Ear Pain in Children: Is It an Ear Infection and What to Do?

Your child is rubbing or pulling their ear, has a fever, and is more irritable than usual — especially at night. This is the classic picture of an ear infection (otitis media), one of the most common reasons children visit a paediatrician in India. Here is what you need to know.

Types of Ear Infections

• Acute Otitis Media (AOM): Infection behind the eardrum (middle ear). Causes ear pain, fever, and in young children — pulling or rubbing the ear. The most common type requiring treatment.
• Otitis Media with Effusion ("Glue Ear"): Fluid behind the eardrum without active infection. Usually painless, but causes muffled hearing. Very common after ear infections or with chronic allergies. Often resolves on its own.
• Swimmer's Ear (Otitis Externa): Infection of the outer ear canal. Causes pain especially when pulling the outer ear. Treated with ear drops, not oral antibiotics.

Signs of Ear Infection in Young Children

Infants and toddlers cannot say "my ear hurts." Watch for:

• Tugging, pulling, or batting at the ear
• Fever (though fever alone is not enough to diagnose an ear infection)
• More crying than usual, especially at night or when lying flat
• Difficulty sleeping
• Poor feeding
• Pus or discharge from the ear (means the eardrum has perforated — this is not dangerous and usually relieves pain, but needs attention)

Do All Ear Infections Need Antibiotics?

Not always. Recent guidelines recommend watchful waiting for 48–72 hours in mild cases in children over 2 years with no complications. Many acute ear infections in this age group resolve without antibiotics. However, antibiotics are recommended immediately for:

• Children under 2 years
• Bilateral ear infections
• Severe symptoms or high fever
• Ear discharge
• Children who are very unwell

When to Seek Immediate Medical Attention

• Redness, swelling, or tenderness behind the ear (mastoiditis)
• Severe ear pain that is not controlled with paracetamol
• Child is very unwell, confused, or has a stiff neck

"Ear infections are very common and usually straightforward to treat. But please do not use any ear drops or put anything in the ear without a doctor's examination first — especially if the eardrum may be perforated."

Dr. Sushma B provides comprehensive paediatric care including management of ear infections at Sri Anand Child and Neuro Center, Chanda Nagar. Call +91 90633 66983.