Ear infections

How can I tell if my baby has an ear infection?

It can be difficult to tell, but if your child has a cough or runny nose and then suddenly develops a fever about three to five days later, it may be caused by an ear infection. She may also tug at her ear or be out of sorts. If she is toddling, she may have balance problems and be more clumsy than normal.

Sucking and swallowing can also hurt, so if your baby starts to feed and then pulls away from your breast or a bottle, seemingly in pain, see your doctor.

How common are ear infections?

Ear infections are very common in pre-school children, especially in countries where there are cold winter months.

What causes them?

The problem starts in the Eustachian tube, which connects the middle ear to the back of the nose and throat, and transports bacteria from there to the middle ear, whenever you yawn or swallow. That's fine as long as the tube is in working order; a healthy Eustachian tube lets the fluids drain back out. But if the tube is swollen due to a cold, allergy, or sinus infection, the fluid can become trapped in the middle ear.

At this point, any bacteria or viruses living in the fluid have a warm, wet environment in which to flourish; pus develops, and pressure on the eardrum causes it to bulge and become inflamed, a condition known as acute otitis media. Fever appears as your child's body attempts to fight the infection.

Another reason children are susceptible to ear infections is that their Eustachian tubes are short and horizontal. As your child grows up, the tube will triple in length from half an inch/1.25 centimetres to 1.5 inches/3.8 centimetres. It will also become more vertical, reducing the likelihood of infection.

Treatment with antibiotics, usually Amoxicillin, will wipe out the germs, but the fluid may take weeks or months to be reabsorbed by the body. Fluid alone may not require medical attention, but if your child has the symptoms of an ear infection, such as a fever, it would be a good idea to call your family doctor or paediatrician. A persistent build up of thick fluid in the Eustachian tubes, known as "glue ear", also needs attention. Read our article on treating ear infections for more information.

What will increase the likelihood that my child will develop an ear infection?

Several factors can increase the risk of ear infections, including:

• allowing your child to drink his bottle lying down;
• using formula milk rather than breastmilk;
• using a pacifier;
• exposure to cigarette smoke;
• attending playschool or childcare centres when less than a year old, because there is greater exposure to coughs and colds, which can lead to more ear infections.

Are ear infections serious?

They can be. They can cause babies a lot of pain, and their parents a lot of worry and disruption to normal life. A severe or untreated infection can break the eardrum and flood the ear canal. Although this happens very rarely, it's important to ask your paediatrician to examine your child's ear if you think she may have an infection or if the symptoms have not improved, with or without treatment, within three days.

Repeated ear infections can also lead to hearing loss, and while the eardrum heals well, repeated infections can cause scarring. This also happens in a relatively small number of cases, but it's important to stop repeated mild ear infections developing into severe infections to prevent possible long-term damage to your child's hearing.

While your baby is in the throes of an ear infection, you may find yourself staying up all night with a wailing child, making several trips to the doctor and to the pharmacist for medicines, and worrying whether repeated ear infections will lead to hearing loss. All of this can be very stressful.

What does it mean if I see pus oozing from the ear canal?

The appearance of pus or bloody-yellowish fluid means that your child has developed a small hole in the eardrum, which will usually heal by itself within about two weeks, but you should call your doctor.