ear infection child travel health tips

Overview

An ear infection (otitis media) is a painful inflammation of the middle ear, often caused by fluid building up behind the eardrum. This fluid can become infected with bacteria or viruses.

Very common. Three out of four children have at least one ear infection by their third birthday.

Ear infections mainly affect babies and children between 6 months and 3 years, but older children and adults can also get them.

Symptoms

Common symptoms

• Ear pain (especially when lying down)
• Pulling or tugging at the ear
• Trouble hearing
• Fussiness or crying
• Difficulty sleeping
• Fever
• Fluid draining from the ear

Symptoms in children

• Crying and fussiness that gets worse at night
• Tugging at the ear
• Loss of appetite or trouble eating
• Balance problems
• Fever
• Not responding to quiet sounds

Symptoms in older adults

• Ear pain or pressure
• Muffled hearing
• Dizziness or ringing in the ear

Causes

Main causes

• Bacteria or viruses causing infection in the middle ear
• The Eustachian tube (a small passage from the middle ear to the throat) becomes swollen and blocks fluid drainage
• Swelling and congestion from a cold, flu, or allergies

Risk factors

• Age under 3 years
• Repeated colds or respiratory infections
• Daycare attendance
• Bottle-feeding while lying down
• Exposure to second-hand smoke
• Air travel, especially during take-off and landing

When to see a doctor

See a doctor urgently if:

• If your child is under 6 months and you suspect an ear infection
• Ear pain has not improved after 48 hours
• Signs of infection spreading, such as high fever, swollen neck, or severe pain
• Fluid with blood or pus draining from the ear

Book a routine appointment if:

• If your child has had several ear infections in a few months
• If your child's hearing is not improving after an infection
• For a follow-up check to confirm the infection has cleared

Diagnosis

A doctor or nurse can usually tell if your child has an ear infection by looking into the ear with a lighted instrument called an otoscope. They may also use a pneumatic otoscope that puffs a tiny amount of air to see if the eardrum moves correctly.

Tests that may be done

• History and physical exam with an otoscope
• Pneumatic otoscopy to test eardrum movement
• Tympanometry (a small probe that measures eardrum flexibility)
• In some cases, a sample of ear fluid is sent to a lab

What to expect at your appointment

A check-up is quick and usually painless. Your child may be asked to be still. The doctor will look at the eardrum and may test its movement. Some children cry during the exam, but it is brief.

Treatment

Treatment depends on the cause. For mild infections, especially in older children, the doctor may recommend home care and watching the infection for a few days. For bacterial infections, they may prescribe an antibiotic. Pain relief and comfort measures are always important.

Self-care at home

• Keep your child comfortable with a warm (not hot) compress over the ear
• Offer plenty of fluids to help swallowing and pressure equalisation
• Raise the head end of the cot slightly (on a safe, flat surface) to help drainage
• During air travel, encourage swallowing: give a breastfeed, bottle, sippy cup, or a dummy/pacifier during take-off and landing
• Do not insert anything into the ear to clean or drain it
• Do not give your child any medicine without checking with a doctor or pharmacist first

Medical treatments

A doctor may prescribe an antibiotic if the infection is bacterial or severe. Antibiotics are not useful for viral infections, so wait-and-see may be recommended. Pain relief medication, appropriate for your child's age and weight, may be suggested — ask your doctor or pharmacist for the right type and dose. Never give aspirin to children.

When is surgery considered?

For repeated ear infections (for example, three infections in six months), a doctor might recommend a minor procedure to place small tubes in the eardrum. These tubes allow air in and fluid out, reducing future infections. This decision is always made on an individual basis.

Living with this condition

Help your child through an ear infection by giving plenty of rest and comfort. Follow the treatment plan from your doctor. For travel, plan ahead: pack any medicines you might need (with instructions), carry a printed summary of your child's medical history, and check with your airline about any special assistance if needed.

Lifestyle tips

• Plan breaks during long car journeys to allow your child to sit up and swallow
• If flying, keep your child awake during descent and landing and encourage feeding or drinking
• Avoid altitude changes while your child has an active ear infection unless a healthcare professional says it's safe
• Use a warm compress in-flight to soothe ear discomfort
• Stay hydrated and avoid smoky environments

Diet and exercise

Encourage your child to drink plenty of fluids. Swallowing helps open the Eustachian tube. There is no need to change normal meals, but offer softer foods if ear pain makes chewing uncomfortable. Normal play and activity can continue as energy allows.

Mental health and emotional wellbeing

Ear infections can be upsetting for children and tiring for parents. It's normal to feel frustrated or anxious, especially during travel. Remember this is temporary and you are doing the right things to comfort your child. If you feel overwhelmed, talk to your health visitor, GP, or a child health nurse.

Prevention

You can't prevent every ear infection, but you can reduce the risk. Breastfeeding for at least 6 months lowers the risk. Avoid second-hand smoke. Keep your child's vaccinations up to date. During travel, try to manage cold symptoms and encourage swallowing during pressure changes.

Vaccines

Childhood vaccinations, including the pneumococcal vaccine and flu vaccine, can prevent some infections caused by certain bacteria and viruses. Make sure your child is up to date with their routine immunisations before travelling.

Screening programmes

There is no routine screening for ear infections. Regular hearing checks in childhood may be offered in some places. If you have concerns about your child's hearing, talk to your doctor.

Complications

If left untreated

• Temporary hearing loss (usually improves after infection)
• A tear or hole in the eardrum (perforation)
• Infection spreading to the bone behind the ear (mastoiditis) — a rare but serious complication
• In very rare cases, spread to the inner ear or brain, which can be dangerous

Long-term outlook

With proper care, most ear infections clear up completely and hearing returns to normal. Even when a child gets repeated infections, their hearing usually improves as they grow older and the Eustachian tubes get bigger and work better. Rare complications can be treated in hospital. There is every reason to be hopeful.

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