Fever with ear pain in infants

Fever with ear pain in infants: How to recognize otitis?

The combination of high fever and signs of ear pain most often indicates acute middle otitis — inflammation of the middle ear. It is one of the most common bacterial infections in early‑age children. Since an infant cannot tell exactly what hurts, parents need to know the indirect signs of this condition.

Why do infants often have ear pain?

The reason lies in anatomy. The Eustachian tube, which connects the nasopharynx and the middle ear, is very short, wide, and positioned more horizontally in infants than in adults. Because of this, any nasal infection (for example, a common runny nose) can easily reach the middle ear, causing inflammation and fluid buildup behind the eardrum.

How to suspect ear pain?

Pay attention to the following symptoms, especially if they appear during an upper respiratory infection:

• Sudden, piercing crying, especially at night or while lying down.
• The child pulls at the ear, or rubs the head against a pillow.
• Loss of appetite: the child starts feeding but then, crying, drops the breast or bottle because sucking and swallowing increase pressure and pain in the ear.
• Ear discharge: If the eardrum ruptures, pus or fluid may leak from the ear.
• High fever.

What should parents do?

If otitis is suspected, it is essential to see a pediatrician or ENT specialist. Only a doctor, using a special instrument (otoscope), can examine the eardrum and confirm the diagnosis. Treatment usually includes analgesics (ibuprofen or paracetamol), nasal decongestant drops to reduce swelling, and, in case of bacterial infection, antibiotics.

Never put anything into the child's ear without a doctor's prescription! For other symptoms related to fever, read our section "Fever in children".