The most reliable signs that your child has an ear infection are fever, persistent crying or fussiness, trouble sleeping, and fluid draining from the ear. In babies and toddlers who can’t tell you what hurts, you’ll need to watch for behavioral changes and physical clues, since ear infections are one of the most common childhood illnesses and often follow a cold or upper respiratory infection.
Signs in Babies and Toddlers
Young children can’t point to their ear and say it hurts, so you’re looking for a cluster of behaviors that suggest something beyond normal fussiness. The key signs include tugging or pulling at one or both ears, crying that’s harder to console than usual, trouble falling or staying asleep, and fever. You may also notice your child having trouble with balance, seeming clumsier than normal, or not responding to quiet sounds the way they usually do.
One behavior that catches many parents off guard is increased crying during feeding or when lying down. The sucking and swallowing motions during nursing or bottle-feeding change the pressure inside the ear, which intensifies pain. Lying flat does the same thing. If your baby is suddenly refusing to eat or screams when you lay them down but calms when held upright, an ear infection is a strong possibility.
Fluid draining from the ear is another clear signal. This discharge may look like pus or contain traces of blood. It typically means the eardrum has ruptured from pressure buildup, which sounds alarming but usually heals on its own. Ironically, many children feel better once the fluid drains because the painful pressure is relieved.
Signs in Older Children
Once kids can talk, the picture gets simpler. They’ll often tell you their ear hurts or feels “full” or “plugged.” You might notice them turning up the TV volume, asking you to repeat yourself, or seeming distracted when you speak to them from across the room. This mild hearing loss happens because fluid trapped behind the eardrum muffles sound. It’s temporary and typically resolves once the infection clears, though repeated infections can lead to longer-lasting hearing changes.
Older children may also complain of a headache or general pain on one side of their face. Some describe a feeling of pressure, similar to what you’d feel on an airplane during descent.
Is It Teething or an Ear Infection?
This is one of the trickiest calls for parents, because teething and ear infections share a few symptoms: fussiness, occasional ear pulling, and disrupted sleep. The differences, though, are fairly consistent once you know what to look for.
Teething tends to cause swollen or tender gums, a noticeable increase in drooling, and a strong urge to chew on anything available. It may cause a mild temperature rise, but not a true fever. Ear infections, by contrast, produce fevers often above 100.4°F, persistent crying that doesn’t improve with distraction, and sometimes visible fluid from the ear. Babies with ear infections also tend to cry more when lying down, while teething pain doesn’t typically change with position.
If your child is pulling at their ears but also gnawing on toys, drooling heavily, and has no fever, teething is the more likely cause. If they have a fever, seem to be in real distress especially at night, and the fussiness has lasted more than a couple of days, an ear infection deserves a closer look.
How Balance and Coordination Are Affected
The middle ear plays a direct role in balance, so fluid buildup from an infection can make your child noticeably clumsier. Toddlers may stumble or fall more often than usual. Older kids might seem unsteady or complain of dizziness. Research has consistently shown that during an active episode of middle ear fluid buildup, children’s balance measurably deteriorates. This is one of the most common causes of balance problems in young children, and it resolves as the fluid drains and the infection heals.
What Happens at the Doctor’s Office
A pediatrician diagnoses an ear infection by looking at the eardrum with a small lighted instrument. What they’re checking for is whether the eardrum is bulging outward from fluid pressure behind it, whether it’s red and inflamed, and whether there’s visible pus in the middle ear space. A normal eardrum looks pearly gray and slightly translucent. An infected one looks swollen, red, or cloudy.
Not every ear infection requires antibiotics. Current guidelines from the American Academy of Pediatrics recommend immediate antibiotic treatment for children under 2, for infections affecting both ears, or when pus is draining from the ear. For older children with a mild infection in just one ear, doctors often suggest a “watchful waiting” approach: managing pain at home for 48 to 72 hours and starting antibiotics only if symptoms don’t improve. This works because many ear infections are caused by viruses, which antibiotics can’t treat, and roughly half of mild cases resolve on their own.
Managing Pain at Home
Whether your child is waiting out a mild infection or taking antibiotics, pain management matters. Children’s ibuprofen and acetaminophen are the standard options. Ibuprofen can be given every 6 to 8 hours and has the added benefit of reducing inflammation, but it’s not approved for babies under 6 months. For younger infants, acetaminophen is the safer choice.
Always dose by your child’s weight rather than age for accuracy, and use the measuring syringe that comes with the medicine rather than a kitchen spoon. Combination products that contain more than one active ingredient should be avoided in children under 6.
A warm (not hot) washcloth held against the ear can also provide some comfort. Keeping your child’s head slightly elevated during sleep helps reduce pressure on the eardrum, which is why many kids with ear infections sleep better in a car seat or propped-up position than flat in a crib.
When the Situation Is More Urgent
Most ear infections are painful but not dangerous. However, certain signs call for prompt medical attention:
- Fever of 102.2°F or higher in any child, or 100.4°F or higher in a baby under 3 months
- Pus or bloody fluid draining from the ear
- Symptoms lasting more than 2 to 3 days without improvement
- Worsening symptoms after they initially seemed to be getting better
- Unusual lethargy or your child seeming severely unwell
- Swelling or redness behind the ear, which can signal a rare but serious bone infection
Hearing that doesn’t bounce back within a few weeks after the infection clears also warrants a follow-up visit, especially in children who are learning to talk, since persistent fluid can interfere with speech development during a critical window.