Ear Infections in Children: What Parents Need to Know About Symptoms, Treatment & When to Come In

Ear infections are the number one reason children visit the doctor after well-child checkups. By age 3, approximately 75% of children will have had at least one ear infection. They’re painful, they’re disruptive, and they often strike at the worst possible time — overnight, on weekends, or right before a school day.

I’m Dr. Lisa Clay, board-certified family physician and founder of Monarch Medicine Urgent Care in Carmel. Here’s what I want every parent to know about ear infections — including when antibiotics are needed and when watchful waiting is the better call.

Types of Ear Infections

Type	What It Is	Common In
Acute Otitis Media (AOM)	Bacterial or viral infection behind the eardrum (middle ear). Fluid + inflammation + pain.	Children 6 months – 3 years (peak age)
Otitis Media with Effusion (OME)	Fluid behind the eardrum without active infection. Often follows AOM. “Glue ear.”	Children after a cold or resolved ear infection
Otitis Externa	Infection of the outer ear canal. “Swimmer’s ear.” Pain with ear tugging.	Children and adults, especially after swimming

The most common — and the one parents are usually concerned about — is acute otitis media (AOM), the classic middle ear infection.

Ear Infection Symptoms by Age

Infants and Toddlers (can’t tell you it hurts)

• Pulling or tugging at ears
• Increased fussiness or crying, especially when lying down
• Difficulty sleeping
• Fever (may or may not be present)
• Reduced appetite or difficulty feeding
• Drainage from the ear (yellow, white, or blood-tinged)
• Not responding to sounds normally

Older Children (can describe symptoms)

• “My ear hurts” — often one-sided
• Feeling of fullness or pressure in the ear
• Muffled hearing or difficulty hearing
• Fever
• Headache
• Drainage from the ear

Do All Ear Infections Need Antibiotics?

No — and this is one of the most important things for parents to understand. Current medical guidelines (AAP 2013, still current) recommend different approaches based on the child’s age and severity:

Age	Mild/Moderate AOM (one ear)	Severe AOM or Both Ears
6 months – 2 years	Antibiotics OR watchful waiting (parent choice with physician guidance)	Antibiotics
2 years and older	Watchful waiting is appropriate — recheck in 48–72 hours if no improvement	Antibiotics
Under 6 months	Always antibiotics — too young for watchful waiting

Watchful waiting means managing pain (ibuprofen/acetaminophen), monitoring symptoms, and returning for antibiotics if things don’t improve in 48–72 hours. This approach reduces unnecessary antibiotic use and is supported by strong evidence — about 80% of uncomplicated ear infections resolve on their own.

Treatment at Monarch Medicine

Here’s what happens when you bring your child in for a suspected ear infection:

1. Otoscope examination — we look at both eardrums to assess for inflammation, fluid, bulging, or perforation
2. Symptom assessment — fever, duration, severity, one ear vs. both
3. Treatment decision — antibiotics (typically amoxicillin) if indicated, or watchful waiting plan with pain management and a clear timeline for follow-up
4. Prescription sent to pharmacy before you leave (if antibiotics prescribed)
5. School/daycare note provided same-day if needed
6. Follow-up plan via MyChart — return if not improving in 48–72 hours

Recurring Ear Infections

If your child has 3 or more ear infections in 6 months, or 4+ in a year, that’s a pattern worth evaluating further. Recurring infections may indicate:

• Persistent fluid behind the eardrum (OME) that isn’t clearing
• Enlarged adenoids contributing to Eustachian tube dysfunction
• Structural factors or allergies

Your physician at Monarch Medicine will evaluate the pattern and discuss whether referral to a pediatric ENT for possible ear tube placement is appropriate. We document the full history in Epic/MyChart so the ENT has complete records.

Swimmer’s Ear: Different Infection, Different Treatment

Otitis externa (swimmer’s ear) is an infection of the outer ear canal — not the middle ear. It’s caused by water trapped in the ear canal creating a bacterial breeding ground. Symptoms include pain when you pull on the earlobe, itching, swelling, and sometimes drainage.

Treatment is antibiotic ear drops (not oral antibiotics) and keeping the ear dry. We diagnose and treat swimmer’s ear walk-in at Monarch Medicine.

This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Ear infections require evaluation by a qualified healthcare provider. Do not administer antibiotics without a physician evaluation. If your child has swelling behind the ear, high fever with stiff neck, or facial drooping, call 911 or go to the nearest emergency room immediately.