What is an ear infection?
An ear infection, or acute otitis media (AOM), happens when fluid builds up behind the eardrum and becomes infected. It is common in children, especially after a cold or other upper respiratory infection.
Most ear infections get better on their own. The important question is whether your child needs antibiotics right away or whether watching symptoms for a short period is reasonable.
When are antibiotics needed?
Antibiotics can be helpful for some children with acute otitis media, but they are not necessary for every ear infection.
Children younger than 6 months generally need prompt medical evaluation.
Children 6 months to 2 years may need antibiotics depending on whether one or both ears are affected and how severe the symptoms are.
Children age 2 years and older with mild symptoms may sometimes be observed before starting antibiotics.
Severe ear pain, significant fever, or worsening symptoms can change the recommendation.
Your child’s age, symptoms, examination findings, and overall health all matter.
When is watchful waiting appropriate?
For some children, especially those older than 6 months with mild symptoms, watchful waiting may be a safe and effective approach. This means monitoring symptoms closely and having a plan to start antibiotics if your child does not improve or gets worse.
Your child is 6 months or older.
Symptoms are mild.
Ear pain is manageable.
Fever is not severe.
Your child can be followed closely by their doctor.
You have a clear plan for what to do if symptoms worsen.
During this time
During this time, focus on keeping your child comfortable. Pain and fever medicines may help when appropriate for your child’s age and health. Follow the dosing instructions from your child’s doctor or pharmacist.
The goal isn't to give antibiotics to every child. It's to give the right treatment to the right child at the right time.
Red-flag symptoms: when to seek care right away
- Severe or worsening ear pain
- Fever that is high or persistent
- Severe drainage from the ear
- Symptoms that are getting worse instead of better
- Trouble hearing or significant balance problems
- Swelling or redness behind the ear
- Repeated ear infections
- Your child appears unusually ill or difficult to wake
The bottom line
Most ear infections do not automatically mean your child needs antibiotics. The right decision depends on your child’s age, symptoms, examination findings, and how severe the infection appears. If your child’s symptoms are mild, your doctor may recommend watching closely before starting antibiotics. If symptoms are severe, worsening, or your child is very young, antibiotics may be appropriate.
Questions to ask your doctor
- Does my child actually have an ear infection?
- Is watchful waiting appropriate for my child?
- How severe are my child's symptoms?
- When should I start antibiotics if symptoms do not improve?
- What should I use for pain or fever?
- When should I call the doctor again?
- What symptoms mean my child needs urgent medical attention?
- Does my child have recurrent ear infections?