Ear infections in children: antibiotics or not, pain relief, and glue ear
Last updated September 3, 2026.
Most childhood ear infections are triggered by a cold, and most clear up in about 3 days with pain relief alone, no antibiotics needed. That surprises parents, because the first night of earache is genuinely distressing. The skill is knowing which ear infections need a doctor and which need paracetamol, a warm compress, and time.
What does it look like?
Earache, often at night, during or just after a cold: crying, pulling or rubbing at the ear, fever, irritability, disturbed sleep, and going off feeds or food. Babies cannot point, so the combination of a cold plus a suddenly miserable, ear-tugging, feverish baby is the picture. Fluid or pus draining from the ear means the eardrum has perforated to release pressure; it sounds alarming, usually relieves the pain immediately, and the drum almost always heals by itself within weeks. Muffled hearing during and after the infection is expected and usually temporary.
What actually helps?
- Pain relief is the main treatment: paracetamol or ibuprofen dosed by weight from the packet. This is not just comfort: a settled child drinks, sleeps, and heals. Give it regularly through the bad first 48 hours rather than waiting for tears.
- Warmth on the ear: a warm (not hot) flannel or covered warm compress held against the sore ear eases the ache for many children. Never put anything inside the ear: no drops unless prescribed, no cotton buds, no oil.
- Antibiotics are selective, not automatic: guidance reserves them for children under 2 with infection in both ears, any child with discharge from the ear, severe symptoms, or cases not improving after about 3 days. Most ear infections are viral or self-limiting bacterial ones, and antibiotics do not speed those up while carrying side effects like diarrhea and rashes.
- Prop and feed upright: slightly raise the head of the cot for sleep, and bottle-feed in an upright position; flat feeding lets milk pool toward the ear tubes. Keep them away from cigarette smoke entirely, which is a proven driver of ear infections.
- Watch the hearing afterward: fluid lingering behind the eardrum (glue ear) can dull hearing for weeks after the infection clears. If hearing seems reduced for more than a few weeks, speech seems delayed, or the TV creeps louder, get a hearing check.
When is it an emergency?
Most ear infections are home-manageable, but some signs change that. Same-day care for: redness, swelling, or tenderness behind the ear, or the ear sticking out at a new angle (possible mastoiditis, an infection of the bone behind the ear); a child who is listless, not drinking, or hard to wake; severe headache with a stiff neck; or symptoms in a baby under 6 months. A burst eardrum with discharge needs a doctor within a day or two for antibiotic drops or tablets, but is not a blue-light emergency on its own. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Does my child need antibiotics for an ear infection?
Usually not. Most childhood ear infections clear on their own in about 3 days, and studies show antibiotics shorten the average course only marginally while causing side effects like diarrhea and rashes in a share of children. Guidance reserves antibiotics for: children under 2 with both ears infected, any child with pus draining from the ear, severe illness, or no improvement after about 3 days. The main home treatment, pain relief with paracetamol or ibuprofen, is what every child needs regardless.
How long does an ear infection last in a child?
The worst of the pain typically peaks in the first 24 to 48 hours and most children are clearly improving by day 3. Milder symptoms can trail for about a week. Muffled hearing from fluid behind the eardrum commonly outlasts the infection by several weeks and usually clears by itself; that is glue ear, not a continuing infection. Pain that is not improving at all by day 3, or a second fever spike after initial improvement, deserves a review.
Why does my child keep getting ear infections?
Young children have short, horizontal ear tubes that drain poorly, and each cold swells them shut. The amplifiers: daycare exposure to viruses, pacifier use beyond infancy, bottle-feeding lying flat, and household cigarette smoke, which is a well-proven risk factor and a concrete reason to keep smoke away from them. Most children grow out of the vulnerable window by school age. Grommets (ventilation tubes) are the option for genuinely recurrent cases, decided by an ENT specialist.
Fluid is coming out of my childs ear. What does that mean?
It usually means the eardrum has perforated to release the pressure of trapped pus, which sounds scary but typically brings instant pain relief and heals on its own within a few weeks. Keep the ear dry (cotton wool coated in petroleum jelly for baths, no swimming), never poke anything inside, and see a doctor within a day or two: a perforated eardrum with discharge is one of the situations where antibiotic treatment is recommended, and they will confirm the drum is healing.
Can ear infections affect my childs hearing or speech?
Temporarily, yes: fluid behind the eardrum muffles hearing during and for weeks after infection, like listening underwater. Occasional episodes do no lasting harm. The situation that matters is persistent glue ear: months of dull hearing during the language-learning years can delay speech. Signs to act on: your child seems not to hear you, the TV volume creeps up, speech is slow to develop, or teachers report inattention. Those warrant a hearing test and an ENT opinion, and grommets are the standard fix when it persists.
When should I take my child to the doctor for an ear infection?
Within a day or two for: discharge from the ear, a baby under 6 months, an under-2 with both ears affected, symptoms not improving after 3 days, or frequent recurrences. Same-day urgent for: redness, swelling, or tenderness behind the ear or the ear sticking out, a child who is listless, not drinking, or hard to wake, severe headache with a stiff neck, or any non-blanching rash. Home care with pain relief is right for the ordinary pattern: post-cold earache in a drinking, responsive child.
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