It is common for young children to contract infections that affect their ears. Specifically, by the time your child is age three, they will likely experience a middle ear infection. This is expected - as children are exposed to more germs in their environment, their susceptibility to infections increases.

After your child is diagnosed with an infection, you may ask: Are other symptoms related to their infection? Is their infection contagious? How should they sleep? Should they stay home from school or daycare?

It's natural to worry about the health of your little one and want to keep other family members safe. But worry no more! Read on for answers to common questions that may arise after an ear infection diagnosis so you can have peace of mind.

A quick guide to ear infections in children

An ear infection, or otitis media, is when the middle part of the ear becomes filled with fluid due to a bacterial or viral infection. The infection can cause discomfort, pain, and sometimes hearing difficulties. They are common in children under three years old due to the structure of their Eustachian tubes (pronounced “you-stay-shee-un”), which are responsible for draining fluid from the middle ear to the throat and balancing pressure on either side of the eardrum. 

Types of infections

There are three main types of ear infections: Acute Otitis Media (AOM), Otitis Media with Effusion (OME), and Chronic Otitis Media with Effusion (COME).

With AOM, or a middle ear infection, the middle ear becomes infected and swollen, and fluid is trapped behind the eardrum, causing pain and often a fever. Middle ear infections are so common in children that we've written an in-depth guide about them.

OME occurs when fluid remains trapped in the middle ear. The fluid can be present in the ear as part of a cold virus and not cause any problems or may remain after a bacterial infection has cleared up. The child might not show any symptoms, but the continued presence of fluid can lead to hearing difficulties.

COME happens when fluid remains in the middle ear for a long duration or returns repeatedly, even without an infection. This chronic condition can affect hearing and may require treatment to prevent speech and language developmental delays.

Causes: If my child has an ear infection, how did they get it?

Ear infections typically occur due to a child having a cold virus. Fluid builds up in the middle ear, creating an environment where viruses, bacteria, or a combination can thrive.

Other factors contributing to ear infections in children include:

• Allergies
• Exposure to secondhand smoke
• Frequent upper respiratory infections
• Child care (due to frequent exposure to viruses)

Note: in younger children, the anatomy of the Eustachian tubes also contributes to the persistent collection of the fluid.

Symptoms: How do I know if my child might have an ear infection?

Children often have a runny nose or cough a few days before their ear pain begins. If an ear infection develops, you may see one of many symptoms, varying in severity based on the infection's cause and the child's age. Typical symptoms include fever, ear pain, tugging at the ear, reduced appetite, crankiness, and trouble sleeping. 

In some cases, you may see ear drainage (clear, yellow, bloody, or pus-filled); however, drainage only occurs when the pressure of the infection is high enough to cause a rupture in the eardrum. A small hole is then present, letting the fluid pass from the middle ear to the ear canal.

Diagnosis: How will the doctor know my child has an ear infection?

A doctor will conduct an ear exam using an otoscope, which allows them to look into the ear canal and evaluate the eardrum or the “tympanic membrane.” They'll look for signs of infection, including inflammation (redness) and fluid (clear or cloudy).

If you’re unable to see your child's pediatrician, a pediatric telemedicine service like Blueberry Pediatrics can help you diagnose and treat ear infections from home. All Blueberry families receive a video otoscope, which allows parents to record and send inner ear videos to Blueberry’s board-certified pediatricians, who will review your child’s video and provide treatment guidance.

Treatment: What are the available options for my child's ear infection? Are antibiotics necessary?

Your pediatrician will work with you to determine the best course of treatment for your child, based on their age, severity of symptoms, and the doctor’s impression. Blueberry Pediatrics follows the American Association of Pediatrics’ guidelines with the below general recommendations.

Babies under six months

It is recommended that antibiotics are prescribed and the entire course of antibiotics are administered, regardless of displayed symptoms.

Infants older than six months, toddlers, and children

Doctors cannot tell through an exam if a virus or bacteria is the most likely cause of an ear infection and therefore recommend ‘watchful waiting’ if the child does not have moderate to severe symptoms (high fever, severe pain, etc.). The waiting period allows an infection to clear and avoid antibiotics. Your doctor may prescribe antibiotics or ear drops if it does not improve in a few days.

A note about antibiotics: Overusing antibiotics may cause resistance within the body, eventually leading to problems finding an antibiotic to treat illnesses. Blueberry pediatricians are careful with prescribing antibiotics and follow guidelines established by the American Academy of Pediatrics.

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Your ear infection questions answered

In the previous section, we discussed the fundamentals of ear infections, covering triggers, signs, and approaches to treatment. Now that we have a solid understanding let's address common questions parents often have about this condition.

Is an ear infection contagious?

Ear infections are not necessarily contagious, but the original cause of the ear infection can be.

For example, if a child has a common cold virus and develops congestion, fluid can build up in the middle ear and become an infection. The original cold can be contagious to other contacts but may not become an ear infection for those people.

Do I need to keep my child at home?

If a child has an ear infection, no fever, and is acting well, they can attend school or daycare. If, however, they have a higher level of discomfort, you may want to keep them home. 

Need a doctor’s note? After diagnosing your child’s ear infection, a Blueberry pediatrician can provide a doctor’s note if your child needs to stay home from school or daycare.

Do ear infections cause eye discharge?

Ear infections may not directly cause eye discharge, but some bacteria or viruses can cause an infection in the ears and eyes simultaneously.

What’s the best way for children to sleep with an ear infection?

At times, the pain from an ear infection may disrupt your child's sleep. While it is best to let the pain subside naturally, if your child is in severe pain, you may give pain relievers such as acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil, only for children six months or older). 

Pain relief from acetaminophen lasts 4-6 hours, while Ibuprofen lasts 6-8 hours. In general, try to keep your child’s bedtime routine as normal and consistent as possible.

Can an ear infection cause other symptoms?

Your child may experience other symptoms after being diagnosed with an ear infection, and you may wonder if the ear infection is to blame. Below we explore those symptoms and their correlation to the infection.

Headaches

No. However, the viral or bacterial infection that has caused the ear infection certainly can cause other symptoms, such as headaches.

Vomiting 

In general, an ear infection itself does not cause vomiting. Sometimes, the viral or bacterial illness that causes an ear infection may also cause vomiting. In rare cases, the fluid buildup in the ear may cause dizziness, vertigo, and possibly balance problems, any of which may lead to vomiting.

Diarrhea

Ear infections do not cause diarrhea. However, viral and bacterial illnesses can cause both ear infections and diarrhea.

Upset stomach

Generally, ear infections do not cause an upset stomach. The viral or bacterial illness causing the ear infection may also cause an upset stomach, as may the antibiotic medicines used to help treat ear infections. 

One thing to remember: Viral and bacterial infections cause ear infections. The initial virus that caused the ear infection could cause other symptoms such as headache, vomiting, diarrhea, upset stomach, and upper respiratory cold symptoms - but the ear infection itself does not cause the symptoms.

How can I prevent ear infections?

There are a few key things you can do to reduce your child's risk of ear infections. 

Immunization

Keeping your child up-to-date with vaccines - in particular, the pneumococcal vaccine - can protect against a common bacterial cause of ear infection. Additionally, the yearly flu vaccine protects your child from influenza, which can cause ear infections.

Allergy Treatment

If your child has allergies, continue to administer allergy treatment as recommended by your physician. This reduces inflammation in the nasal passages and throat and allows the Eustachian tubes to drain.

Encourage Hand Washing

Frequent hand washing can help deter the spread of illness-spreading germs at home, school, and daycare. Wash hands for at least 20 seconds using soap and warm water.

Avoid Tobacco Smoke Exposure

Exposure to secondhand smoke is a known risk factor for ear infections. Avoid exposing your child to tobacco smoke from cigarettes, cigars, pipes, and electronic cigarettes (vaping).

Talk with a pediatrician about your child's ear pain

Blueberry Pediatrics offers unlimited, on-demand virtual pediatric care. Parents can connect with board-certified pediatricians through text message, a phone call, or a video visit anytime for any question. Some of the most common conditions our pediatricians advise are related to eye and ear pain.

Each Blueberry family receives an at-home medical kit to help diagnose more illnesses from home.

The best part? An entire year of Blueberry membership costs less than the typical copay of a single urgent care visit, and one membership covers all children in your household! It's like having a doctor's office in your house. Sign up here.

Sources:

• Allan S. Lieberthal, Aaron E. Carroll, Tasnee Chonmaitree, Theodore G. Ganiats, Alejandro Hoberman, Mary Anne Jackson, Mark D. Joffe, Donald T. Miller, Richard M. Rosenfeld, Xavier D. Sevilla, Richard H. Schwartz, Pauline A. Thomas, David E. Tunkel. (2013 March). The Diagnosis and Management of Acute Otitis Media. Pediatrics March 2013
• Milligan, S., & McCrery, S. (2013, October 1). Should children with acute otitis media routinely be treated with antibiotics? No: Most children older than two years do not require antibiotics. American Family Physician. 
• National Institute on Deafness and Other Communication Disorders. (2015, August 18). Ear Infections in Children. NIDCD.