February is ENT Kids Month—a time to focus on children's ear, nose, and throat health. Ear infections in children is the number one reason a parent takes their child to see a doctor.
If your child has had multiple rounds of antibiotics for painful ear infections, or if they seem to be "ignoring you" or struggling to hear, you're not alone. By age 4, most children will experience fluid behind the ear drum ("glue ear"), and 3 in 4 will have at least one acute ear infection. This guide helps you understand the difference and know what to do.
Spotting the Difference: Infection vs Fluid
It's easy to confuse these two common issues, but they are managed very differently.
· Acute Middle Ear Infection (AOM): This is a painful, sudden infection. Think of a child with fever, tugging at their ear, crying, and having trouble sleeping. The eardrum is inflamed, red and bulging. The ear drum may burst leading to thick yellow or blood stained fluid leaking from the ear.
· Glue Ear (OME): This is fluid stuck behind the eardrum without active infection. The main symptom is muffled hearing. Your child might turn up the TV volume, say "what?" often, seem inattentive or naughty, have balance issues or delayed speech. There is usually no pain or fever.
What You Can Do at Home
For sudden ear pain, your first step is pain relief (like children's paracetamol or ibuprofen). Most ear infections get better on their own. Remember, antibiotics aren't always the answer and should be used judiciously.
When to Consider Antibiotics
Antibiotics should be considered for infants under 6 months, if the infection is in both ears, for children with severe symptoms (e.g., fever >39°C, severe pain, very unwell), for indigenous children (who are at higher risk of infection), or if symptoms persist beyond 48-72 hours despite adequate pain relief.
For glue ear, know that most cases clear up by themselves within 3 months. You can support your child by getting face-to-face time in a quiet room when speaking, reading books with them and ensuring teachers know they might need to speak clearly and check for understanding.
The Eustachian tube (ET) plays a critical role in middle ear infections. It is a tube made from cartilage and bone that connects the back of the nose to the middle ear. It ventilates the middle ear during chewing, blowing the nose, ‘popping’ the ears during a flight or during diving. In children, the Eustachian tube is shorter, more horizontal, and has less efficient muscular opening compared to adults, leading to Eustachian tube dysfunction (ETD) and subsequent middle ear problems. Older children might want to try using a device such as the Otovent balloon three times a day to help restore the function of the eustachian tube.
Avoiding smoking in the car and in the house, reducing daycare exposure and swimming lessons, getting rid of the dummy, reducing dairy intake and avoiding bottle feeding whilst lying down are measures that may help prevent middle ear infections. Breastfeeding and ensuring your child’s vaccinations are up to date are protective.
