Pediatric Ear Infections: When to Worry (and When Not To)

What’s typical?

Most childhood ear infections start after a viral cold. Congestion causes the eustachian tubes (tiny pressure-equalizing tunnels) to swell shut, trapping fluid behind the eardrum. That fluid can become infected (acute otitis media) or simply sit there without infection (otitis media with effusion).

Common signs

• Ear pain (pulling/tugging in infants)

• Fever, irritability, poor sleep

• Decreased appetite, mild vomiting/diarrhea

• Temporary hearing muffling or “echo” sensation

Home relief & timing (what helps most)

• Pain control first. Use child-safe acetaminophen or ibuprofen (dose by weight per package/clinician guidance).

• Fluids + rest. Hydration thins mucus and helps drainage.

• Nasal care. Saline sprays/drops and gentle suction for little ones.

• Watchful waiting (when appropriate). For many children with mild symptoms, observation for 24–48 hours is reasonable before antibiotics. Your pediatrician will guide this based on age/severity.

Avoid placing oils or drops in the ear unless your clinician recommends them—especially if there could be a perforation (hole) in the eardrum.

When to call your pediatrician urgently

• Severe ear pain, high fever, or your child seems very ill

• Drainage from the ear (could indicate eardrum perforation)

• Symptoms not improving after 48–72 hours

• Infants <6 months with ear pain/fever

• Neck stiffness, redness/swelling behind the ear, or the ear sticking out (possible complication)

When an ENT referral can help

• Recurrent acute otitis media (RAOM):
  3 infections in 6 months or 4 in 12 months (with at least one in the past 6 months)

• Persistent fluid (otitis media with effusion) lasting >3 months, especially with hearing loss or speech delay

• Complications (eardrum perforations that don’t heal, mastoiditis, balance problems)

• Concerns about adenoid hypertrophy, nasal obstruction, or chronic snoring/sleep issues

Tampa Bay Area Care

Vitale ENT — Wesley Chapel • Lutz • Zephyrhills
Request an appointment: (813) 406-4400 | VitaleENT.com