ear infection child at night

Overview

An ear infection is when the middle part of the ear, just behind the eardrum, becomes swollen, sore, and filled with fluid. It often starts after a cold, and bacteria or viruses can cause it. In children, the tube that drains fluid from the ear is short and flat, so germs can get trapped easily.

Yes, ear infections are very common. Around 8 in 10 children have at least one ear infection by their third birthday.

Ear infections are most common in babies and young children between 6 months and 2 years. They also happen more often in autumn and winter.

Symptoms

Common symptoms

• Ear pain or a feeling of pressure
• Muffled hearing
• Trouble sleeping

Symptoms in children

• Tugging or pulling at the ear
• Crying more than usual, especially while lying down at night
• Fever (temperature above normal)
• Poor feeding or loss of appetite
• Not responding to quiet sounds
• Balance problems or clumsiness

Symptoms in older adults

• Older children and adults may describe a dull, sharp, or throbbing earache
• A feeling that the ear is blocked or full
• Mild dizziness or hearing changes

Causes

Main causes

• A viral or bacterial infection that spreads from a cold, flu, or sore throat
• Fluid blocking the Eustachian tube, the drain that connects the middle ear to the back of the nose
• The middle ear not equalising pressure properly, especially when a child is lying down

Risk factors

• Age: babies and toddlers have shorter, more horizontal Eustachian tubes
• Bottle-feeding while lying down
• Using a pacifier after 6 months
• Exposure to secondhand tobacco smoke
• Going to group childcare where viruses spread easily

When to see a doctor

Diagnosis

A doctor will look into your child’s ear using a small tool with a light (an otoscope). They may gently puff a little air to see whether the eardrum is moving correctly. This usually takes just a minute.

Tests that may be done

• Pneumatic otoscopy — an ear exam that checks eardrum movement
• Tympanometry — a quick test of the middle ear pressure
• A hearing test if fluid stays for a long time or infections keep coming back

What to expect at your appointment

The appointment is very quick. Your child may sit on your lap. The doctor will shine a light into the ear and finish the check in under a minute. They will then explain what is happening and whether any treatment is needed.

Treatment

Treatment focuses on comfort, pain relief, and supporting the immune system. Antibiotics are used only if the infection is caused by bacteria and the child is very unwell or at higher risk of complications.

Self-care at home

• Hold a warm, damp cloth gently over the outside of the child’s ear for 10 minutes
• Keep your child upright or propped up during rest to ease pressure
• Encourage plenty of fluids to keep the body well hydrated
• Use age-appropriate pain relief — ask your pharmacist what the right option is for your child

Medical treatments

A doctor may prescribe an antibiotic liquid for your child to take by mouth. If that happens, it is important to complete the full course even if symptoms improve. Some children may be offered ear drops, but these are generally for infections of the outer ear rather than the middle ear.

When is surgery considered?

Surgery is not usually needed. If your child has very frequent ear infections or persistent hearing problems, a specialist might recommend tiny tubes (grommets) inserted into the eardrum to help fluid drain. This is a short day operation under a very light anaesthetic.

Living with this condition

Ear infection pain can be worse at night, so settle your child calmly with a warm drink, a favourite toy, and a slightly upright sleeping position. The pain typically eases within 48 hours, but the fluid may take weeks to fully go away.

Lifestyle tips

• Keep children away from smoke
• Make sure hands are washed regularly to reduce colds
• Try to avoid a dummy/pacifier after your child is 6 months old
• Consider breastfeeding as it may offer some protection against ear infections

Diet and exercise

There is no special diet, but soft foods like porridge or soup may be easier if chewing causes discomfort. Ordinary physical activity is fine once your child is well enough to play.

Mental health and emotional wellbeing

Sleepless nights can be exhausting for parents and children. Try to share nighttime tasks with your partner or another adult, and remember that this phase will pass. Reassure your child with calm, gentle care.

Prevention

You cannot prevent all ear infections, but you can lower your child’s risk by avoiding smoke, attending childcare groups wisely, and keeping vaccinations up to date.

Vaccines

Vaccinations against flu and pneumococcal disease can reduce some causes of ear infection. Check your child’s routine immunization schedule.

Screening programmes

There is no routine ear screening for all children, but if ear infections happen again and again, your doctor may suggest a hearing check to make sure any fluid is not affecting speech.

Complications

If left untreated

• Temporary hearing loss while fluid remains in the ear
• Persistent fluid leading to speech or language delay in young children
• A burst eardrum that usually heals itself but may leave a small hole
• Rarely, infection spreading to nearby tissue (mastoiditis) or the brain

Long-term outlook

The great news is that almost all children recover completely from ear infections without long-term problems. With the right support, comfort, and follow-up when needed, your child will soon be sleeping peacefully again.

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