Child ear infection: the signs, home care and when to see a doctor

Most child ear infections get better on their own within about 3 days, the NHS says. While you wait, your job is to ease the pain, keep drinks going and watch for the few signs that need a doctor. Middle ear infections often start with a cold. The other common kind in Singapore is swimmer's ear, an infection of the ear canal.

How to care for a child ear infection at home, step by step

1. Give paracetamol or ibuprofen for the pain, at the dose on the label or the one your doctor or pharmacist gives. The NHS says children under 16 should not take aspirin.
2. Hold a cool, damp cloth on the outer ear while the medicine starts to work. The AAP says some children prefer warmth, but heat or cold left on too long can hurt the skin.
3. Keep drinks and feeds coming, little and often. Feed a baby with their head higher than their tummy, as the AAP advises.
4. Put nothing inside the ear, not even a cotton bud or a finger, the NHS says. If fluid leaks out, wipe it from the outer ear with cotton wool and don't plug the canal.
5. Keep water out of the sore ear. The NHS says no swimming, and no water or shampoo in the ear, while the infection lasts.
6. Prop an older child up on pillows to sleep, which RCH says may help. Never put pillows in a baby's cot.
7. Skip decongestants and antihistamines. The NHS says there's no evidence they help with ear infections.
8. Write down when the pain started, each temperature and any fluid from the ear. Our fever checker shows when a temperature needs a doctor.
9. Tell grandparents or your helper the plan: which medicine went in and when, nothing in the ear, and which signs mean a doctor.
10. See a doctor if the pain or fever is still there after 48 hours, RCH advises. The NHS says a baby under 12 months with a suspected ear infection should see a GP.

Middle ear or outer ear: how to tell them apart

A middle ear infection sits behind the eardrum. Young children get more of them because the tubes linking the middle ear to the throat are shorter and softer, SingHealth explains. An outer ear infection, or swimmer's ear, is in the skin of the ear canal. HealthHub says Singapore's high humidity raises the risk, and so does swimming often.

After a swim, help the water drain out. HealthHub suggests tilting the head and gently pulling the ear in different directions, and earplugs to keep water out. Leave the cotton buds in the drawer. HealthHub says the ear cleans itself and the wax helps protect against infection. If your child has weekly swimming lessons, a quick dry after each one is an easy habit.

Signs in a child who's too young to tell you

Babies show ear pain in other ways. The NHS says young children may rub or pull at their ear, stop reacting to some sounds, get irritable or go off their food, and KKH adds fussiness and poor sleep. Look for it a few days into a cold: the AAP says ear infections often start on day 3.

Ear pulling on its own isn't proof. RCH says rubbing or playing with the ears is not usually a sign of infection unless other symptoms are there, and the AAP notes many babies tug their ears to soothe themselves. In a young child, RCH says a fever can be the only clue. The AAP puts the peak age at 6 months to 2 years. For a fever in a young baby, our guide to baby fever sets out the age rules.

Sometimes the eardrum gets a small tear and pus leaks out. It looks alarming, but RCH says it often makes the child feel better, and SingHealth says the eardrum usually heals naturally. Book a check anyway, since KKH says pus from the ear needs a doctor's opinion.

How doctors decide on antibiotics

Your GP or polyclinic doctor looks at the eardrum with a small light and magnifier. Then they weigh your child's age and how unwell they are. RCH says the best treatment for most middle ear infections is rest, and antibiotics won't help if a virus is the cause. The AAP says around 80% of childhood ear infections clear up without medicine, so a doctor may wait 48 to 72 hours before prescribing.

Antibiotics are more likely in some cases. The AAP lists a child under 2, a severe infection with serious pain or fever, symptoms that get worse after several days, and a weak immune system. SingHealth's page says a course of antibiotics is usually given for a middle ear infection, with medicine for pain and fever. So two doctors may make different calls. Ask yours why they chose to treat or to wait.

If your child gets antibiotics, give them as the label says until the course is done. The AAP says around 1 in 5 children get side effects such as nausea, diarrhoea, stomach pain or a rash, so tell the doctor if you see these. For ear drops, our guide on giving medicine to a baby walks through the steps.

Glue ear and when a hearing check matters

After an infection, fluid can sit behind the eardrum for weeks. This is glue ear, or otitis media with effusion. KKH says up to 60% of children have at least one episode by age 6. It often follows a cold and in most cases clears by itself, though this can take up to 3 months.

Most children don't notice their hearing is dull. KKH says you may see them turn up the TV or miss parts of a conversation, and a teacher may say they seem inattentive. This matters while they're learning to talk. KKH calls hearing loss the single most important cause of delayed speech.

Ask for a hearing test if hearing still seems dull 2 weeks after an infection, as RCH advises, or after repeated infections, as SingHealth advises. If fluid stays, an ENT doctor may suggest grommets, tiny tubes placed in the eardrum to let the fluid out. KKH does this as a day surgery under general anaesthetic, and the tubes fall out by themselves in 6 months to a year. Our guide to speech milestones and delay covers hearing and speech checks in Singapore.

Flying with ear pain

A child with an ear infection can usually still fly. The AAP says children taking antibiotics for one can travel safely, and for most the flight won't make the pain worse. Ask your doctor or pharmacist about pain relief for the trip.

For the descent, the AAP suggests having your child swallow drinks or suck on a pacifier, and says children over 6 can chew gum. Our guide to baby sleep while travelling covers feeds at take-off and landing.

When to see a doctor

See your GP or polyclinic doctor if the pain or fever lasts past 48 hours, or if hearing is still dull 2 weeks later (both RCH). Go too if pus comes from the ear (KKH), or if your child has more than four ear infections in a year (RCH). The NHS says a baby under 12 months with a suspected ear infection should see a GP. KKH says your polyclinic or family doctor can treat common conditions in young children and refer you to KKH if needed.

Go to Children's Emergency if you see any of these:

• Swelling, redness or tenderness building behind the ear, on the head itself (RCH and the AAP)
• A stiff neck, or a child who can't move their neck normally (KKH and the AAP)
• A child who is very drowsy or not waking up properly (RCH says call an ambulance; KKH lists drowsiness as an emergency)
• A crooked smile, or weakness on one side of the face (AAP)
• Pain that paracetamol or ibuprofen doesn't touch, with a very irritable child (RCH)
• A fever or any illness in a baby under 3 months (KKH)
• Something stuck in the ear (KKH)
• A child who looks or acts very sick (AAP)

For these, go to KKH Children's Emergency or NUH Children's Emergency. KKH says children with life-threatening conditions are seen first, so expect a wait for milder problems. Call 995 for an emergency, such as a seizure, trouble breathing or a child you can't wake. To find a doctor near you for the follow-up, try our paediatrician map.

Frequently asked questions

Is a child ear infection contagious?

No. The AAP says your child can't catch an ear infection from someone else. The cold that often comes first does spread, so hand washing still helps. Our guide to common childhood illnesses covers the bugs that do the rounds at preschool.

Can my child go to preschool with an ear infection?

The AAP says children can go back to childcare or school as soon as they feel well enough. Its symptom guide adds: once any fever is gone. Check your centre's own sick-child policy too, and tell the teachers about any medicine due during the day.

Can my child swim with an ear infection?

Keep them out of the pool for now. The NHS says no swimming during an ear infection. The AAP is less strict for a middle ear infection: swimming is fine if nothing is draining and the eardrum has no tear. Ask your doctor before the next lesson, and dry the ears well after each swim.

How long does an ear infection last in a child?

RCH says most middle ear infections last 2 to 4 days. A cough and blocked nose can hang on for up to 3 weeks. Hearing can stay muffled until the fluid clears, which RCH says may take up to a month.

Why does my child keep getting ear infections?

SingHealth says children under 3 are the most prone, and colds, childcare, cigarette smoke and a family history all add to the risk. The AAP says feeding a baby lying flat, or letting them hold their own bottle, can send milk towards the middle ear. SingHealth says the pneumococcal and Haemophilus vaccines lower the risk, so check what's due on our vaccination schedule and keep your home smoke-free.

Do pacifiers cause ear infections?

The NHS lists stopping the dummy after 6 months as one way to help prevent ear infections. Our guide to the best pacifier for a newborn covers when to start and when to stop.