Doctor looking in baby's ear with otoscope, mother holds
Illnesses/First Aid

Ear Infections: Signs, Treatment, and Watchful Waiting

July 6, 2026

Key takeaways: Ear infections often follow colds and are most common between 6 and 18 months. Signs include fussiness, poor sleep, ear tugging with fever, and ear drainage. Babies under 6 months are usually treated with antibiotics; some older babies with mild symptoms can be watched. Pain relief helps.

Ear infections (acute otitis media) are among the most common reasons babies visit the doctor. Here’s what to know.

Why Babies Get Ear Infections

The eustachian tube connects the middle ear to the back of the throat. In babies, it’s short, narrow, and more horizontal, so fluid and germs from a cold can get trapped behind the eardrum, leading to infection.

Risk Factors

  • Recent cold or respiratory infection.
  • Age 6 to 18 months.
  • Group childcare.
  • Exposure to tobacco smoke.
  • Bottle feeding while lying flat.
  • Pacifier use after 6 months.
  • Family history of ear infections.

Signs

  • Fussiness, especially when lying down.
  • Trouble sleeping.
  • Tugging or rubbing the ear (with other symptoms; ear tugging alone is common in healthy babies).
  • Fever.
  • Poor feeding.
  • Fluid or pus draining from the ear.
  • Trouble hearing or responding to sounds.

Diagnosis

A doctor diagnoses an ear infection by looking at the eardrum. A bulging, red eardrum with fluid behind it suggests infection. Symptoms alone aren’t enough to diagnose it.

From the author

From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book covers common first-year illnesses and the warning signs that mean it’s time to call the doctor, explained the way I’d explain them at the bedside.

See the book on Amazon →

Treatment

Pain relief: acetaminophen (for babies 2 months and older, with your doctor’s guidance for babies under 3 months) or ibuprofen (6 months and older), dosed by weight.

Antibiotics: the AAP’s guideline recommends antibiotics for:

  • Babies under 6 months with an ear infection.
  • Babies 6 to 23 months with infections in both ears or with severe symptoms (high fever or significant pain).
  • Children with ear drainage.

Watchful waiting: for some babies 6 months and older with mild symptoms in one ear, the doctor may suggest watching for 48 to 72 hours, since many ear infections clear on their own. If symptoms don’t improve or get worse, antibiotics are started.

Finish the full course of antibiotics if prescribed, even if your baby feels better.

Fluid That Lingers

After an ear infection, fluid can remain behind the eardrum for weeks to months (otitis media with effusion). It usually clears on its own. Your doctor may recheck the ears, especially if there are concerns about hearing or speech.

Recurrent Ear Infections

Babies with frequent ear infections (3 in 6 months or 4 in a year) may be referred to an ear, nose, and throat specialist to discuss ear tubes.

Prevention

  • Breastfeed if possible.
  • Keep your baby away from smoke.
  • Hold your baby upright for bottle feeds; never prop a bottle.
  • Limit pacifier use after 6 months.
  • Keep vaccines up to date, including pneumococcal and flu vaccines.
  • Wash hands to reduce colds.

Call your baby’s doctor if your baby: is under 3 months with any fever of 100.4°F or higher; has ear pain with fever; has fluid or pus from the ear; is very fussy or won’t feed; or isn’t improving within 48 to 72 hours of treatment. Seek urgent care for swelling, redness, or pain behind the ear, a stiff neck, or if your baby seems very ill.

The Bottom Line

Ear infections are common after colds. Pain relief helps right away. Antibiotics are recommended for young babies and more severe cases, while some milder cases in older babies can be watched.

Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.

Related Articles

Sources

  1. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999.
  2. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
  3. Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022;166(1 Suppl):S1-S55.
  4. Rovers MM, Numans ME, Langenbach E, et al. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008;25(4):233-236.
  5. Sullivan JE, Farrar HC; Section on Clinical Pharmacology and Therapeutics; Committee on Drugs. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580-587.

This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.

Leave a Reply