When to get help

Under 12 months, see a GP. The NHS routes older children to a pharmacist, who can give the same treatments as a GP, but babies under 12 months are named as a GP case. That is the first thing to know.

Ask for an urgent GP appointment, or call NHS 111 in the UK, the GP out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, or Healthline on 0800 611 116 in New Zealand, if your baby has symptoms of an ear infection and:

seems generally unwell;
has a very high temperature, or feels hot, cold or shivery — and remember the overriding age thresholds, 38°C (100.4°F) under three months and 39°C (102.2°F) from three to six months;
has swelling around the ear;
has fluid coming out of the ear;
has a change in hearing or new hearing loss;
is being sick, seems dizzy, or has a severe sore throat;
is under 12 months and has earache in both ears;
has a weakened immune system.

The NHS notes you should call 111 rather than use 111 online for a child under 5. Call emergency services — 999, 112, 911, 000 or 111 depending on your country — for the general red flags in any unwell baby, including a non-blanching rash, difficulty breathing, a first seizure, a stiff neck or a baby who cannot be roused.

The ear-pulling myth

The American Academy of Pediatrics addresses this head on: many adults assume that a child tugging or pulling at an ear means an ear infection, but many babies and small children do it to self-soothe or simply to play with their ears. On its own it means very little. It is also a common teething behaviour, and the NHS lists rubbing an ear among ordinary teething signs.

What actually suggests an ear infection in a baby

Because a baby cannot report pain, the NHS lists indirect signs for young children:

rubbing or pulling their ear, alongside other symptoms;
not reacting to some sounds;
being irritable or restless;
being off their food;
losing their balance repeatedly.

Add the general symptoms: pain inside the ear, a high temperature, difficulty hearing, discharge running out of the ear, and a feeling of pressure or fullness. The AAP notes that ear pain is commonly worse at night, which is why so many of these become 2am problems, and that discharge can mean the eardrum has perforated — which sounds alarming but usually relieves the pain and heals.

The strongest practical clue is context. Ear infections usually follow a cold. The AAP explains the mechanism: the eustachian tube connecting the middle ear to the back of the nose becomes blocked, usually because of a cold or allergies, fluid builds up behind the eardrum, and that fluid is a good place for bacteria or viruses to grow.

How long, and how common

The NHS says most ear infections clear within three days, although symptoms can sometimes last up to a week. The AAP notes that nearly five out of every six children will have one before their third birthday, and that for some children they become a recurring pattern that costs sleep.

Antibiotics: the honest position

NICE guideline NG91 covers antimicrobial prescribing for acute otitis media, and the whole point of that guideline is that most cases do not need antibiotics. The NHS says most ear infections clear up on their own and that a pharmacist or GP may give antibiotic tablets or eardrops where they are needed. The AAP puts it the same way: while most ear infections go away on their own, some require medication.

Babies are treated more cautiously than older children, which is why the under-12-months rule exists. Do not read the general advice about waiting and watching as applying to a three-month-old.

What helps

Paracetamol or ibuprofen for pain. Check the label for suitability at your baby's age and weight, or ask a pharmacist. No aspirin under 16.
Wipe away any discharge from the outer ear with cotton wool.
Do not put anything inside the ear — not cotton buds, not fingers.
Keep water and shampoo out of the ear.
Do not use decongestants or antihistamines. The NHS states there is no evidence they help with ear infections.

If eardrops are prescribed, the NHS notes they may not work if used incorrectly: remove discharge first, lie your baby on their side with the affected ear facing up, gently work the drops in, and keep them lying down for a few minutes.

Reducing the chances

You cannot prevent the ones that follow colds, and colds are unavoidable. The NHS lists what does help: make sure your baby has had all their childhood vaccinations, keep them away from smoky environments, and try not to give a dummy after six months.

That last one is specific and often missed. The vaccination point matters too — pneumococcal and flu vaccines reduce some of the infections that lead to middle ear disease.

Recurrent infections and hearing

The AAP notes that some children with prolonged hearing loss related to ear infections may have delayed speech and language development, and that fluid can linger after the infection itself has gone. The NHS says to see a GP if you or your child keep getting ear infections. If your baby seems not to respond to sound after a run of infections, say so at their next review rather than waiting for it to be noticed.

Nursery and childcare

There is no exclusion for an ear infection itself. The NHS's general advice applies: if your baby has a high temperature or is not well enough for normal activities, keep them at home and away from other people until they feel better. UKHSA guidance for education and childcare settings takes the same approach.

Ear Infections in Babies