How to Tell If a Toddler Has an Ear Infection: Key Signs and Symptoms

Ear infections are a common issue among young children, especially toddlers, and can cause significant discomfort if left untreated. Understanding the signs and symptoms of an ear infection in your toddler is crucial for ensuring proper care and quick relief. In this article, we will discuss how to determine if your toddler may be suffering from an ear infection and what to watch out for.

Toddlers may not be able to verbally communicate their pain or discomfort, making it essential for caregivers to be vigilant in observing their behavior. Some common indicators of an ear infection in young children include tugging or pulling at the ear, increased fussiness or irritability, and difficulty sleeping 1. Additionally, fever, fluid draining from the ear, or a sudden loss of balance can all signal the presence of an infection 2.

As parents or caregivers, being attentive to these signs is key in identifying potential ear infections and seeking medical attention when necessary. Prompt treatment can help alleviate pain, prevent complications, and maintain overall health and wellbeing in your child.

Recognizing Ear Infection Symptoms

Pain and Tugging at the Ear

A telltale sign of an ear infection in toddlers is pain in and around the ear. Young children might not be able to express their discomfort, so keep an eye out for them tugging at their ear, crying, or showing distress while laying down or chewing, as these can aggravate the pain. 1


Fever is another common symptom of an ear infection in toddlers. They may have a higher than normal body temperature, indicating their body is fighting off an infection. 2

Trouble Sleeping

Ear infections can make it uncomfortable for toddlers to sleep, due to the increased pressure on the eardrum while lying down. They may exhibit difficulty falling asleep or staying asleep. 3

Irritability and Fussiness

Toddlers with ear infections may become more irritable and fussy than usual. They may cry more often or be easily upset, especially if their sleep is disrupted or the pain worsens. 4

Loss of Appetite

Chewing or swallowing can aggravate ear pain, making it difficult for toddlers to eat or drink. This can lead to a loss of appetite or a decreased interest in feeding. 5

Difficulty Hearing

Ear infections can impact a toddler’s hearing, making it difficult for them to respond to soft noises or understand spoken words. If you notice your child’s ability to hear is diminished, it could be a sign of an ear infection. 6

Balance Issues

The inner ear plays a major role in maintaining balance. An ear infection may cause toddlers to exhibit problems with balance, such as unsteadiness, stumbling, or falling more often than usual. 7

Fluid Draining from the Ear

In some cases, fluid may drain from the affected ear, a possible sign of a ruptured eardrum. If you observe fluid or pus draining from your toddler’s ear, it’s important to contact a healthcare professional for assessment and treatment. 8

Causes and Risk Factors

Bacteria and Viruses

Ear infections in toddlers are often caused by bacteria or viruses, with the middle ear being commonly affected. The infection typically occurs when fluid builds up behind the eardrum, creating a breeding ground for bacteria or viruses.

Eustachian Tube Dysfunction

The Eustachian tubes connect the middle ear to the back of the throat, helping to drain fluid and equalize pressure. In young children, these tubes are shorter and more horizontal, making it easier for bacteria and viruses to enter the middle ear. This can lead to Eustachian tube dysfunction, which can cause fluid buildup and infections.

Upper Respiratory Infections

Upper respiratory infections, such as colds and flu, can cause inflammation and congestion that may lead to ear infections. The swelling and mucus produced during a cold or flu can block the Eustachian tubes, making it difficult for fluid to drain from the middle ear.

Secondhand Smoke Exposure

Exposure to secondhand smoke can increase the risk of ear infections in toddlers. The chemicals present in cigarette smoke can irritate and inflame the Eustachian tubes, making it more difficult for them to function properly and increasing the risk of infection.

Young Age and Immune System Development

Young children are more prone to ear infections due to their developing immune systems. According to the NIDCD, five out of six children will have at least one ear infection by their third birthday. As children’s immune systems develop, they become better at fighting off infections, leading to a decrease in the frequency of ear infections as they grow older.

Types of Ear Infections

Acute Otitis Media (AOM)

Acute Otitis Media (AOM) is the most common type of ear infection, especially in young children. AOM occurs when the middle ear becomes infected and inflamed, leading to a buildup of fluid and pressure. Some of the primary symptoms of AOM include:

  • Ear pain
  • Fever
  • Trouble hearing
  • Fluid drainage from the ear

It is essential to get proper treatment for AOM, as untreated cases can lead to more severe complications, including hearing loss and even mastoiditis, an infection of the bone behind the ear.

Otitis Media with Effusion (OME)

Otitis Media with Effusion (OME), sometimes called “glue ear,” is a condition where fluid accumulates in the middle ear without any signs of infection. This mainly affects toddlers and can result from a previous AOM or from Eustachian tube dysfunction. The symptoms of OME usually include:

  • Troubled hearing
  • Loss of balance
  • Difficulty sleeping due to ear discomfort

Treatment for OME typically involves watchful waiting, as most cases resolve on their own. However, if the condition persists or affects hearing significantly, a doctor might recommend interventions such as inserting ear tubes to help with fluid drainage.

Chronic Otitis Media with Effusion (COME)

Chronic Otitis Media with Effusion (COME) is a persistent case of OME that lasts for more than three months. This condition can negatively impact a child’s hearing, speech, and language development. The main symptoms of COME are similar to OME, including:

  • Trouble hearing
  • Ear fullness or pressure
  • Persistent fluid in the middle ear

Treatment for COME may involve the use of ear tubes, as mentioned earlier, to assist in fluid drainage and relieve pressure on the eardrum. In more severe cases, the doctor might recommend surgical interventions to eliminate the source of ongoing infection or improve Eustachian tube function.

In summary, it is crucial to monitor your child for any signs of ear infection and get the appropriate medical attention if needed. Early treatment can prevent complications and promote a healthy recovery.

Diagnosis and Medical Examination

When it comes to diagnosing ear infections in toddlers, there are a few important steps that healthcare providers undertake to accurately identify the issue and provide proper care.

Medical History and Physical Examination

The first step in the diagnostic process is taking a comprehensive medical history and performing a physical examination. During this process, the healthcare provider will ask questions about the toddler’s symptoms and any history of ear infections. They will then examine the child’s ear using a lighted instrument called an otoscope. This allows them to assess the eardrum’s appearance.

A healthy eardrum is pinkish-gray and translucent (clear). In the case of an ear infection, the eardrum may be inflamed, swollen, or red. The provider may also use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum.


An audiogram is a hearing test conducted by an audiologist or ENT (ear, nose, and throat) specialist. It evaluates the toddler’s hearing ability and can help identify if the ear infection has caused hearing loss or damage. This test assesses:

  • Hearing thresholds
  • Sound discrimination
  • Middle and inner ear function

The results from the audiogram will provide valuable information to guide the healthcare provider’s treatment plan for the ear infection.


Tympanometry is another diagnostic test that healthcare providers use in evaluating ear infections in toddlers. This test measures the movement of the eardrum in response to changes in air pressure, providing information about:

  • Eardrum mobility
  • Middle ear pressure
  • Fluid behind the eardrum

This test will further help the healthcare provider determine the severity of the infection and guide their treatment decisions.

Once the doctor has diagnosed the ear infection, they may prescribe ear drops or other appropriate treatments to alleviate symptoms and facilitate healing. Regular follow-ups and monitoring are necessary to ensure complete resolution of the infection and to address any complications that may arise.

Treatments and Home Remedies

Pain Relief and Reducing Fever

For pain relief and reducing fever in toddlers with ear infections, over-the-counter (OTC) medications such as acetaminophen and ibuprofen can be used. Make sure to follow the recommended dosage instructions and guidelines for the child’s age and weight. It is important to consult with your pediatrician before administering any medications.

Antibiotics for Bacterial Infections

When it comes to treating bacterial ear infections in toddlers, your doctor may prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Antibiotics are effective in treating most ear infections and aid in clearing the infection more quickly. However, it is crucial to complete the entire course of antibiotics to ensure a full recovery and prevent antibiotic resistance.

Observation and Reevaluation

In some cases, especially when the ear infection is not severe, a doctor may choose a “wait and see” approach before prescribing antibiotics. This method allows the child’s immune system a chance to fight the infection on its own. During this time, OTC pain relievers like acetaminophen and ibuprofen can be used to manage pain and fever. If there is no improvement within a few days, the doctor may reconsider the option of antibiotic treatment.

Ear Tubes for Recurrent Infections

For toddlers who experience recurrent ear infections, ear tubes may be considered as a treatment option. Ear tubes help prevent the buildup of fluid in the middle ear, reducing the risk of further infections and improving hearing. This procedure should be discussed with a pediatric ear, nose, and throat (ENT) doctor to determine if it is right for your child.

Remember to consult with your pediatrician for the most appropriate treatment options tailored to your child’s specific situation. Monitoring your child’s symptoms closely and following their treatment plan will help ensure a swift recovery from ear infections.

Prevention and Health Tips

Preventing ear infections in toddlers involves a combination of steps that focus on maintaining good health and minimizing exposure to factors that may increase the risk of infections. Here are some key areas to consider while working on ear infection prevention.

Breastfeeding and Proper Nutrition

Breastfeeding has been shown to reduce the risk of early ear infections in infants, as the mother’s antibodies can help strengthen the child’s immune system. Whenever possible, it is recommended to breastfeed at least for the first six months of the baby’s life. Proper nutrition is also essential for building a healthy immune system. Encourage your toddler to consume a balanced diet that includes a variety of fruits, vegetables, proteins, and healthy fats.

Avoiding Secondhand Smoke

Exposure to secondhand smoke has been linked to an increased risk of ear infections in children. It is important to keep your toddler away from smoking areas and smoke-filled environments. Establish a smoke-free home and avoid exposing your child to cigarette smoke whenever possible.


Keeping your child up-to-date on their vaccines is crucial in preventing ear infections. Children who receive the recommended vaccines, such as the 13-valent pneumococcal conjugate vaccine (PCV13), experience fewer ear infections than their unvaccinated counterparts. Remember to follow the American Academy of Pediatrics guidelines and consult with your pediatrician about the appropriate immunization schedule for your child.

Proper Hygiene and Hand Washing

Frequent hand washing and maintaining good hygiene habits can significantly decrease the spread of germs that cause ear infections. Teach your toddler to wash their hands thoroughly with soap and water, especially after sneezing, coughing, or touching their face. As a parent, remember to wash your hands frequently as well to minimize the spread of germs in your household.

Nasal Saline Irrigation

Nasal saline irrigation, when used as directed, can help reduce congestion and alleviate the symptoms associated with colds and allergies, which may lead to ear infections. Consult with your pediatrician before starting saline irrigation for your toddler, and always follow their guidance on proper usage and frequency.

By following these preventative measures and health tips, you can significantly reduce the risk of ear infections in your toddler and contribute to their overall wellbeing.


  1. NIDCD

  2. Johns Hopkins Medicine

  3. Riley Children’s Health

  4. Verywell Health

  5. Johns Hopkins Medicine

  6. Riley Children’s Health

  7. Verywell Health

  8. WebMD

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About the author
Daisy is a writer, mom, and expert on all things toddler-related. As a parent of three young children, she's experienced the highs and lows of parenthood firsthand, and she's passionate about sharing her insights with others. Through her website, The Toddler Life, Daisy offers practical advice and tips on everything from potty training to picky eaters. She's not afraid to get real about the challenges of parenting, and her honest and relatable writing style has earned her a loyal following of readers.

How to Tell If a Toddler Has an Ear Infection: Key Signs and Symptoms

How to Tell If a Toddler Has an Ear Infection: Key Signs and Symptoms