Ear infections are common in young children. Many parents can relate to the helplessness of watching a child tug on an ear in pain. In those moments, it’s easy to feel uncertain about what to do next. If you find yourself comforting a child with an earache, you are not alone. Understanding why these infections occur, and how to support your child’s recovery, can make managing them less challenging.
Why Young Children Are More Vulnerable
The average young child experiences 7 to 10 viral upper respiratory infections (colds) every year, explains Dr. Julie Wei, director of the Division of Otolaryngology at Akron Children’s Hospital. When adults get congested, they can automatically blow their nose or “pop” their ears by pinching their nose and blowing to equalize pressure behind the eardrum. However, infants, toddlers and preschool-aged children do not have that ability.
“Infants, toddlers and preschool-aged children do not routinely sniff involuntarily or on command, nor blow their nose, and they have small size heads,” Wei says.
Because of this difference in head size and inability to equalize pressure, when young children get sick and have congestion, their Eustachian tubes, the narrow passages connecting the middle ear to the back of the nose and throat, cannot easily equalize pressure inside and outside of their ear.
This imbalance, according to Wei, creates negative pressure behind the eardrum. She notes that this pressure difference “causes the middle ear mucosa, mucous membrane, and epithelium to have increased goblet cells, which secrete mucus — hence ‘fluid’ behind ear drums and ear infections.”
Can Ear Infections be Prevented?
Unfortunately, parents cannot completely prevent ear infections. Wei notes, “Some infants and young toddlers are lucky and get less, some get more.” Children attending group daycare settings may experience more infections compared to children receiving care in-home simply due to increased exposure to common colds.
Wei adds, “The only definitive prevention is to avoid children’s exposure to second-hand smoke.”
What can Parents do During an Infection?
When an ear infection occurs, supportive care focuses on keeping your child comfortable. For infants 6 months or older, over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin) can help manage the fever and discomfort. It is also important to be patient with the recovery process.
Wei explains that parents should know “even after finishing oral antibiotics, fluid may persist behind the ear drum for
up to a month or longer.” So if fluid remains after antibiotics, it doesn’t mean that treatment failed.
When Should Parents be Concerned?
While most ear infections resolve safely, there are times when parents should contact their child’s doctor:
- High fevers that do not decrease with acetaminophen or ibuprofen
- Infants younger than 6 months of age displaying symptoms
- Ear infections in unvaccinated children
- Children who face a higher risk of serious complications like meningitis
- Having had multiple rounds of antibiotics and still experiencing recurrent infections
When to See a Specialist
For children with chronic or recurrent infections, Wei suggests seeing an ear, nose and throat (ENT) specialist to consider pressure equalization tubes. These tiny ear tubes physically allow the middle ear space to equalize pressure and drain, which can help children “avoid oral antibiotics for up to a year or longer” and allow them to avoid ear infections when catching a regular cold.
