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Understanding Ear Infections in Children

Posted on Feb 22, 2021

Young children often experience ear infections. Parents need to know the signs of ear infections and when to seek treatment. On this week’s On Call for All Kids, Rachel Dawkins, M.D., a pediatrician and medical director of the Pediatric and Adolescent Medicine Clinics in the Johns Hopkins All Children’s Department of Pediatric Medicine, answers some questions that are on parents’ minds.

What is Otitis Media?

Otitis media is an ear infection. This is an infection of the middle ear caused by viruses or bacteria behind the eardrum. Kids are more prone to ear infections than adults because of the anatomy of their inner ears.

My baby is constantly pulling at her ears. Does she have an ear infection?

Likely not. Children often play with or tug at their ears. It can be very soothing, especially if a child is teething or trying to fall asleep. I have many parents who bring 4-month-olds to the office because they are constantly poking at their ears when they never did before. But guess what? Developmentally, babies find their ears around this age. They also put their feet in their mouths at this age, but I’ve never had a parent bring a kid in for that!

What are common symptoms of ear infections?

Usually, we see fever with ear infections. Babies may also be super fussy especially when lying down. Older kids might complain of ear pain.

My child’s ear canal looks reddish. Is that an ear infection?

No. Otitis media is an infection of the middle ear past the ear drum. It can’t be seen on external inspection of the ear. If the ear canal is very swollen and red, that might be swimmer’s ear or otitis externa. Sometimes it might be red/brown wax in the ear canal.

What is the best treatment for an ear infection?

You might be surprised to know that most ear infections do not require treatment as most ear infections are viral or will resolve on their own. For severe or recurrent ear infections, your pediatrician may prescribe antibiotics. But the good thing to know is that studies have shown that the majority of ear infections will resolve on their own in 10 days without treatment. If your child is in pain, a pain reliever like acetaminophen or ibuprofen might help. Dosing depends on your child’s age and weight.

How do I reduce my child’s risk of getting an ear infection?

There are actually quite a few things parents can do to decrease risk for ear infections:

  • Avoid secondhand smoke exposure
  • Keep your infant’s vaccines up to date
  • Breastfeed your baby
  • Wash hands frequently

My child seems to have a ton of earwax. What’s the best way to clean my baby’s ears?

Ear wax is normal! Just like some adults have oily skin and some have dry, some children are wax producers and some are not. Wax is not harmful for the most part. A good rule of thumb my pediatrician taught me is “Never put something smaller than your elbow in your ear.” Cotton swabs can push the wax further back in the ear, scratch the ear canal and poke a hole in the eardrum. Parents can use the corner of a washcloth to clean the outside of the ear.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. You also can explore more advice from Rachel Dawkins, M.D., and advice for parents of infants and toddlers.


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