How to recognize an ear infection in a child? Symptoms, duration, and step-by-step treatment.
Does your child wake up crying at night, holding their ear? This is a common scenario among parents of toddlers, as ear infections are one of the most common childhood infections. They usually appear suddenly—often after a cold or runny nose—and can be quite frightening. In this article, we explain the causes of catarrhal otitis media in children, the symptoms of acute otitis media, how long an ear infection lasts in children, the treatment process, and the antibiotics used. You'll also learn what otitis externa is in children and what to do if your child develops it.
Acute otitis media – what is it and why do children get sick most often?
Acute otitis media (AOM) is a sudden inflammation of the mucous membrane and structures of the middle ear . It is usually accompanied by the accumulation of purulent discharge in the tympanic cavity.
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The middle ear lies on the inside of the eardrum and connects to the nasopharynx via the auditory tube (Eustachian tube), which is responsible for equalizing pressure and clearing the ear. In children, the Eustachian tube is shorter, wider, and more horizontal than in adults. This allows bacteria and viruses from the nose or throat to enter the ear more easily. Furthermore, an immature immune system and frequent respiratory infections increase the risk of ear infections in children.
At what age are ear infections most common in children?
The statistics are clear: 19 to 62% of infants experience at least one episode of AOM in the first year of life. By the age of 3, as many as 85% of children experience otitis media, with the peak incidence occurring between 6 and 18 months of age . After 7 years of age, the risk of developing the disease decreases significantly [4, 10].
Where does the pain come from? Ear infections in children – symptoms and causes.
Most often, ear infections in children develop as a complication of a viral infection of the upper respiratory tract – a cold or a runny nose. Viruses (including RSV, influenza, and adenoviruses) cause swelling of the nasal mucosa and Eustachian tube, impeding the drainage of secretions. This is called catarrhal otitis in children , which allows bacteria to enter the tympanic cavity.
Catarrhal ear infection in a child – when a runny nose paves the way for infection
The most common bacteria causing AOM are [4, 12, 13]:
- Streptococcus pneumoniae – 27–52% of cases,
- Haemophilus influenzae – 16–52%,
- Moraxella catarrhalis – 2–20%.
Ear infection in a child – symptoms that should alarm parents
Acute otitis media in children may have various symptoms – they are not always obvious, especially in infants (so-called non-specific symptoms):
🔹 Ear pain (otalgia) – sharp, sudden, worsening at night or when lying down.
🔹 Fever – in about half of cases, it accompanies AOM in children, but its absence does not rule out otitis media. High fever (>39°C) with vomiting may indicate a more severe course of the disease and requires immediate medical consultation.
🔹 Nonspecific symptoms: Irritability, anxiety, crying, loss of appetite, trouble sleeping. It's important to remember that symptoms such as ear pulling are not sufficient on their own to diagnose AOM.
🔹 Ear discharge – if the eardrum ruptures (perforates), purulent or bloody discharge may appear, which usually relieves pain by reducing the pressure in the eardrum.
Disturbing symptoms should always be consulted with a doctor who will recommend appropriate treatment for your child's ear infection and, if deemed necessary, will also determine which antibiotic will be appropriate.
What about ear infections in children – what is the treatment like?
Let's start with the good news: AOM is a disease that is often self-limiting . In most children (over 50%–60%), symptoms resolve spontaneously within 24–72 hours [13].
Therefore, for uncomplicated mild to moderate AOM in children over 2 years of age, doctors recommend a watchful waiting strategy for 48–72 hours. During this time, treatment for a child's ear infection focuses on relieving pain and fever.
What can I do to treat a child's ear infection ? The key medications in the symptomatic treatment of AOM are painkillers and antipyretics (symptomatic treatment):
- Ibuprofen (10 mg/kg every 6–8 hours, up to a maximum of 40 mg/kg/24 hours in children over 3 months of age)
Expert advises
Ibuprofen is the first-line medication for AOM and should be administered to children over 3 months of age, regardless of whether or not a doctor prescribes an antibiotic for an ear infection. It should be administered according to the package insert to provide relief from pain and fever (if present). What else is prescribed for ear infections in children? Treatment of ear infections in children often includes nasal decongestants. These are commonly recommended as supportive therapy for AOM, especially in cases of concomitant rhinitis (including catarrhal otitis media), although meta-analyses have not proven their effect on accelerating the resolution of AOM.
What antibiotic for an ear infection in a child and when is it necessary?
Antibiotics aren't always necessary to treat AOM . They are used when the condition is more severe or affects young children. A doctor always decides whether and which antibiotic to administer to a child with an ear infection.
Antibiotic therapy is usually mandatory when:
- The baby is less than 6 months old.
- A toddler under 2 years old was diagnosed with bilateral ear infections.
- AOM is characterized by high fever and/or vomiting.
- There is discharge from the ear (ruptured eardrum).
- The toddler suffers from chronic diseases, immune disorders or recurrent ear infections.
What antibiotic is most often recommended for a child's ear infection?
What does a doctor most often prescribe for a child's ear infection? The medication used for AOM is usually amoxicillin , which is effective against most bacteria, including pneumococci. If there is no improvement, the doctor may recommend amoxicillin with clavulanic acid.
What antibiotics should I take for an ear infection in a child with a penicillin allergy? Cephalosporins (e.g., cefuroxime, ceftriaxone) or macrolides (azithromycin, clarithromycin).
How long does antibiotic therapy last for a child with an ear infection?
In younger children (under 5 years of age), it is recommended to administer the antibiotic for 10–12 days ; in older children (over 5 years of age), the treatment may last 5–7 days.
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How long does it take to treat a child's ear infection? If symptoms persist despite antibiotic treatment, or the eardrum is significantly bulging and at risk of rupture, a paracentesis (cutting the eardrum) procedure may be necessary, which provides significant pain relief for the child—at the doctor's discretion.
How long does an ear infection last in a child?
You already know what to use for a child's ear infection and what the treatment involves, but another question often asked by parents is: how long does the illness last?
Acute symptoms typically last up to 7 days. However, tympanic effusion may persist for several months – in 40% of children for over a month, and in 10% for over 3 months [4].
This can cause temporary conductive hearing loss, so close cooperation with your doctor and subsequent ENT follow-up after the illness is very important.
Recurrent ear infections in children – where does it come from and how to prevent it?
Recurrent otitis media in children is diagnosed when at least three episodes of AOM occur within 6 months or four within a year . The problem affects approximately 15% of children, mainly those under 2 years of age [4].
The causes of recurrent ear infections in a child may be:
- frequent preschool infections,
- passive smoking (i.e. frequent exposure of a child to tobacco smoke),
- enlarged pharyngeal tonsil,
- immune disorders,
- bacterial biofilm in the nasopharynx or Eustachian tube, which makes it difficult to completely cure the infection. Bacteria in the biofilm are more resistant to leczenie antibiotics.
Treatment of recurrent otitis media and prevention of recurrence
🔹 Elimination of environmental factors:
Avoiding tobacco smoke (has a huge impact!), breastfeeding for at least the first 6 months, and avoiding using a pacifier after 6 months of age.
🔹 Protective vaccinations:
Pneumococcal (PCV) and influenza vaccination.
🔹 Surgical treatment:
In cases where an enlarged adenoid and OM (otitis media with effusion) are both present, adenoidectomy (adenotomy) is recommended. Ventilation tubes may also be necessary, especially if the hearing loss persists for a long time.
🔹 Probiotics:
What additional measures should be taken to treat recurrent otitis media in children? New research indicates that recolonization of the nasopharynx with probiotic strains, such as Streptococcus salivarius K12 , can significantly reduce the frequency of AOM episodes and is promising for treating otitis media in children [1].
Otitis externa in children – causes, symptoms and treatment
Otitis externa (OE) in children , commonly known as "swimmer's ear ," is an inflammation of the skin of the ear canal . It most often occurs in the summer, after bathing or swimming. It is caused by damage to the ear's natural protective barrier—the acidic layer of earwax—and the intrusion of bacteria such as Pseudomonas aeruginosa or Staphylococcus aureus.
Otitis externa in a child – how to recognize it?
The symptoms are very characteristic:
- severe ear pain that increases when touched or pressed,
- feeling of "fullness" in the ear,
- itching, redness and swelling of the ear canal,
- sometimes a slight fever.
Your child may avoid touching their ear or cry when putting on a hat. If you notice these worrying symptoms, always consult a doctor.
What to do with otitis externa in a child?
To treat otitis externa in children, after consulting a doctor, antibiotic and glucocorticosteroid drops are primarily used . Fluoroquinolone drops (e.g., ciprofloxacin) are safe and effective, even if the eardrum is perforated.
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Senior specialist in the Department of Assessment and Cooperation Development, Institute of Mother and Child
Summary: ear infection in children – symptoms, treatment and prevention
Ear infections are common in childhood and can occur, among other things, as a complication of upper respiratory tract infections (so-called catarrhal otitis in children ). Although many cases of AOM resolve spontaneously, it's always worth consulting a doctor , especially if you experience fever, severe pain, or ear discharge. Early intervention can help avoid complications and minimize the risk of recurrent ear infections in your child.
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By consulting a doctor, we'll be sure to know what to treat a child's ear infection. We'll ask how long the illness has been going on, and what symptoms should raise particular concern. Remember – even if symptomatic treatment and observation are recommended in some cases, only a doctor can choose the right course of action and decide whether and which antibiotic will be effective for a child's ear infection.
Bibliography (access to internet sources as of 30.10.2025/XNUMX/XNUMX):
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- Dona D., Baraldi M., Brigadoi G., Lundin R., Perilongo G., Hamdy RF et al. (2025). Antibiotic treatment of acute and recurrent otitis media in children: an Italian intersociety Consensus. BMC Pediatrics, 51: 50. DOI: 10.1186/s13052-025-01894-z.
- Hassmann-Poznańska E., Dzierżanowska D., Poznańska M. (2014). Acute diffuse otitis externa. Polish Otorhinolaryngology Review3, 84–89. DOI: 10.1016/j.ppotor.2014.04.002.
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- Niemczyk E., Dębska M., Zawadzka-Głos L. (2015). Acute otitis media in children hospitalized in 2014 at the Pediatric Otolaryngology Clinic of the Medical University of Warsaw. New Pediatrics, 3: 87–92. URL: http://www.nowapediatria.pl/wp-content/uploads/2015/11/np_2015_087-092.pdf
- Pucher B., Jończyk-Potoczna K., Sroczyński J. et al. (2015). Mastoiditis as a complication of acute otitis media in a child with congenital neutropenia. Otorhinolaryngology, 14(1): 54–57.
- Varrasso DA (2009). 2004 American Academy of Pediatrics and American Academy of Family Physicians Guidelines for the Diagnosis and Management of Acute Otitis Media (AOM). Translated by Wojciech Grądalski, MD. Medicine after Diploma (2010), 02. URL: https://podyplomie.pl/publish/system/articles/pdfarticles/000/011/213/original/Strony_od_MpD_2010_02-10.pdf
- Załęska-Ponganis J., Jackowska T. (2013). Brain abscess of the etiology Streptococcus pyogenes as a complication of acute otitis media in a 7-year-old girl. Developmental Age Medicine4, 386–392. URL: https://medwiekurozwoj.pl/articles/2013-4-12.pdf
- Zielnik-Jurkiewicz B., Bielicka A. (2007). Bacterial resistance profile in acute otitis media in children after ineffective antibiotic therapy. Otorhinolaryngology, 6(4): 189–193.
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- Hassmann-Poznańska E. Acute otitis media in a child. Polish Otolaryngology Review, vol. 1, no. 3, July-September 2012.
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