ear infection child with nausea

Overview

An ear infection (also called otitis media) is a common illness of the middle ear—the small space just behind the eardrum. It often starts after a cold and can cause pain, fever, and sometimes nausea and vomiting. Nausea happens when the infection upsets the balance system deep in the ear, or when fever and pain make your child feel unwell.

Yes, ear infections are very common in childhood. More than 8 in 10 children will have at least one middle ear infection by age 3.

It most often affects babies and children between 6 months and 3 years old, but it can happen at any age. Older children and adults get ear infections less often.

Symptoms

Common symptoms

• Ear pain (especially when lying down)
• Fever
• Nausea or stomach ache
• Poor sleep or fussiness
• Muffled hearing or a feeling of fullness in the ear

Symptoms in children

• Tugging or rubbing the ear
• Crying more than usual, especially at night
• Being irritable or restless
• Vomiting or feeling like throwing up
• Losing balance or seeming clumsy
• Not responding to quiet sounds
• A yellowish or milky fluid draining from the ear (if the eardrum bursts)

Symptoms in older adults

• In older children and adults, ear pain and a feeling of pressure are more common. Nausea can still occur, especially when balancing is affected, but it is less typical than in infants and toddlers.

Causes

Main causes

• Most ear infections start with a cold or flu that blocks the Eustachian tube—the small passage that drains fluid from the middle ear
• Fluid builds up and can become infected with viruses or bacteria
• The infection makes the eardrum swell and look red, causing pain and sometimes nausea from the pressure and from the balance system nearby

Risk factors

• Age under 3 (Eustachian tubes are shorter and more horizontal)
• Drinking from a bottle while lying down
• Exposure to second-hand smoke
• Attending daycare or being around many children
• Not having been breastfed (breastfeeding seems to offer some protection)
• Seasonal colds, especially in autumn and winter

When to see a doctor

See a doctor urgently if:

• If your child is under 6 months with any possible ear infection
• If your child has serious symptoms like a stiff neck, confusion, or trouble breathing
• If symptoms get worse after 2–3 days
• If you cannot keep your child hydrated because of vomiting

Book a routine appointment if:

• If ear pain lasts more than a day or two
• If your child keeps getting ear infections (for example, 3 or more in 6 months)
• If you are worried about hearing problems or speech delay
• If your child has fluid draining from the ear

Diagnosis

A doctor will take a quick history and look inside your child’s ear with a tool called an otoscope with a light. They will check the eardrum for redness, bulging, or fluid behind it. In some cases, they may use a device that puffs a small burst of air to see how the eardrum moves.

Tests that may be done

• Otoscopy (looking at the eardrum with a light)
• Tympanometry (a quick, painless test that measures how the eardrum moves and detects fluid)
• Hearing test (if infections are repeated or lasting)

What to expect at your appointment

The check is usually quick and not painful. Your child may be upset about being held still. For a hearing test or tympanometry, your child does not need to do anything except sit still for a few minutes. Make sure the doctor knows about vomiting or nausea, because that changes how they may recommend managing the illness.

Treatment

Most ear infections are caused by viruses and get better on their own. Treatment focuses on easing pain and keeping your child comfortable. Antibiotics are only used when the infection is severe, appears to be bacterial, or is not improving. Always ask your child’s doctor or pharmacist before giving any medicine, including over-the-counter pain relief.

Self-care at home

• Give your child extra fluids to drink in small, frequent sips
• Use a warm (not hot) cloth or pad against the outside of the ear for comfort
• Keep your child upright when awake and raise the head of the mattress slightly for sleep
• Distract and soothe—cuddling, gentle play, or reading a story can help reduce pain awareness
• Do not put anything inside the ear, including cotton buds

Medical treatments

Pain relief, if recommended by your doctor or pharmacist, can help. A doctor may prescribe antibiotic drops or an oral antibiotic for a bacterial infection. They might also suggest a local anaesthetic ear drop for pain (not for all ear infections, especially if the eardrum is at risk). For children with recurrent infections, a specialist may be involved. Always follow the exact prescription instructions and finish any course of antibiotics your child is given.

When is surgery considered?

Surgery is rarely needed but may be considered if ear infections keep coming back, or if water that stays in the ear (known as 'glue ear') causes hearing problems or speech delay. The most common procedure is the placement of small ventilation tubes, often called grommets, in the eardrum. This is done under a short general anaesthetic. Your specialist will talk through the pros and cons with you.

Living with this condition

While your child has an ear infection, keep a calm routine, offer soft foods, and monitor temperature and fluid intake. Write down concerns and bring them to your next appointment.

Lifestyle tips

• Keep your child away from cigarette smoke
• Encourage handwashing to reduce colds
• When bottle-feeding, keep your baby upright
• Avoid over-the-counter cough and cold medicines in children under 6

Diet and exercise

Offer water, breast milk, or formula frequently. If your child feels sick, try small amounts of clear fluids (like flat, non-fizzy, unsweetened fluids) and bland food like toast or crackers. No special diet is needed; ordinary meals can return once the nausea improves and your child feels hungry.

Mental health and emotional wellbeing

A child in pain can be very upset, and nights can be hard for everyone. It is normal to feel tired and stressed. Remind yourself that most ear infections are short-lived. If you feel anxious or overwhelmed, talk to your partner, a friend, or a health professional. For mental health support, contact your GP or a local crisis line.

Prevention

You cannot always prevent ear infections, but you can reduce the chances by limiting exposure to colds, avoiding smoke, breastfeeding when possible, and treating colds with good nasal hygiene.

Vaccines

Immunisations given to children protect against some infections that can lead to ear infections, such as flu and certain bacterial diseases. Ask your health professional about recommended vaccines for your child.

Screening programmes

Routine screening for ear infections is not done. However, if your child has repeated ear infections or fluid behind the eardrum, a hearing test can check for any effects on hearing. This may also be offered at routine developmental reviews.

Complications

If left untreated

• Fluid in the middle ear that lasts for weeks, sometimes causing temporary hearing loss
• An ear drum that bursts (a hole or scar that usually heals on its own)
• Spread of the infection to the bone behind the ear (mastoiditis) — this is rare
• Meningitis or a brain abscess — extremely rare

Long-term outlook

With the right support, the outlook is very good. Most children completely recover with no lasting effects. Even when infections keep happening, there are effective treatments and specialists who can help protect your child’s hearing and development.

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