How to recognize an ear infection in an infant
Infants cannot tell you their ear hurts, so you have to watch for physical signs and changes in behavior. The most common signal is pulling or tugging at the ear, especially on one side. Your infant may do this repeatedly, particularly when lying down or at night. Other infants show no ear-pulling at all, so this sign alone is not definitive.
Look for fever — a temperature of 100.4°F (38°C) or higher taken rectally. Many ear infections come with fever, though not all. You may also notice drainage from the ear, which can look like clear fluid, pus, or blood on the outside of the ear or on your infant's pillow. Drainage usually means the eardrum has ruptured, which is painful but often allows the pressure to release.
Behavioral changes often matter more than any single physical sign. Your infant may be unusually fussy or irritable, cry more than normal, have trouble sleeping, or seem uncomfortable when feeding. Some infants refuse to eat or drink because sucking and swallowing change the pressure in the ear canal and cause pain. A sudden change in your infant's mood or sleep pattern, especially alongside a recent cold or upper respiratory infection, is worth mentioning to your pediatrician.
Key Takeaways
- Ear pulling, fever, and drainage are common signs, but infants show different combinations of symptoms and some show almost none.
- Behavioral changes like unusual fussiness, sleep disruption, or feeding refusal often signal an ear infection more reliably than physical signs alone.
- Ear infections usually follow a cold or upper respiratory infection by a few days to a week.
- Contact your pediatrician if your infant has fever, drainage from the ear, or a sudden change in behavior — do not wait for multiple signs to appear together.
When to call your pediatrician
Call during business hours if your infant is under 6 months old and has a fever, even if you suspect an ear infection. Fever in very young infants needs evaluation because it can signal other serious conditions. If your infant is older than 6 months, has a fever under 102°F, and seems otherwise well, you can often wait for a daytime appointment unless the fever lasts more than 48 hours or your infant seems increasingly uncomfortable.
Call immediately or go to urgent care if your infant has a fever above 103°F, is unusually drowsy or hard to wake, has a stiff neck, has a rash that does not blanch (turn white) when you press it, or is having trouble breathing. These are not typical ear infection signs and need prompt medical attention. Also seek immediate care if your infant has drainage from the ear and a high fever, as this combination sometimes indicates a more serious infection.
What happens during an ear exam
Your pediatrician will use an otoscope, a small handheld light with a magnifying lens, to look inside your infant's ear canal. They are checking for redness, fluid behind the eardrum, or a bulging eardrum — all signs of infection. The exam takes less than a minute per ear. Your infant may not like the otoscope in their ear and may cry or pull away, which is normal and does not affect the exam.
Some pediatricians also use a tool called a pneumatic otoscope, which puffs a small amount of air into the ear canal to test whether the eardrum moves normally. A eardrum that does not move suggests fluid behind it. This test is painless but can startle an infant. Your pediatrician may also check your infant's throat and listen to their lungs with a stethoscope, since ear infections often occur alongside other respiratory infections.
Differences between viral and bacterial ear infections
Most ear infections in infants are viral, meaning they are caused by a virus and will resolve on their own within a few days to a week. Viral ear infections cause the same symptoms as bacterial ones — fever, fussiness, drainage — so your pediatrician cannot always tell the difference by looking at the ear alone. If your infant seems to be improving after 48 to 72 hours, the infection is likely viral.
Bacterial ear infections are less common but more likely to need treatment with antibiotics. Your pediatrician may prescribe antibiotics immediately if they see signs strongly suggesting a bacterial infection, or they may wait 48 hours to see whether your infant improves without them. This "wait and see" approach is standard for infants over 6 months old with mild to moderate symptoms. Infants under 6 months are more likely to receive antibiotics right away because they are at higher risk for complications.
If antibiotics are prescribed, give them exactly as directed, even if your infant seems better after a few days. Stopping early can allow the infection to return and may lead to antibiotic resistance. Most infants feel noticeably better within 24 to 48 hours of starting antibiotics.
Pain relief and comfort measures at home
Over-the-counter pain relievers can help while you wait for an appointment or while the infection resolves. Acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) both reduce fever and pain. Use the dose based on your infant's weight, not age, and follow the label instructions or ask your pharmacist. Do not give ibuprofen to infants under 6 months old unless your pediatrician directs you to.
Comfort measures matter as much as medication. Keep your infant upright or semi-upright when possible — lying flat increases pressure in the ear and makes pain worse. A warm (not hot) compress held against the outside of the ear for 10 to 15 minutes can soothe discomfort. Make sure the compress is not so warm that it could burn delicate skin. Offer frequent feeds or sips of water to keep your infant hydrated, especially if fever is present.
Avoid smoke, strong perfumes, and other irritants, as these can worsen inflammation in the ear canal. If your infant uses a pacifier, continue offering it — sucking can actually help relieve ear pressure. Do not put anything inside the ear canal, including cotton swabs or drops, unless your pediatrician specifically directs you to.
Why infants get ear infections more often than older children
Infants have shorter, more horizontal Eustachian tubes — the narrow passages that connect the middle ear to the back of the throat and normally drain fluid. In older children and adults, these tubes are longer and angled downward, so fluid drains more easily. In infants, fluid pools more readily, especially after a cold or when the infant is lying down. This is why ear infections are so common in the first two years of life.
Infants also have developing immune systems, so they catch more colds and upper respiratory infections overall. Each cold increases the risk of a secondary ear infection. This is not a sign of a problem with your infant — it is normal development. Most infants have at least one ear infection by age 3, and many have several. Recurrent infections (three or more in six months, or four or more in a year) may warrant discussion with your pediatrician about prevention or monitoring strategies.
Frequently Asked Questions
Can I tell if my infant has an ear infection without seeing a doctor?
You can recognize signs that suggest an ear infection — fever, ear pulling, drainage, fussiness — but only a pediatrician can confirm it by looking inside the ear with an otoscope. Many conditions cause similar symptoms, so do not assume your infant has an ear infection based on behavior alone. Contact your pediatrician to arrange an exam.
Is it normal for my infant to have multiple ear infections?
Yes. Most infants have at least one ear infection by age 3. If your infant has three or more in six months or four or more in a year, mention this pattern to your pediatrician — they may recommend monitoring strategies or discuss whether tubes might help, though this is uncommon in infants under 12 months.
What should I do if my infant has drainage from the ear?
Drainage usually means the eardrum has ruptured from pressure buildup, which is painful but often relieves pressure and allows healing. Contact your pediatrician the same day if possible. Do not put anything in the ear canal. Keep the outer ear clean and dry. Most ruptured eardrums heal on their own within a few weeks.
Can I prevent ear infections in my infant?
You cannot prevent them entirely, but you can reduce risk by keeping your infant away from secondhand smoke, avoiding bottle propping (hold the bottle yourself), and breastfeeding if possible — breast milk contains antibodies that may offer some protection. Keeping your infant's vaccinations current also helps prevent some infections that lead to ear problems.
How long does an ear infection last?
Viral ear infections usually improve within three to seven days. Bacterial infections treated with antibiotics typically show improvement within 24 to 48 hours of starting treatment. Some infants have lingering fluid in the ear for weeks after the infection clears, which is normal and usually does not need treatment.