How do I know if my baby has an ear infection?

Babies with ear infections tend to be irritable, cry more than usual, pull or rub their ear, have difficulty sleeping, and refuse the bottle or breast. Fever above 38 C (100.4 F) is common. If your baby is under 6 months with these symptoms, see the pediatrician the same day.

Are ear infections contagious?

The ear infection itself is not contagious. However, the cold or flu that causes it is transmissible. Children in daycare have more ear infections — not because of the infection itself, but because they are exposed to more respiratory viruses.

Does every ear infection need antibiotics?

No. About 80% of acute middle ear infections resolve spontaneously within 48-72 hours. The pediatrician may choose watchful waiting with pain relievers for children over 2 years with mild symptoms. Antibiotics are indicated for children under 2, severe cases, or when there is no improvement within 48-72 hours.

Can I put drops in my child's ear?

Never put anything in the ear without medical guidance. Home remedies, olive oil, or alcohol can worsen the inflammation or mask important signs. If there is discharge from the ear, see the pediatrician — it may be a perforated eardrum that needs evaluation.

Why does my child keep getting ear infections?

Children have a shorter and more horizontal Eustachian tube (the canal between the ear and nose) than adults, making it easier for secretions to enter. Risk factors include: daycare attendance, smoke exposure, pacifier use, bottle-feeding while lying down, and family history of ear infections. Three or more episodes in 6 months warrant investigation.

Can ear infections cause hearing loss?

Repeated ear infections can cause fluid buildup in the middle ear (secretory otitis), leading to temporary hearing loss. If untreated, this can affect speech development. Recurrent ear infections should be monitored by the pediatrician and, if necessary, by an ENT specialist.

Ear Infection in Babies and Children: Symptoms and When to See a Pediatrician

Your child is crying, pulling their ear, and refusing to sleep. It could be an ear infection (otitis) — the infection that affects 1 in 5 children after a cold. It is one of the most common reasons for urgent pediatric visits and a major source of worry for parents. The good news: most cases resolve well with proper treatment. In this guide, I explain how to identify ear infections, when to worry, and what to do — including practical guidance for expat families navigating healthcare in Brazil.

What Is an Ear Infection (Otitis)?

Acute otitis media (AOM) is an infection of the middle ear — the space behind the eardrum. When a child has a cold or flu, nasal secretions can travel up the Eustachian tube (a canal connecting the nose to the ear) and accumulate in the middle ear, creating an environment where bacteria thrive.

Children are much more prone to ear infections than adults for an anatomical reason: the Eustachian tube in children is shorter, more horizontal, and more flexible, which makes it easier for secretions to pass from the nose to the ear.

Key Facts About Ear Infections in Children

1 in 5

children with a cold develop an ear infection

80%

of cases resolve without antibiotics

6m-3y

highest-risk age group

Symptoms of Ear Infection in Babies and Children

Older children can tell you their ear hurts. But in babies, the signs are indirect — you need to watch their behavior carefully.

In Babies (0-2 years)

Repeatedly pulling or rubbing the ear

Intense crying and irritability

Difficulty sleeping

Refusing the bottle or breast (sucking causes pain)

Fever (may or may not be present)

Discharge from the ear

Not responding to sounds ("blocked" ear)

In Older Children (3+ years)

Ear pain (usually one side)

"Blocked" or muffled hearing

Difficulty hearing

Fever

Pain worsens when lying down

Dizziness or loss of balance

Headache

An important clue: ear infections frequently appear 2-3 days after the start of a cold. If your child was improving from a cold and suddenly worsens with fever and irritability, think of an ear infection.

Suspect your child has an ear infection?

Dr. Paula can examine your child's ears and recommend the best treatment. Same-day appointments available in Itaim Bibi.

Talk to the Pediatrician

What Causes Ear Infections in Children?

Ear infections almost always start with a viral infection (cold, flu) that inflames the Eustachian tube. Secretions accumulate in the middle ear and bacteria proliferate. The most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Risk Factors

→Attending daycare: Greater exposure to respiratory viruses

→Age between 6 months and 3 years: Immature Eustachian tube

→Pacifier use: Alters pressure in the Eustachian tube

→Bottle-feeding while lying down: Milk can reflux into the tube

→Exposure to cigarette smoke: Inflames the nasal lining

→Family history of ear infections: Genetic factor affecting tube anatomy

When to See the Pediatrician

See the Pediatrician TODAY If:

Baby under 6 months with suspected ear pain

Fever above 39 C (102 F)

Discharge (pus or blood) from the ear

Severe pain that does not improve with pain relief

Child very lethargic or unresponsive

Symptoms not improving after 48-72 hours

Swelling or redness behind the ear (may be mastoiditis)

If the ear pain is mild and the child is otherwise well (playing, eating), it is reasonable to observe for 24-48 hours with pain relief before seeking medical attention. To learn more about when it is time to see the pediatrician, read: When to Take Your Baby to the Pediatrician.

Treatment of Ear Infections

Treatment depends on the child's age and the severity of symptoms. Not every ear infection needs antibiotics — and this is one of the most important takeaways from this guide.

Situation	Approach
Under 6 months	Immediate antibiotics (amoxicillin for 10 days)
6 months - 2 years, mild symptoms	Watchful waiting for 48-72h OR antibiotics
6 months - 2 years, severe symptoms	Immediate antibiotics (amoxicillin for 10 days)
Over 2 years, mild symptoms	Watchful waiting for 48-72h with pain relief
Over 2 years, severe symptoms	Antibiotics (amoxicillin for 7 days)
Ear with discharge (perforation)	Antibiotics + local care

What Is Watchful Waiting?

It means: treat the pain with analgesics (paracetamol or ibuprofen), reassess in 48-72 hours, and start antibiotics only if there is no improvement. This approach avoids unnecessary antibiotic use in up to 80% of cases.

Note: Watchful waiting is only safe if you can return to the pediatrician within 48-72 hours. If that is not possible, antibiotics are the safer choice.

Home Care

What to Do

Give pain relief at the correct dose (paracetamol or ibuprofen)

Apply warm compresses to the ear for comfort

Elevate the head of the crib/bed (reduces pressure)

Saline nasal irrigation

Offer fluids frequently

Complete the FULL course of antibiotics if prescribed

What NOT to Do

Put oil, olive oil, or homemade drops in the ear

Insert cotton swabs or objects into the ear

Give antibiotics without medical prescription

Stop antibiotics before completing the course

Let the child swim in the pool

Ignore discharge coming from the ear

How to Prevent Ear Infections

Since most ear infections start with a cold or flu, preventing respiratory infections is the best strategy. Breastfeeding and vaccines are fundamental allies in prevention:

Keep vaccinations current

Pneumococcal and influenza vaccines significantly reduce ear infections

Breastfeed for at least 6 months

Breastfeeding reduces ear infections by up to 50%

Avoid smoking near the child

Passive smoking inflames the nasal lining and the Eustachian tube

Feed baby upright

Never offer a bottle with the baby lying flat — milk can reflux into the ear

Limit pacifier use after 6 months

Prolonged pacifier use increases ear infection risk

Nasal irrigation

Saline rinse helps keep the Eustachian tube clear

Recurrent Ear Infections: When to Investigate

Some children get ear infections frequently. We call them recurrent ear infections when there are:

→3 or more episodes in 6 months
→4 or more episodes in 12 months

In these cases, the pediatrician may refer to an ENT specialist (otorhinolaryngologist) to evaluate whether ear tubes (tympanostomy tubes) are needed. The presence of allergic rhinitis or sinusitis can contribute to recurrent ear infections. It is also important to check for secretory otitis (fluid buildup without active infection), which can cause temporary hearing loss and affect speech development.

If ear infections are associated with frequent colds (which is common in children attending daycare), read more about managing respiratory illness: Bronchiolitis in Babies and baby sleep tips for when illness disrupts nighttime routines.

Note for Expat Families

In Brazil, ENT specialists can be consulted directly without a referral in the private system. Dr. Paula maintains a network of English-speaking specialists and can arrange a referral promptly if your child needs further evaluation. All documentation is provided in English for international insurance reimbursement.