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Ear Infections in Children: What Every Parent Should Know

Ear infections are the most common reason children are prescribed antibiotics in the United States — but most don’t need them. This free guide from Dr. Dylan Levy, MD, ENT Surgeon, explains exactly when antibiotics are necessary, when watchful waiting is the right call, and what questions to ask your child’s doctor. Based on the AAP Clinical Practice Guideline for Acute Otitis Media.
Free Ear Infection Guide
Two pages. Easy to understand. Backed by expert guidelines.



FAQ

Not always. The AAP guideline supports watchful waiting for children over 6 months with mild, one-sided ear infections. Most resolve on their own within 48–72 hours. Antibiotics are recommended when the child is under 6 months, has a fever above 102.2°F, has severe pain, or has infections in both ears. Ask your doctor whether waiting is appropriate before filling a prescription.

AOM (Acute Otitis Media) is an active bacterial infection behind the eardrum. OME (Otitis Media with Effusion) is fluid without infection, also called glue ear. Antibiotics do not help OME. Most cases resolve within 3 months.

Watchful waiting means treating pain and fever while monitoring symptoms before starting antibiotics. The AAP supports this for mild cases in children over 6 months. A delayed prescription may be used if symptoms do not improve within 48–72 hours.

Immediate treatment is needed if the child is under 6 months, has fever ≥102.2°F, severe pain lasting 48+ hours, ear drainage, bilateral infection under age 2, or looks very ill. Otherwise, watchful waiting may be appropriate.

Ear tubes are recommended for persistent fluid (3+ months with hearing issues) or frequent infections (3 in 6 months or 4 in 12 months). A hearing test is required before surgery decisions.

Content written by Dr. Dylan Levy, MD — Practicing ENT Surgeon, Bronx, NY. Based on: AAP Clinical Practice Guideline: Acute Otitis Media (Lieberthal et al., 2013, reaffirmed 2019) and AAO-HNS CPG: Tympanostomy Tubes in Children (Rosenfeld et al., 2022).

Medical Disclaimer

BoogerDownBronx provides general health education based on published clinical practice guidelines. All content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. The information on this site is not a substitute for professional medical care. Always consult your physician or qualified healthcare provider with questions about your medical condition. If you are experiencing a medical emergency, call 911 immediately. Content is based on guidelines published by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the American Academy of Pediatrics (AAP), and other relevant medical specialty organizations.