After a cold or sniffles, some children wake up tugging an ear, feverish, or crying when they lie down. An ear infection—usually an infection of the middle ear behind the eardrum—is one of the most common reasons parents bring a child to my clinic. What I tell parents is that most improve with careful home care and a clear plan with your paediatrician; not every case needs an antibiotic on day one.
What an ear infection is
The middle ear is a small air-filled space behind the eardrum. A short tube (the eustachian tube) connects it to the back of the nose and throat. In young children that tube is shorter and more horizontal, so fluid drains less easily after a cold or allergy congestion. Germs can then grow in the trapped fluid. The American Academy of Pediatrics explains on HealthyChildren.org that this middle-ear infection is called otitis media, and that nearly five out of six children will have at least one before their third birthday. It is different from “swimmer’s ear,” which affects the outer ear canal.
Why it matters—and what to watch for
Ear pain can spoil sleep and mood. Babies may be irritable, feed poorly, or fuss when laid flat. Older children may say the ear hurts, feels full, or that hearing seems muffled. Fever and, less often, drainage from the ear (which can mean the eardrum has opened a little) are other clues. Ear tugging alone is not enough—toddlers also pull ears when they are tired or exploring—so look at the whole picture with your doctor.
According to the U.S. Centers for Disease Control and Prevention (CDC), contact a clinician promptly for a high fever (about 39°C / 102.2°F or higher), pus or fluid from the ear, worsening symptoms, hearing concerns, or middle-ear symptoms that last more than two to three days.
What you can do—and when antibiotics help
Many middle-ear infections improve as the immune system clears the fluid. HealthyChildren notes that around 80% of childhood ear infections clear without antibiotics. For milder illness, clinicians often use watchful waiting or a delayed prescription for about 48–72 hours while focusing on comfort—exactly the approach the CDC describes for many mild cases. Age-appropriate paracetamol (acetaminophen) or ibuprofen can ease pain and fever; never give aspirin to children. Avoid leftover antibiotics or “just in case” courses from previous illnesses.
Antibiotics are more likely when the child is under two years, the illness is severe, both ears are involved in a young child, symptoms are getting worse, or there are other medical risks. If a course is prescribed, finish it as directed even if your child feels better midway. When you want a calm in-person check—especially if pain is strong at night—you can book an appointment.
Prevention that actually helps
Ear infections themselves are not contagious, but the colds that trigger them are. Handwashing, a smoke-free home, upright bottle-feeding (not lying flat with a bottle), breastfeeding when possible, and staying current on vaccines that reduce serious respiratory infections—including flu and pneumococcal vaccines on your paediatrician’s schedule—all lower risk. I explain who needs a yearly dose, and when, in my guide to the flu shot for kids this season.
Parent takeaways
- Ear pain after a cold is common; look for fever, sleep disruption, poor feeding, and hearing changes—not ear tugging alone.
- Many mild cases improve in a few days with pain relief and watchful waiting; antibiotics are reserved for higher-risk or severe illness.
- Seek care sooner for high fever, ear drainage, worsening pain, or symptoms lasting beyond two to three days.
In my clinic, the most useful thing I can do is look in the ear, check the whole child, and agree a clear plan with you—including exactly when to come back if things are not improving.
Frequently asked questions
Do all ear infections in children need antibiotics?
No. Many mild middle-ear infections improve on their own as the body clears the fluid; HealthyChildren.org notes that around 80% of childhood ear infections clear without antibiotics. For milder illness, doctors often use watchful waiting for about 48–72 hours with pain relief. Antibiotics are more likely for children under two, severe illness, both ears affected in a young child, or symptoms that are getting worse.
Is ear tugging a sure sign of an ear infection?
Not on its own. Toddlers also pull their ears when they are tired or exploring. Look at the whole picture: fever, ear pain, poor sleep or feeding, fussing when laid flat, ear drainage, or muffled hearing.
When should I take my child to the doctor for ear pain?
See a clinician promptly for a high fever (about 39°C / 102.2°F or higher), pus or fluid from the ear, worsening symptoms, hearing concerns, or ear symptoms that last more than two to three days.
Are ear infections contagious?
The ear infection itself is not contagious, but the colds that trigger it are. Handwashing, a smoke-free home, upright bottle-feeding, breastfeeding when possible, and staying current on vaccines such as flu and pneumococcal vaccines all lower the risk.
This article is for general information and parent education. It is not a substitute for personal medical advice. Always discuss your child’s symptoms with a qualified clinician.
Sources: HealthyChildren.org / AAP — Ear Infections in Children; CDC — Ear Infection Basics.
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