Ear Infection in Children: How to Relieve Pain and When to See a Doctor

Middle of the night — your child wakes up crying, tugging at their ear, impossible to settle. Every parent knows this scenario, and knows exactly how helpless it can make you feel. Acute otitis media (middle ear infection) is one of the most common causes of pain in young children and one of the most frequent reasons for paediatric visits. Studies suggest that by the age of three, at least 80% of children will have experienced at least one episode.

The good news is that in many cases you can effectively relieve pain at home using over-the-counter medicines. The less welcome news is that not all ear pain is the same, and some situations need medical attention as soon as possible. This article will help you tell the difference.

The autumn and winter months see a sharp rise in cases — there is a reason middle ear infections are sometimes called "the waiting-room disease." It is worth knowing what to do before you get to that waiting room, and how to recognise when a visit is genuinely essential.

Please note: the information below is educational in nature. If in any doubt, always consult a doctor or pharmacist.

What happens in the ear during an infection?

The middle ear is a small air-filled space behind the eardrum. It connects to the throat via the Eustachian tube — in young children this tube is short, horizontal and relatively wide, which makes it very easy for bacteria and viruses from the upper respiratory tract to migrate upward into the ear.

When an infection takes hold, the mucous membrane of the middle ear swells, fluid accumulates, and pressure builds in the enclosed space. This pressure is the main cause of the intense, throbbing pain that so often worsens when lying down. Your child may be irritable, running a temperature, and lose their appetite — hearing may also be temporarily reduced.

Relieving pain at home: paracetamol and ibuprofen

The first and most important thing you can do is give your child an over-the-counter pain and fever reliever. For ear infections, two well-evidenced active ingredients are available:

Paracetamol

The first-choice medicine for children from one month of age. It relieves pain and reduces fever, is well tolerated and widely available as syrups, suspensions, suppositories and dispersible tablets.

• Dosage: 10–15 mg per kilogram of body weight, every 4–6 hours (maximum 4 times in 24 hours).
• Example: A child weighing 15 kg — a single dose of 150–225 mg, for instance 7.5–11 ml of a 120 mg/5 ml syrup or 5–7.5 ml of a 250 mg/5 ml suspension.
• Important: do not exceed the daily dose. Paracetamol is safe at recommended doses, but overdose damages the liver.

Ibuprofen

For children over 3 months of age (most over-the-counter (OTC) guidelines recommend from 6 months). It has stronger anti-inflammatory action than paracetamol, which can be an added advantage in ear infections — it helps reduce swelling of the mucous membrane.

• Dosage: 5–10 mg per kilogram of body weight, every 6–8 hours (maximum 3 times in 24 hours).
• Example: A child weighing 15 kg — a single dose of 75–150 mg, for instance 3.75–7.5 ml of a 100 mg/5 ml suspension.
• Important: do not use if the child is dehydrated, vomiting, has kidney problems, or is under 3 months old without first consulting a doctor.

You can alternate the two medicines (for example paracetamol, then ibuprofen 3 hours later) if the pain is severe and one medicine alone is not giving enough relief — this strategy is widely used and considered safe. Always read the package leaflets carefully and calculate the dose from the child's current weight, not their age.

Warmth as a complement: when does it help?

Gentle warmth applied to the ear can bring a child some comfort alongside medication — but only when there is no sign of discharge from the ear or a perforated eardrum.

• A warm (not hot!) compress is enough — for example a cloth warmed on a radiator or a heat pad set to the lowest setting and wrapped in a thin towel.
• The temperature should be comfortable against a child's delicate skin: warm, but not scalding.
• Duration: 10–15 minutes, a few times a day.
• Never apply heat if fluid, pus or blood is leaking from the ear — that is a warning sign requiring medical attention, not a home remedy.

A semi-upright position or slightly elevated head (such as a rolled towel placed under the head end of the mattress) may also reduce the feeling of pressure by helping Eustachian tube drainage.

What you should absolutely NOT do

Ear infections come with many home-remedy myths. Some are harmless; others can genuinely cause harm.

Do not put anything in the ear without medical advice

over-the-counter ear drops (for example those containing lidocaine or phenazone) should only be used when the eardrum is intact. If you are not certain the eardrum is undamaged — and with a middle ear infection you can never be certain without an otoscopic examination — drops that enter the middle ear can damage hearing. Do not use olive oil, garlic, propolis, or any other home remedies either.

Do not clean the ear with cotton buds

Cotton buds push wax further in, can mechanically damage the delicate ear canal, and — in the worst case — perforate the eardrum. Earwax serves a protective function and under normal circumstances the ear canal cleans itself naturally.

Do not stop antibiotics early

If a doctor has prescribed antibiotics, give them for the full recommended course (typically 7–10 days), even if your child feels better after 2–3 days. Stopping early risks the infection returning with bacteria that are harder to treat.

Do not ignore repeated episodes

If a child has 3 or more ear infections in a year, a specialist ENT assessment is needed. Recurrent infections can lead to permanent hearing loss, delayed speech development, and other complications.

When do you need to see a doctor?

Not every ear infection demands an immediate consultation — but there are situations where waiting until morning or until the next available appointment is simply too risky.

Under 2 years old — always see a doctor

Infants and young children under 2 should be seen by a doctor at every suspected episode of middle ear infection. In this age group the illness can progress rapidly, the risk of complications (including mastoiditis) is higher, and diagnosis based on symptoms alone is more difficult. Do not wait.

Temperature above 39 °C (102 °F) or fever not responding to medication

A high temperature that persists despite regular paracetamol or ibuprofen is a sign that the body is struggling to fight the infection and may need additional treatment.

Discharge from the ear

Fluid, pus or blood flowing from the ear canal means the eardrum has perforated — it has burst under pressure. Paradoxically, the pain may ease at this point, but the situation requires medical assessment. The good news: in children the eardrum usually heals on its own — but a doctor needs to confirm this.

Pain lasting more than 48 hours despite treatment

If your child has been taking pain relief regularly for two days and is still not getting better — it is time for a visit. Antibiotic treatment may be needed, or other causes of ear pain may need to be ruled out.

Other warning signs

• Swelling, redness or tenderness of the skin behind the ear (possible mastoiditis).
• Sudden problems with balance, dizziness, or severe headache.
• The child is unusually drowsy, difficult to rouse, or is behaving differently from normal.
• Pain is getting worse after 48 hours rather than improving.

Antibiotics: yes or no?

The majority of acute middle ear infections in children over 2 years old resolve on their own within 2–7 days — even without antibiotics. For this reason, clinical guidelines recommend a "watchful waiting" approach: give pain relief for 48–72 hours and observe whether the child improves. Clinical evidence clearly shows that routinely prescribing antibiotics for every ear infection does not significantly speed up recovery, and contributes to growing antibiotic resistance.

Antibiotics are recommended without delay for:

• Children under 2 years of age (especially under 6 months — always),
• Children with ear discharge indicating a perforated eardrum,
• Severe illness (high fever above 39 °C, intense pain not responding to medication, the child is unwell in themselves),
• Both ears infected at the same time in children under 2 years,
• Children with weakened immune systems or anatomical ear abnormalities.

Amoxicillin is the antibiotic of first choice in most international guidelines. The decision to prescribe is made by a doctor after examining the ear with an otoscope — parents should neither push for a prescription nor refuse one without good reason. Remember that antibiotics are prescription-only medicines and require a consultation with a doctor.

Prevention: how to reduce the risk of recurrences?

Given how many children experience ear infections, the natural question is: can they be prevented? Complete elimination of the risk is not possible, but several well-evidenced actions genuinely make a difference.

• Breastfeeding — for at least the first 6 months significantly reduces the risk of middle ear infections. Antibodies and immune-active components in breast milk strengthen the mucous membrane of the Eustachian tube.
• Smoke-free environment — passive smoking damages the Eustachian tube epithelium and is one of the strongest risk factors for recurrent ear infections. Children exposed to cigarette smoke develop ear infections 2–3 times more often than children raised in smoke-free environments.
• Vaccinations — the pneumococcal vaccine (PCV13 or PCV15 depending on country guidance) and seasonal flu vaccine substantially reduce the risk of bacterial ear infections. Pneumococci account for a significant proportion of bacterial cases — protecting against them offers real benefit.
• Feeding infants in an upright position — not lying flat, which prevents milk from refluxing through the Eustachian tube. This applies to both breastfeeding and bottle feeding.
• Hand hygiene and limiting contact with sick individuals — ear infections often follow a cold or flu. Regular handwashing, avoiding crowded places during peak infection season, and prompt treatment of upper respiratory infections all reduce the risk of complications.
• Limit dummy (pacifier) use after 6 months — research suggests that using a dummy during sleep increases the risk of middle ear infections, probably through its effect on the opening mechanism of the Eustachian tube.

Frequently asked questions

Does an ear infection hurt more at night than during the day?

Usually, yes. In the lying position, pressure in the middle ear increases, which intensifies the pain. This is why ear infections so often "wake" children at night. Raising the head by 15–20 degrees (for example a few folded towels placed under the head end of an infant's mattress) can bring some relief — but it does not replace a pain reliever.

Can you bath a child with an ear infection?

Yes — bathing is fine with a middle ear infection, because the infection is behind the eardrum and water during normal bathing does not penetrate through the ear canal to reach it. Avoid bathing, however, if there is discharge from the ear or if your child has had grommets (ventilation tubes) inserted.

How long does a middle ear infection last in a child?

Most uncomplicated cases resolve within 3–7 days. A feeling of blocked ears and mild hearing reduction can persist for 2–4 weeks after the pain has gone — this is normal and usually does not need further treatment, provided it resolves on its own.

Is an ear infection contagious?

A middle ear infection itself is not contagious. However, the viral or bacterial upper respiratory infection that triggered it can spread to others. A child with an ear infection who has no fever and is generally well can usually attend nursery or school, unless their doctor advises otherwise.

When are grommets fitted?

Grommets (ventilation tubes) are inserted by an ENT specialist when ear infections recur too frequently (more than 3–4 times per year) or when otitis media with effusion ("glue ear") persists with hearing loss for more than 3 months. The procedure is performed under brief general anaesthesia, usually as a day case.

Can a child fly after an ear infection?

It is best to wait at least a week after symptoms have fully resolved before your child travels by air. Pressure changes during take-off and landing can be very painful if the ear has not completely healed. If the flight cannot be avoided, a doctor may recommend a nasal decongestant beforehand to reduce swelling of the mucous membranes.

Summary

✅ Paracetamol or ibuprofen — always dosed by current body weight, not age — is the most effective way to relieve ear pain in a child.

✅ A warm compress on the ear can complement medication, but it never replaces a pain reliever and is absolutely contraindicated if there is any discharge from the ear.

✅ Do not put anything in the ear without medical advice — the risk of damaging hearing if the eardrum is intact is real.

✅ Children under 2, those with fever not responding to medication, ear discharge, or pain lasting more than 48 hours all need prompt medical review.

✅ Most middle ear infections in older children resolve without antibiotics — the decision always rests with a doctor after examining the ear.

✅ Prevention means vaccinations, a smoke-free environment, and breastfeeding — these genuinely reduce the risk of recurrences.

Disclaimer

This article is for educational and informational purposes only. It does not replace medical advice or consultation with a pharmacist. Every child is different, and treatment of an ear infection should be tailored individually by a qualified healthcare professional. If you have any concerns about your child's health, always consult a doctor or pharmacist.

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