When your baby is fussy, tugging at their ear, or waking up crying in the middle of the night, it’s natural to wonder if they might have an ear infection. You’re not imagining it, and you’re doing the right thing by paying attention to these signs.

The Short Answer

The most common signs of an ear infection in a young child include ear pain or discomfort (often shown by tugging or rubbing the ear), fever, trouble sleeping, fussiness or irritability, difficulty hearing or responding to sounds, and fluid draining from the ear. Babies and toddlers who can’t yet tell you their ear hurts will often show you through their behavior: crying more than usual, especially when lying down, or seeming uncomfortable when you touch the area around their ear.

What You’ll Notice

Ear infections can look different depending on your child’s age. In infants and toddlers who can’t yet say what hurts, you might see:

• Increased fussiness or crying, particularly at night or when lying flat
• Tugging, pulling, or batting at one or both ears
• Trouble sleeping or frequent waking
• Fever (often between 100°F and 104°F, though not always present)
• Difficulty with balance or clumsiness
• Reduced appetite or trouble with feeding or drinking, since sucking and swallowing can increase ear pressure and pain
• Fluid draining from the ear (yellow, clear, or bloody)
• Not responding to quiet sounds, or seeming less aware of noises around them

Older children who can communicate may tell you directly that their ear hurts, feels full, or sounds muffled.

What’s Normal for Their Age

Ear infections are especially common in young children. According to the American Academy of Pediatrics, most children will have at least one ear infection by their third birthday. This is because the part of the ear that connects to the back of the throat (the eustachian tube) is shorter, more horizontal, and narrower in young children than in adults, making it easier for fluid to get trapped and infected.

Newborns and infants under 6 months can get ear infections, though they’re somewhat less common in this age group. Toddlers and preschoolers tend to have the highest rates, especially if they’re in group childcare settings or around other children frequently. As children grow and their anatomy matures, ear infections usually become less frequent.

It’s also normal for a child to have some temporary hearing changes during or right after a cold, even without a full ear infection. Fluid can sit behind the eardrum without being infected. Your pediatrician can help tell the difference.

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Why Does My Child Keep Getting Ear Infections?

Some children are more prone to ear infections than others. Contributing factors can include age (younger children are at higher risk), frequent colds or upper respiratory infections, exposure to secondhand smoke, bottle feeding while lying flat, use of a pacifier beyond infancy, and attendance at group childcare. Allergies and enlarged adenoids can also play a role by affecting drainage. If your child has repeated infections, your pediatrician can talk with you about patterns and possible next steps.

What Could Be Causing It

Middle Ear Infection (Acute Otitis Media)

This is the classic ear infection, where fluid builds up in the space behind the eardrum and becomes infected, often following a cold or respiratory virus. Bacteria or viruses can cause it. The fluid puts pressure on the eardrum, leading to pain and sometimes fever.

Ear Fluid Without Infection (Otitis Media with Effusion)

After a cold or ear infection clears, fluid can remain in the middle ear for weeks or even months without being infected. This may cause mild hearing changes or a feeling of fullness, but typically not fever or significant pain. Your pediatrician will monitor this at visits.

Outer Ear Infection (Swimmer’s Ear)

This affects the ear canal (the tube leading to the eardrum) rather than the middle ear. It’s more common in older children and usually happens after swimming or moisture gets trapped in the canal. Pain often worsens when you gently pull on the outer ear.

When to Call the Pediatrician, and When It’s an Emergency

It’s important to know when to reach out. Here’s a helpful guide:

Monitor at home:

• Your child has mild fussiness or ear tugging but is otherwise eating, playing, and acting like themselves
• Symptoms appeared in the last 24 hours and your child is over 6 months old, has no fever, and is comfortable

Schedule a visit (same day or next day):

• Your child has ear pain or tugging with a fever
• Symptoms have lasted more than a day or are getting worse
• Your child is having trouble sleeping or eating due to discomfort
• You see fluid or drainage coming from the ear
• Your infant under 6 months shows any signs of an ear infection

Call for urgent or same-day guidance:

• Your child has a fever over 102.2°F that doesn’t come down with comfort measures
• Your baby under 3 months has any fever of 100.4°F or higher (this is always urgent)
• Severe ear pain that seems unbearable
• Swelling, redness, or tenderness behind the ear
• Your child seems very ill, listless, or isn’t drinking fluids

Go to the emergency room or call 911:

• Your child has a stiff neck, severe headache, or confusion along with ear symptoms
• Sudden weakness in the face or drooping on one side
• Your child is under 3 months with any fever
• Signs of severe dehydration (no wet diapers in 8-12 hours, sunken soft spot, extreme lethargy)
• A seizure
• Difficulty breathing

How It’s Evaluated

At your visit, the pediatrician will ask about your child’s symptoms: when they started, what you’ve noticed, whether your child has had a recent cold, and any other concerns. They’ll check your child’s temperature and overall appearance.

Using a lighted instrument called an otoscope, the provider will look inside your child’s ears to see the eardrum. They’re checking for redness, bulging, fluid behind the drum, and how well the eardrum moves. They’ll also examine your child’s nose, throat, and neck, and listen to their breathing.

In some cases, especially if your child has had multiple infections or persistent fluid, the pediatrician might use a different tool to measure how the eardrum responds to gentle air pressure. This helps assess fluid buildup even when infection isn’t active.

Treatment and Management

Treatment depends on your child’s age, symptoms, and what the pediatrician finds during the exam. Not every ear infection requires immediate intervention.

For some children, especially those over 6 months with mild symptoms and no high fever, a watch-and-wait approach may be appropriate. Many ear infections, particularly those caused by viruses, will improve on their own within a few days. Your pediatrician may suggest comfort measures and a follow-up plan.

When needed, your pediatrician may discuss options to help your child feel better and support healing. Pain relief is often the first priority. Your provider can guide you on safe and appropriate ways to ease discomfort based on your child’s age and weight.

If your child has recurrent infections or persistent fluid affecting hearing, your pediatrician may refer you to an ear, nose, and throat specialist to discuss further options.

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What You Can Do at Home

While you’re waiting for your appointment or during recovery, there are safe, comforting steps you can take:

• Keep your child hydrated. Offer frequent small sips of breast milk, formula, or water (age-appropriate).
• Let your child rest with their head slightly elevated, which can ease pressure. A small pillow under the mattress (not loose in the crib) can help for older infants and toddlers.
• Offer comfort through holding, rocking, or quiet activities. Your presence is soothing.
• Use a warm (not hot) compress gently held against the outside of the ear for a few minutes at a time, if your child tolerates it.
• Avoid inserting anything into the ear canal, including cotton swabs.
• Continue breastfeeding if you’re nursing. It provides comfort and immune support.

Never give your child any over-the-counter or prescription treatments without checking with your pediatrician first. Dosing and safety depend on age and weight, and some products are not safe for young children.

Questions to Ask at the Visit

It helps to come prepared. Consider asking:

• Is this an ear infection, or could it be something else?
• What can I do to help my child feel more comfortable?
• Should we treat this now, or is it safe to wait and watch?
• When should I expect improvement, and what should I watch for?
• How can I tell if my child’s hearing is affected?
• Are there steps I can take to prevent future infections?
• When should we schedule a follow-up?

From a Pediatrics Perspective

Many parents worry that every time their child tugs at their ear, it means an infection. It’s completely understandable. The truth is, babies and toddlers explore their ears just like they explore their toes. Ear tugging alone, without other symptoms like fever, fussiness, or sleep trouble, often isn’t a sign of infection.

It’s also a common misconception that ear infections always need immediate treatment. Research supported by the American Academy of Pediatrics shows that many cases, particularly in older infants and children with mild symptoms, resolve on their own. Your pediatrician will help you decide the best course based on your child’s specific situation.

Some parents feel anxious if their child has had multiple infections. This doesn’t mean you’ve done anything wrong. Young children’s ear anatomy makes infections common, and most children outgrow this stage as they get older. Your pediatrician is your partner in managing this and will keep a close eye on your child’s hearing and development.

We’re Here to Help

If you’re noticing signs that worry you, or if your child just isn’t acting like themselves, trust your instincts. At Holly Springs Pediatrics, we welcome families from Holly Springs, Apex, Cary, Fuquay Varina, Morrisville, and New Hill, and we’re here to support you through sick visits, checkups, and all the questions in between. You can request an appointment anytime, and we’ll work together to help your child feel better.