Ear Infection
Acute Otitis Media
Ear infection Basics:
- Acute otitis media is an infection in the middle ear that sometimes occurs during or after a cold or viral illness. This is different from an external or “swimmer’s ear” infection.
- Symptoms can include: fever, ear pain/tugging, fussiness, decreased appetite, trouble hearing, vomiting.
- Antibiotics are commonly used to treat ear infections. If started, the entire course of antibiotics should be taken as prescribed, even if symptoms improve quickly. If your child is 2 or older, healthy, and doesn’t have high fevers or severe pain your doctor may choose to wait 24-48 hours before starting antibiotics.
- Antibiotic side effects include diarrhea, upset stomach, allergic reactions, or rashes.
- Ear infections are not contagious so your child can return to school/daycare once fever free for 24 hours without needing fever reducing medications.
- Children with frequent ear infections (ie, 3 in 6 months or 4 in 12 months) may benefit from seeing an Ear, Nose, and Throat specialist (ENT) to discuss ear tube surgery.
- Routine childhood vaccines help prevent ear infections.

General Treatment:
- Your doctor may elect to start an antibiotic based on your child’s age and symptoms.
- Fever/Pain control: Use Acetaminophen every 4 – 6 hours (up to 5 times/day) and Ibuprofen every 6 hours (up to 4 times/day) to control fever. These may be alternated or given together.
- Hydration – We expect a minimum of 4 voids per day. Small, frequent sips of water, Pedialyte or formula/breast milk are best.
- Congestion – Use nasal saline drops/spray followed by suction or nose blowing; humidifiers and steamy bathrooms can also help improve congestion. Clearing the nose helps ears drain more efficiently.
When to seek care:
- If symptoms (fever or bad ear pain) are still present 72 hours after starting treatment
- If your child is not making a minimum of 4 voids per day
- If you notice bloody drainage from the ear
- If your child develops a significant rash
- If you are concerned
When to go to the Emergency Room:
- If your child is in respiratory distress (wheezing, trouble breathing)
- If your child is lethargic or difficult to arouse
- If your child is showing signs of severe dehydration: lethargy, little/no urine output, dry lips, sunken fontanelle (soft spot)
- If you are worried
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