Middle ear infections are one of the most common reasons parents bring young children to see a doctor. This fact sheet helps you understand what to expect, how to help your child feel better at home, and when to seek medical advice.
Useful facts
What is middle ear infection?
Behind the ear drum is a small space that’s filled with air: the middle ear. When germs (such as viruses or bacteria) enter, for example during a cold, an infection can develop. Middle ear infection is also known as “acute otitis media”.
How dangerous is it?
In most children, it is a harmless infection that gets better by itself within 3-7 days without any complications.
How common is it?
Middle ear infection is very common, mostly affecting children. More than half of all children suffer at least one middle ear infection by the time they’re 7. Symptoms usually last 3 days but can last up to 7. Most children and young people get better within 3 days without the need for antibiotics.
Who’s affected?
Middle ear infections are more common in children who breathe in tobacco smoke, attend day care (nursery,) or who drink formula milk rather than breast milk.
What are the symptoms?
Older children usually complain of ear ache, while younger children often pull or rub their ears. It is common to get a high temperature, difficulty hearing, thick fluid (discharge) running out of the ear, a feeling of pressure or fullness inside the ear, and itching and irritation around the ear. Other common symptoms in small children include being irritable or restless, crying, disturbed sleep, cough, a runny or snuffly nose, and poor feeding.
Does my child need antibiotics?
Antibiotics make little difference to pain or recovery for most children, but they can cause side‑effects and make antibiotics less effective in future.
Most children with a mild middle ear infection will not benefit from antibiotics. Antibiotics may be prescribed if your child is very unwell (eg high fever and/or vomiting), if they are considered at risk of complications, if they develop a leaking ear, or, in children younger than 2 years, have infections in both ears. Your child may be prescribed ‘back up’ antibiotics, to be started only if they do not improve or become more unwell.
What can I expect to happen?
Symptoms: Symptoms of middle ear infection tend to develop quickly and usually last 3 days, but can last 7 days. Most children and young people get better within 3 days without the need for antibiotics.
Fluid leaking from the ear: A hole may form in the ear drum and cause infected thick fluid (pus) to run out of the ear. This usually relieves the pain as it reduces the pressure on the ear drum.
Treatment for ear infection in children
Giving painkillers: You can give either Paracetamol or Ibuprofen if your child is unwell or appears distressed. Do not give both at the same time unless advised by a health professional. You can try the alternative medicine if your child does not respond to the first one you start with. Always follow the manufacturer’s instructions. Do not give Aspirin to children under the age of 16. Don’t give antihistamines or decongestants – they don’t help ear infections and can cause side effects in young children.
What can I do to help my child get better now and in the future?
Your community pharmacy can assess your child’s ear, offer treatment advice and tell you if you need to see a GP.
Wipe away discharge: Wipe any discharge away but do not put anything in the ear, including cotton buds and fingers.
Keep your child cool: Avoid over or underdressing a feverish child. Keep your central heating down. Tepid sponging is not recommended.
Fluids: Offer your child regular fluids. If you’re breastfeeding, offer as many feeds as your child will take. Avoid dummies and feeding while lying flat.
Body checks: Check your child at night regularly for signs of serious illness.
Use a warm or cold flannel: A warm or cold flannel applied to the ear can help.
When should I seek medical attention?
Most ear infections are mild and get better on their own. It is safe to ‘watch and wait’ for 2–3 days if your child is otherwise well.
Call 999 or go to A&E immediately if your child:
- Has a stiff neck, is sensitive to light, has a rash, or has a seizure (fit)
- Is unusually difficult to wake or very drowsy
- Has slurred speech or seems confused
- Seems very unsteady on their feet
- Is under 3 months old with a high temperature
- Is getting rapidly worse
Call your GP surgery or 111 (England & Wales), Phone First (Northern Ireland), or NHS24 (Scotland) if your child:
- Has a high temperature (a high temperature, or fever, is common – be more concerned about how unwell your child seems than the exact number on the thermometer.)
- Is vomiting
- Has fluid or pus draining from the ear
- Has swelling, redness, or tenderness behind or around the ear (this can occasionally indicate a more serious infection and needs prompt assessment)
- Has not started to improve after 3 days
- Has an underlying condition such as diabetes or a weakened immune system
- Has repeated ear infections
- Has any hearing loss that hasn’t improved 6 to 8 weeks after the infection has cleared
If you cannot get urgent advice and your child seems very unwell, call 999. You know your child best. If they seem very different from usual or you are worried, seek medical advice – even if they don’t fit the list above.
Where can I find out more?
A member of your pharmacy team can help you in assessing and treating your child’s symptoms, otherwise you can visit an NHS website.
In England, as part of the NHS Pharmacy First Service participating community pharmacies offer ear examinations and appropriate advice.
NHS England Website:
NHS Inform, Scotland:
NI Direct, Northern Ireland:
NHS111, Wales:
We review our health information every two years and this information is due to be updated in October 2026.
