Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

Is It an Ear Infection?

Is It an Ear Infection?

Wouldn’t it be great if your one-year-old could say, “Hey, mom, I apologize for screaming so much last night – it’s just that I’m feeling some fullness and discomfort in my left ear, and I think it’s probably an infection.” That would be wonderful. But your kid doesn’t say that. Instead she gets a cold, and she’s kind of fussy, and she has some low-grade fevers, and she’s kind of tugging at her ears, and you’re wondering for days if she might have an ear infection. You don’t want to rush in only to have the pediatrician say it’s just a virus, but you also don’t want to wait so long that her little eardrum bursts from all the pus. When should you go in? Even though there’s no way to know for sure when your kid has an ear infection, we can sharpen your skills and hopefully save you some unnecessary trips to the doctor.

First, something has to put that fluid in her ears first so that it can get infected. For young kids this is almost always a cold, where the same fluid in their sinuses can travel through the eustachian tube into the ears. So if your child has been fussy for a few nights but hasn’t had a cold or congestion in weeks, it’s not an ear infection. For older kids, seasonal allergies can also put fluid into the ears.

When your kid does have a cold, here are three signs that make her more likely to have an ear infection. These are the times that you should take her in to the doctor:

1. Intense nighttime fussiness – this usually happens several days into the cold. Kids never sleep that well with colds; drainage, plugged noses, and cough can make them restless. But infected ears hurt bad at night, so kids tend to cry out in pain.

2. Weird fever patterns – Viruses can certainly cause fevers, but these fevers start as symptoms begin and once they’re gone they stay gone. So if your kid gets her first fever on the fourth day of her cold, that could mean that it’s caused by bacteria growing in her ears. You should have the same concern if she has a fever that goes away after two days, but then comes back two days later. Viruses usually don’t do that.

3. Goopy eyes – If your kid wakes up with her eyes crusted shut, or they’re churning out yellow or green goop every hour throughout the day, she’s likely to have “pink eye.” These kids, especially when they’re under three, need to be seen because they have about a 25% chance of also having an ear infection.

There are also some signs that are not likely to indicate an ear infection.

1. Ear tugging or pulling – kids tug on their ears for a lot of reasons: when they’re tired, when they’re bored, and when they’re teething. They can also do it during ear infections, but without one or more of the above symptoms it doesn't mean a lot .

2. The outside of the ear looks red or more wax is coming out – in an ear infection, all the action is deep inside behind the eardrum. It’s sealed off, so the outer part of the ear doesn't show any signs. For the same reason, getting dirty water splashed into the ear doesn’t cause an infection.

So that’s what we’ve got to work with. One more piece of advice – try your best to visit your pediatric office if you suspect an infection. Diagnosing ear infections, and deciding when they need to be treated, isn't straightforward. The providers at urgent cares, who see more adults than kids, don’t have as much experience with them. Plus, it’s important for your doctor track your kid's infections to make decisions about antibiotics and ear tubes.

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