Kids' Ear Infections in Australia: When to See a Doctor, What Helps at Home

Ear infections typically follow a cold. The pattern most parents will recognise: a few days of runny nose, then a child who's suddenly miserable, fevered, and pulling at one ear.

In babies and toddlers (who can't tell you what hurts):

• Pulling, rubbing, or tugging at one ear
• Unusual irritability or crying, especially when lying down
• Fever, often after a few days of a cold
• Trouble feeding (sucking and swallowing change ear pressure and can hurt)
• Disrupted sleep, waking distressed
• Sometimes balance changes, or pus or fluid coming from the ear (which means the eardrum has perforated, this usually relieves pain and heals on its own)

In older children:

• A clear complaint of ear pain
• Reduced hearing on the affected side, often described as muffling
• Fever
• A cold or runny nose in the days before
• Sometimes drainage from the ear

What's usually not an ear infection:

• Itchy ear without pain
• Ear pain only on flying or pressure changes
• Pain that comes only when the outside of the ear is tugged (this can suggest swimmer's ear, an outer ear infection, which is different)

The age pattern is worth knowing. Ear infections peak between six months and two years. From age three onwards, they get less frequent. By school age, most children outgrow them, though some do continue to have recurrent infections that warrant specialist review.

Australian guidelines, in line with international evidence, recommend watchful waiting for many ear infections in otherwise well children. The reason is that most clear up without antibiotics, antibiotics carry side effects (rashes, diarrhoea, allergies), and unnecessary use contributes to antibiotic resistance. That said, the threshold to treat is lower in some children, including very young infants and children with other risk factors.

Watchful waiting is usually appropriate when:

• The child is over two
• They're otherwise well, drinking, and not severely unwell
• Symptoms have only been going for a day or so
• There are no red flags

In this scenario, pain relief and comfort are the priority, and a GP review at 48 to 72 hours if things aren't improving.

See a GP within 24 hours if:

• Your child is under two with a clear ear infection
• Pain is severe and not settling with simple measures
• Symptoms have been getting worse, not better, over 48 hours
• There's drainage from the ear
• Your child has had recurrent ear infections
• You're worried (this counts; parents are usually right)

Red flags that need same-day, in-person care:

• A child who looks very unwell (pale, mottled, lethargic, hard to wake)
• Stiff neck, severe headache, or any change in alertness
• Swelling, redness, or pain behind the ear (this can suggest mastoiditis, a rare but serious complication)
• Persistent vomiting, especially with fever
• Any baby under three months with a fever
• Difficulty breathing
• A rash that doesn't fade under pressure

Call 000 or go to a hospital emergency department if:

• Your child is severely unwell, unresponsive, or having difficulty breathing
• A rash is non-blanching (doesn't fade when you press a glass against it)

Most of the early management of an ear infection is comfort, fluids, and watching closely.

Pain relief. Paracetamol or ibuprofen, given at the right dose for your child's weight, are the mainstays. Don't guess on dosing; use the dosing chart on the packaging or, better, check with your GP, the Royal Children's Hospital Kids Health Info site, or Healthdirect. If you've used pain relief before in the past 24 hours for any reason, mention this when you check, so total daily doses don't add up too high.

Upright comfort. Some children are more comfortable in an upright or slightly inclined position rather than flat on their back. A pillow elevation, an upright cuddle, or a baby car seat for short stints can help.

Fluids. Keep them drinking. Cool drinks, ice blocks, and small frequent sips often work better than large drinks when a child feels miserable. Dehydration is a real risk in unwell young children.

Warm, not hot, on the ear. A warm flannel held against the affected ear can soothe.

What to avoid.

• Don't put oils, drops, or anything else into the ear without GP advice. If the eardrum has perforated (which can happen and is usually self-limiting), drops can sit in the middle ear.
• Don't use cotton buds in the ear canal.
• Don't use aspirin in children. Use paracetamol or ibuprofen.
• Don't let your child swim or fly while the ear infection is acute. (Most paediatric guidance suggests waiting until pain has settled and any drainage has stopped.)

If your child isn't improving after 48 hours of comfort measures, or any red flag appears, see a GP.