears by itself.
