Ear Infections in Infants & Newborns: Signs and Treatment
When your baby is fussy, uncomfortable, and unable to tell you exactly what hurts, it can be overwhelming. You’d trade places with them in an instant if you could. The sleepless nights, the extra snuggles, and the tears (sometimes theirs, sometimes yours) can leave you feeling worn out and worried. Ear infections (acute otitis media) are one of the most common childhood illnesses, and while they can be painful and stressful, the good news is that they’re usually temporary and very treatable.
Ear infections are the second-most common form of illness (after the common cold) in children under two years old. Five out of six children will have at least one ear infection before their third birthday. They happen when infected fluid gets trapped in the air-filled space behind the eardrum, something which happens more frequently in children. Caring parents have all sorts of questions, like whether teething causes ear infections (it doesn’t) or how to comfort their baby. The good news is that most ear infections resolve on their own, and the rest are usually easy to treat. You just need to know what to look out for.
Signs of Ear Infection in Newborns
Newborns can’t communicate verbally, but they still have ways of letting you know when something is amiss. Ear infections cause discomfort, and babies respond to that discomfort in a variety of ways.
- Congestion or a Cold – Because the ears, nose, and throat are all connected, ear infections are almost always associated with a stuffy nose or an upper respiratory infection.
- Ear Manipulation – Pressure in the middle ear may cause babies to pull, tug, hit, or rub their ears to relieve the pain. Although not always reliable, if your baby is grabbing or rubbing their ear or the side of their head, it could be a sign of infection.
- Excessive Crying – An ear infection may result in increased crying or irritability.
- Difficulty Sleeping – When babies lie down, it shifts the pressure in the middle ear. That change can be painful, making it difficult to fall asleep and stay asleep.
- Fever – Fevers are the body’s way of fighting off infections, and they are a common symptom of an ear infection. Monitor your baby’s temperature and contact a doctor if your baby has a fever.
- Loss of Appetite – Between the fever and discomfort, babies with ear infections may not be in the mood to eat. Refusing meals is a common symptom of ear infections in newborns and infants.
- Fluid – Fluid draining out of the ear is often evidence of a ruptured eardrum. That may sound scary, but your baby’s eardrum will heal on its own within a few weeks.
- Loss of Balance – The inner ear is an important part of the body’s balance system. During an ear infection, fluid buildup may cause a temporary loss of balance. This is less noticeable in infants who have not yet learned to sit or stand.
- Difficulty Hearing – When fluid builds up behind the eardrum, it interferes with hearing. Children who aren’t yet speaking may stop responding to auditory stimulation during an ear infection.
Causes of Ear Infection in Newborns
Your baby’s ears are composed of three main parts: the outer ear (that’s the cute part you can see), the middle ear, and the inner ear. Because of its unique structure (especially in infancy), the middle ear is where the majority of ear infections occur.
At the end of the ear canal, you’ll find the eardrum, the beginning of the middle ear. Behind the eardrum, there’s an air-filled space that houses the ear bones, which transmit vibrations to the inner ear. At the bottom of the middle ear, you’ll find the eustachian tubes, which connect the ear to the throat, helping to regulate pressure in the ear and allowing fluid to drain out of the middle ear. When the eustachian tubes become swollen, fluid can’t flow out of the middle ear, resulting in symptoms such as painful pressure in the ear, loss of hearing, and more.
Ear infections are caused by a virus or bacteria, resulting in inflammation of the middle ear space. They can happen when a baby has a cold, congestion, allergies, or some other trigger event. Germs may travel up the eustachian tubes and into the middle ear, causing the infection. Poor air quality, including exposure to secondhand smoke and other air pollutants, also increases the risk of ear infections.
Middle ear infections are more common in children under the age of two because the immune system is still developing and the eustachian tubes are less developed, making them more susceptible.
How to Prevent Ear Infections in Newborns
Vaccination – Vaccines protect your newborn against infection-causing pathogens. The pneumococcal vaccine specifically protects against Streptococcus pneumonia, a common cause of middle ear infections. More generally, kids who are fully vaccinated tend to experience fewer ear infections on average.
Breastfeeding – Human breast milk contains antibodies that improve your baby’s ability to fight off infections. If you are bottle feeding with breast milk or formula, feed your baby in an upright position with the head held higher than the stomach. This helps reduce the risk of fluid traveling through the eustachian tubes and into the inner ear.
Keep Clean – Preventative measures for ear infections are the same as for any other infection. Wash your hands and your baby’s hands frequently and steer clear of friends or family who are sick. Protecting your child from illness reduces their risk of developing an ear infection.
Avoid Smoke – Don’t smoke and avoid exposure to secondhand smoke or other pollutants.
Tympanostomy Tubes (Ear Tubes) – If your child gets chronic recurrent ear infections, they might benefit from a procedure in which small tubes are inserted into an incision in the eardrums. This may not prevent all ear infections, but it can reduce their frequency and make treatment a little easier. Tubes typically stay in place for 12 to 18 months and either fall out or are removed. Then the eardrum heals all on its own.
Treating Ear Infections in Newborns
Many ear infections resolve on their own without any intervention. If your child isn’t in serious pain, you can probably wait to see if things take care of themselves. If your child is at least six months old, child-safe doses of over-the-counter pain medications like acetaminophen or ibuprofen can be used to help manage pain in the meantime.
Antibiotics for a Newborn Ear Infection
Whether your child needs antibiotics depends on their age and the severity of the infection. Antibiotics are not necessary for the majority of ear infections, with one major exception.
- Under 6 months – Babies under 6 months of age are almost always given antibiotics for an ear infection. At that age, the immune system is still developing, babies aren’t yet fully vaccinated, and ear infections can become more severe.
- 6 to 24 months – Antibiotics may or may not be needed, depending on how severe the infection is. The American Academy of Pediatrics recommends working with your pediatrician to determine what treatment, if any, is appropriate.
- Over 2 years – Ear infections often resolve on their own without antibiotics.
If your child has a high fever (over 102°F), discolored discharge, a stiff neck, or is in severe pain, those are serious symptoms and reasons to see a doctor. Whether your child needs antibiotics or just a little reassurance as they fight off an infection, Families First Pediatrics is here to help keep your family happy and healthy.
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