Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Acute Middle Ear Infection in Children


The Manual's Editorial Staff

Reviewed/Revised Jul 2022 | Modified Sep 2022
Get the full details
Topic Resources

What is a middle ear infection?

The middle ear is the space just behind the eardrum. Germs can get in the middle ear and cause an infection. A middle ear infection is also called otitis media. An acute middle ear infection is one that starts quickly and causes lots of symptoms right away.

  • Children with an ear infection have ear pain

  • They may have a fever and trouble sleeping

  • Doctors will look inside your child's ear with a light

  • Most ear infections get better on their own without antibiotics

  • Your child will likely need medicine for pain and fever

What causes ear infections?

The same germs (viruses) that cause the common cold cause most ear infections. Sometimes other types of germs called bacteria cause ear infections.

What are the symptoms of an ear infection?

The infection makes fluid build up in the middle ear. This fluid makes the eardrum bulge and hurt. If the eardrum bulges a lot, it can pop (rupture). Symptoms include:

  • Ear pain—very young children who can't talk may pull at their ear or cry

  • Fever

  • Cranky mood and trouble sleeping

  • Trouble hearing

  • Sometimes blood or fluid drains from the child’s ear if the eardrum ruptures

Rarely, ear infections can cause severe complications if bacteria spread to nearby areas, such as:

How can doctors tell if my child has an ear infection?

Doctors will look inside your child's ears with a special light. They are checking to see if:

  • Your child’s eardrum is bulging or red

  • There's fluid behind the eardrum

They may need to first clean wax from your child's ear so they can see more clearly.

They may squeeze air into your child’s ear to see if the eardrum moves. If it doesn't move as much as it should, your child may have an ear infection.

How is an ear infection treated?

Medicine for your child’s symptoms

  • Treat ear pain and fever with medicine such as acetaminophen or ibuprofen

Some ear drops reduce pain but only for about 30 minutes, so many doctors don't use them. Decongestants or antihistamines, found in cold medicines, won't help your child.


Doctors used to give antibiotics to all children with ear infections. Now doctors know most ear infections go away on their own. However, doctors give antibiotics if your child is:

  • Very young

  • Very sick

  • Doesn't get better quickly or gets worse

Eardrum puncture

Pain from a bulging eardrum may need to be treated with eardrum puncture. In this treatment, doctors poke a tiny hole in the eardrum so the infected fluid can drain out. The hole will heal on its own.

How can I prevent ear infections in my child?

  • Have your child get regular vaccine shots (for infections, such as pneumonia and the flu, that can cause ear infections)

  • Don’t let your child sleep with a bottle (drinking while lying down can trap fluid in the ear)

  • Keep your child away from smokers

Drugs Mentioned In This Article

Generic Name Select Brand Names
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
quiz link

Test your knowledge

Take a Quiz!