Ear Infection Symptoms in Babies and Toddlers

I distinctly remember the time that I noticed my then 8-month-old son tugging on his right ear. That, combined with his unusual crankiness, got my attention. Was he teething? Overtired? Just discovering his ear? Or could he be signaling that he was suffering from an ear infection? He was just getting over a cold, so I decided to call the pediatrician's office. The nurse suggested bringing him in for a quick peek at his ears.

The verdict: no ear infection! While I was relieved, the incident did get me thinking. Did I have to drag him in every time he pulled at his ear? That seemed a little extreme. I decided it was time to learn a little bit more about this common childhood ailment so that I wouldn't miss a real ear infection in the future.

"Next to the common cold, ear infections are the most common disorder in children," says Margaretha Casselbrant, M.D., Ph.D., chief of the division of pediatric otolaryngology at Children's Hospital of Pittsburgh. But ear infections are not always easy for a parent to diagnose because the symptoms can be vague and mimic those of a regular cold or flu. In fact, ear infections often start as a cold with a cough and a runny nose.

While it's certainly tricky, there are still signs that are specific to ear infections. Here's how to tell if it's an ear infection.

Signs It's an Ear Infection

Because infants and toddlers don't yet have the language skills to let you know how they're feeling, detecting an ear infection is especially hard.

Despite what you may have heard, ear tugging is not a reliable sign, according to experts. So what should parents be on alert for?

"In general, a fever above 102 degrees is one of the hallmarks of an ear infection in a nonverbal child," says Max M. April, M.D., a pediatric otolaryngologist in New York City and chair of the committee on pediatric otolaryngology for the American Academy of Otolaryngology-Head and Neck Surgery.

The following signs also may indicate your child has an ear infection.

Pain in the ear

According to the American Academy of Pediatrics, ear infections are painful, so your infant or toddler's tears or increased irritability may be a symptom. Also, if your baby becomes more upset when they're lying down, an ear infection may be to blame, because that position puts pressure on the eustachian tubes.

Difficulty falling or staying asleep

Having a hard time sleeping is also a sign of an ear infection. This is due to the pain from pressure building in the ears. Sometimes active, busy kids will complain more about pain when things quiet down at the end of the day or when it's time for sleep. It's also common for them to wake up in the middle of the night with ear pain.

Fever

A fever is a sign that their immune system is at work fighting off infection. With an ear infection, your child's temperature may range from 99F to 104F when taken rectally.

Trouble hearing

Fluid buildup in the ear may block sound so they may not respond to sounds around them as they normally would. Rest assured: Their hearing will come back once the infection is gone and their ear is free of fluid.

Decreased appetite

The ear infection itself shouldn't cause problems with swallowing, but your child may lose their appetite because they just don't feel well. Vomiting and diarrhea may also crop up. They also may complain of a stomachache.

Fluid or pus draining from your child's ear

While not very common, this is a definite sign of infection, so call the doctor right away. Yellow, white, or green drainage from the ear can signal a perforated eardrum, a condition that can develop if the fluid in the middle ear puts so much pressure on the eardrum that it bursts.

Although a burst eardrum may sound scary and can be very painful for your child, the hole is not serious and will usually heal by itself. And the good news is that your child may start to feel better as fluid drains and pressure decreases.

Still Not Sure? Head to the Doc

The only way to be sure that your child has an ear infection is to visit your pediatrician. Take a child younger than age 2 to the doctor if a cold and/or apparent discomfort doesn't go away in two or three days, or if the fever doesn't go away in one or two days. (If your infant is less than 4 months old, notify your doctor of any fever immediately.)

When your physician peeks in your child's ear to check for signs of an infection, they're looking at the eardrum to see if it is red, thick, or bulging. If so, depending on the severity of the infection and other factors, they may suggest waiting it out to let it resolve on its own. Or they might prescribe medication, typically antibiotics, to help speed healing along.

Additionally, your child's pediatrician can suggest whether your child would benefit from ear drops or over-the-counter pain relievers, such as acetaminophen or ibuprofen. Sitting up and being propped up a bit while sleeping (this is only safe for older children, babies need to sleep flat on their backs in order to reduce the risk of SIDS) can help alleviate ear pain, as can sitting in a warm, steamy bathroom.