What to look for in a baby with an ear infection
Babies cannot tell you their ears hurt, so you have to watch for physical signs and changes in behavior. The most common signs are pulling or tugging at the ear, fever (especially a temperature of 100.4°F or higher), and fussiness or crying that seems worse when the baby lies down. Some babies also have drainage from the ear—either clear fluid or pus—which you might notice on the pillow or in the diaper area if the infection has spread.
Not every baby shows the same signs, and some show very few. A baby might have an ear infection with only mild fussiness, or with no fever at all. This is why watching for a pattern matters more than any single sign. If your baby has been sick with a cold or upper respiratory infection in the past week or two, and now shows any of these signs, an ear infection becomes more likely.
Key Takeaways
- Pulling at the ear, fever, and unusual fussiness—especially when lying down—are the most common signs of an ear infection in babies.
- Drainage from the ear or a foul smell from the ear canal can indicate the infection has ruptured the eardrum and needs prompt attention.
- Babies under 6 months old with fever should be seen by a doctor the same day, even if other signs are mild.
- A doctor looks inside the ear with an otoscope and may use a pneumatic otoscope to check if fluid is behind the eardrum.
- Many ear infections clear on their own within a few days, but a doctor visit helps rule out other conditions and guides treatment.
Fever and how to take a baby's temperature
Fever is a sign the body is fighting an infection, though not all ear infections cause fever. If your baby is under 3 months old, any rectal temperature of 100.4°F or higher is a reason to call the doctor right away—do not wait. Babies this young can have serious infections that do not show many other signs.
For babies 3 months and older, a fever of 101°F or higher, or any fever lasting more than a few days, warrants a call to your pediatrician. A rectal thermometer is the most accurate method for babies under 3 years old. Place the baby on their back or stomach, insert the thermometer gently about half an inch into the rectum, and hold it there for about one minute until it beeps. An ear thermometer (tympanic) can work for babies over 6 months but is less reliable in younger infants.
Ear tugging, drainage, and other physical signs
Babies pull at their ears for many reasons—teething, normal exploration, or just because the ear is there. But if your baby tugs at one ear repeatedly while also seeming uncomfortable, fussy, or feverish, an ear infection becomes more likely. The tugging may be more noticeable when the baby is lying down or trying to sleep.
Drainage from the ear is a more specific sign. If you see fluid, pus, or blood leaking from the ear canal, or if you notice a foul smell, the eardrum may have ruptured from pressure behind it. This is not an emergency, but it does need a doctor's evaluation within a day or two. Do not put anything in the ear canal—just keep it clean and dry, and call your pediatrician.
Changes in sleep, eating, and behavior
Babies with ear infections often sleep poorly because lying flat increases pressure in the middle ear and makes pain worse. You might notice your baby waking more often, resisting naps, or seeming uncomfortable when you try to lay them down. Some babies will sleep better propped up slightly or in a car seat.
Eating can also change. A baby might refuse the bottle or breast, pull away during feeding, or seem less interested in eating altogether. This happens because sucking and swallowing change the pressure in the ear and can trigger pain. If your baby is eating significantly less than usual and seems unwell, mention this to your doctor.
When to call the pediatrician
Call your pediatrician the same day if your baby is under 6 months old and has a fever, regardless of other signs. Also call the same day if your baby has drainage from the ear, severe fussiness that does not improve with comfort measures, or signs of pain that seem to be getting worse rather than better.
You can usually wait until the next business day if your baby is over 6 months old, has a mild fever (under 101°F), and seems otherwise well except for fussiness or ear tugging. However, if the fussiness or suspected ear pain lasts more than a few hours, or if your baby seems to be in real discomfort, do not wait—call that day. Your pediatrician can often fit in a same-day visit for a baby in pain.
What the doctor will do to check for an ear infection
Your pediatrician will look inside your baby's ear using an otoscope, a small handheld light with a magnifying lens. They will gently insert a small plastic tip into the ear canal to see the eardrum. A healthy eardrum is pearly gray and moves slightly. An infected eardrum may be red, swollen, or bulging, and it may not move the way it should.
The doctor may also use a pneumatic otoscope, which sends a small puff of air into the ear canal. This tests whether the eardrum moves normally. If fluid is trapped behind the eardrum (a common finding in ear infections), the eardrum will not move much, and the doctor will see this right away. This test takes only a few seconds and does not hurt, though some babies dislike the sensation.
Frequently Asked Questions
Can a baby have an ear infection without fever?
Yes. Some babies have ear infections with only mild fussiness, ear tugging, or sleep problems and no fever at all. Fever is common but not required for an ear infection to be present. If your baby shows other signs and seems unwell, a doctor visit can confirm whether an infection is there.
How long does it take for an ear infection to go away?
Many ear infections clear on their own within three to five days as the body's immune system fights the infection. Some take longer. Your doctor may recommend pain relief while you wait, or may prescribe antibiotics if the infection is bacterial and severe. Do not assume it will go away without checking with your pediatrician first.
Is it normal for babies to get ear infections?
Yes. Babies' ear tubes are shorter and more horizontal than adults', which makes fluid more likely to get trapped. Most babies have at least one ear infection before age three. Frequent infections (more than three in six months) may warrant further evaluation, but occasional infections are a normal part of childhood.
What should I do if my baby has drainage from the ear?
Keep the outer ear clean and dry, and call your pediatrician within a day. Drainage usually means the eardrum has ruptured from pressure, which is painful but often heals on its own. Your doctor needs to see it to rule out other causes and guide care. Do not put drops or anything else into the ear canal.
Can I treat an ear infection at home while waiting for a doctor visit?
You can help your baby feel more comfortable with acetaminophen or ibuprofen (if your baby is old enough for ibuprofen—ask your pediatrician), and by keeping them propped up slightly rather than flat. A warm (not hot) compress on the outside of the ear may also help. However, only a doctor can diagnose an ear infection and decide whether treatment is needed.