Ear Infections in Babies and Children: Signs, Teething Confusion & When to See a Clinic (South African Guide)
- Samantha Pieterse
- 3 days ago
- 11 min read
Ear infections are among the most common causes of unsettled babies and children, especially at night. A normally content child can suddenly be crying, tugging at their ear, or refusing to lie down, and it’s hard not to worry.
Although ear infections may seem scary, it’s important to remember that not every baby pulling at their ear has an ear infection. Teething, minor congestion, and simple developmental habits can look very similar in the early stages.
The key is knowing which signs indicate normal discomfort and which may mean your child needs a proper ear examination.
In this guide, we’ll walk through the differences between teething and ear infection symptoms, explain why ear pain often seems worse at night, and outline exactly when it’s time to book a sick visit.
What Is an Ear Infection?
An ear infection is what happens when fluid builds up behind the eardrum and becomes inflamed. This space is called the middle ear and connects to the back of the nose through a small channel called the Eustachian tube.
In babies and young children, this tube is shorter and more horizontal than in adults. That makes it easier for fluid to get trapped, especially during or after a cold. When that trapped fluid becomes infected, it can cause pressure, pain, and sometimes fever.
The Main Types of Ear Infections in Children
1. Middle ear infection (Otitis media)
This is the most common type in babies and toddlers. It causes pain deep inside the ear, often worse when lying down, and may be accompanied by fever or temporary reduced hearing.
2. Outer ear infection (Swimmer’s ear)
This affects the ear canal itself rather than the space behind the eardrum. It is less common in babies and usually happens after water exposure. The ear may be painful to touch.
3. Fluid behind the eardrum without infection (Otitis media with effusion)
Sometimes fluid remains after a cold without active infection. This may cause mild discomfort or hearing changes, but not always fever or severe pain.
Most childhood ear pain is related to middle ear infections.
What Are the Signs of an Ear Infection in a Baby or Child?
Ear infection symptoms can look different depending on your child’s age. Babies cannot tell you their ears hurt, while toddlers and older children often can, and across all ages, the pain is often worse at night.
The pattern you should look for is new ear-related discomfort alongside cold symptoms or fever, especially if it disrupts sleep or feeding. Here’s what that typically looks like by age group.
Common ear infection symptoms in babies
In babies, the signs are often behavioural rather than verbal. You may notice:
Pulling or tugging at one ear repeatedly
Crying more than usual, especially when lying down
Fever
Refusing feeds or feeding less than normal
Trouble settling or waking frequently at night
Fluid or discharge coming from the ear
An isolated symptom does not always indicate infection. It’s the combination of discomfort, fever, feeding changes, or sleep disruption that raises concern.
🌡️ If you’re unsure whether your child’s fever needs monitoring at home or medical assessment, you can read our guide on when fever needs a clinic visit.
Ear infection symptoms in toddlers and older children
As children get older, they can usually describe pain more clearly. Common signs include:
Complaining that their ear hurts
Child crying with ear pain, especially at night
Ear pain that seems worse when lying down
Fever
Reduced hearing or saying sounds feels “blocked”
Irritability or sudden clinginess
Ear pain that wakes a child from sleep or escalates within a few hours is more likely to require medical assessment.
It’s worth remembering that many of these signs can also happen with teething, tiredness, or a simple cold. Not every unsettled night or ear tug means there is an infection. What matters most is how uncomfortable your child seems, whether a fever is present, and whether symptoms are improving or getting worse.
Baby Tugging Ear: Is It Teething or an Ear Infection?
One of the most common questions parents search for is: “Why is my baby pulling his ears?”
Ear tugging on its own does not necessarily mean infection. Babies explore their bodies, soothe themselves when tired, and respond to gum discomfort during teething.
The challenge is working out when it’s normal developmental behaviour, and when it signals ear pain. Here’s how to tell the difference.
Why babies pull their ears when teething
During teething, pain from the gums can travel along shared nerve pathways. This is called referred pain, and it can make babies rub their cheeks or tug at their ears even when the ear itself is normal.
Teething-related ear pulling usually happens alongside:
Swollen or tender gums
Increased drooling
Chewing on hands or objects
No fever, or only a mild temperature
Normal feeding overall
Discomfort that comes and goes
Importantly, teething discomfort does not typically cause high fever or severe ear pain that worsens at night.
Signs it may be an ear infection instead of teething
When ear tugging is linked to infection, the pattern usually looks different. You may notice:
A higher fever
Severe or persistent crying
Child crying with ear pain at night
Refusing feeds or drinking less
Obvious signs of being unwell
Symptoms that continue or worsen beyond 48 hours
The combination of fever, disrupted sleep, and feeding changes is more suggestive of ear inflammation than teething alone.
It’s very common for teething and minor colds to overlap in the first few years of life, which is why the signs can feel confusing. Watching how your baby behaves overall, rather than focusing on one isolated symptom, usually gives the best answer.
Why Is Ear Pain Worse at Night in Babies and Children?
Many parents notice the same pattern: their child seems manageable during the day, but by bedtime, they’re suddenly crying with ear pain, sometimes intensely. This doesn’t mean the infection has suddenly become worse. There are very practical reasons why ear pain often feels worse at night.
Lying flat increases pressure in the ear
When a child lies down, fluid inside the middle ear doesn’t drain as easily. This can increase pressure behind the eardrum.
In babies and toddlers, especially, that pressure can cause ear pain that starts or worsens after lying down, especially at night. Because children spend prolonged periods lying down when sleeping or feeding, this can cause more frequent waking or difficulty settling and more discomfort during feeds.
This pressure effect is one of the most common reasons ear pain seems “fine” during the day but escalates at bedtime.
Fewer distractions at night
During the day, children are distracted by movement, play, and noise. At night, everything is quieter. Without distraction, they are more aware of ear pain or a blocked or full sensation. This is why child ear pain at night can feel more dramatic, even if the underlying inflammation hasn’t suddenly worsened.
Fluid pressure builds after a cold
Ear infections often follow a cold. Mucus and inflammation can block normal drainage from the middle ear, allowing fluid to collect. When that fluid presses against the eardrum, it can cause irritability when your baby or child turns their head or cries, which improves briefly when upright.
The position change, rather than rapid infection progression, is usually the reason for the nighttime spike in symptoms.
Night-time ear pain is uncomfortable and exhausting for parents, but it’s a very common pattern with middle ear inflammation. The important question isn’t whether the pain happens at night. It’s how severe it is, whether fever is present, and whether your child is improving over the next day or two.
Do Ear Infections in Babies Always Need Antibiotics?
One of the most common questions parents ask is: “Do ear infections need antibiotics?”
The answer is: not always.
Many ear infections in babies and toddlers are caused by viruses, especially after a cold. Antibiotics only work against bacteria, so they are not automatically needed in every case.
What matters is how severe the symptoms are, your child’s age, and whether things are improving or getting worse.
Can an ear infection go away on its own?
Yes, some mild middle ear infections can settle without antibiotics.
This is more likely when:
Pain is mild to moderate
Fever is low-grade or absent
Your child is still drinking fluids
Symptoms begin improving within 48–72 hours
In these cases, careful monitoring and pain relief may be appropriate while the body clears the infection.
When are antibiotics needed?
Antibiotics are more likely to be recommended when there are signs of bacterial infection or complications. These include:
Persistent high fever
Severe ear pain
Ear discharge (fluid leaking from the ear)
Symptoms not improving after 2–3 days
Babies under 6 months with suspected ear infection
Clinical examination is important here. A red eardrum alone does not always mean antibiotics are required.
Why is the overuse of antibiotics avoided?
Antibiotics are valuable medicines, but they are not risk-free. Using them when they are unlikely to help can lead to unnecessary side effects (such as diarrhoea or rash), disruption of normal gut bacteria, and antibiotic resistance over time
For this reason, healthcare providers balance symptom severity, age, and examination findings before prescribing. Antibiotics are important medicines, but they need to be used carefully to reduce the risk of antibiotic resistance.
Most ear infections improve without complications, whether antibiotics are needed or not. The important thing is that your child is assessed appropriately if symptoms are severe, persistent, or unclear.
How Long Does an Ear Infection Last in Babies and Children?
When your child is in pain, even one night can feel long. A very common question is: “How long does ear infection pain last?” Most uncomplicated middle ear infections follow a predictable pattern. Knowing that pattern helps you decide whether things are progressing normally or whether it’s time for reassessment.
The typical timeline for ear infections
In many babies and children, ear infection symptoms:
Start suddenly, often after a cold
Peak within the first 24–48 hours
Begin improving within 2–3 days
Pain is usually the most intense in the first day or two. Fever, if present, often settles as inflammation improves. It’s also normal for mild ear discomfort or a “blocked” sensation to linger slightly longer than the worst pain.
When should ear pain improve?
You should generally notice:
Less intense crying
Longer stretches of sleep
Improved feeding or appetite
Fever settling
Even if symptoms are not completely gone, there should be an obvious improvement within 48–72 hours in uncomplicated cases. Gradual improvement matters more than instant resolution.
When is reassessment needed?
It’s reasonable to seek further evaluation if:
Pain remains severe beyond 2–3 days
Fever persists or worsens
New ear discharge appears
Your child seems more unwell rather than better
Symptoms settle briefly but then return quickly
A follow-up examination can help determine whether treatment needs to change or whether another cause should be considered. Most ear infections are short-lived and improve within a few days. Watching for overall improvement is often the most helpful guide.
When Should You Take Your Baby or Child to a Clinic for Ear Pain?
Many mild ear infections can be monitored at home for a short period. But some situations require a proper examination to assess the eardrum, confirm the diagnosis, and decide whether treatment is needed.
If you’re wondering, “Should I take my baby to the doctor for ear pain?” these are the situations where medical assessment is recommended.
Seek medical assessment if:
Your baby is under 6 months old and has a fever
Fever is above 38.5°C
Ear pain is severe and not settling
There is fluid or discharge coming from the ear
Symptoms are lasting longer than 2–3 days without improvement
Your child seems unusually sleepy, weak, or difficult to wake
You feel something is “not right” despite mild symptoms
Young babies and children cannot always communicate how unwell they feel, which is why age and behaviour matter just as much as temperature.
Why examination matters
An ear infection cannot be confirmed without looking at the eardrum. Redness alone does not always mean infection, and sometimes ear pain can be referred from other areas, such as the throat.
A simple examination helps to clarify whether there is fluid behind the eardrum, if the infection appears mild or more serious, and if treatment or monitoring is appropriate.
Most ear infections are uncomfortable but not dangerous. The goal of a clinic visit is reassurance, accurate diagnosis, and appropriate treatment, not automatically antibiotics.
💗 If your baby or child has ongoing ear pain, fever, or night-time distress and you’re unsure what to do, you can book a sick baby or child visit at Mums & Bums for an ear assessment and personalised advice.
Can You Treat Ear Pain at Home?
If your child has mild ear pain and is otherwise stable, there are safe ways to keep them comfortable while you monitor symptoms.
The goal of home care is to control pain and provide comfort, not to cure the infection itself. Many uncomplicated ear infections improve over a few days, but discomfort should still be managed properly. Here’s what helps.
Appropriate pain relief
Pain control is the most important part of early ear infection management. For babies and children, age-appropriate doses of Panado (paracetamol) and/or Nurofen (ibuprofen) can reduce pain and fever.
These medicines help by lowering inflammation and relieving pressure discomfort. They do not treat the infection directly, but they make children more comfortable while the body recovers or while waiting for reassessment.
Always use the correct dose for your child’s weight and age.
💊 If you’re unsure how these medicines work together or when they can be used, read our detailed guide on giving Panado and Nurofen safely to babies and children.
Keeping your child upright
Because ear pressure often worsens when lying flat, keeping your child slightly upright can reduce discomfort. Try to:
Hold your baby upright after feeds
Allow toddlers to rest with their head elevated
Avoid fully flat positioning during peak pain
Even small changes in position can improve comfort at night.
Encouraging fluids
Drinking fluids helps maintain hydration and supports recovery, especially if a fever is present. You may notice that swallowing temporarily eases pressure in the ear. Offering breast milk or formula, water (for older children), and small, frequent feeds can help maintain comfort and hydration.
A note on breast milk and ear infections
Breast milk contains natural immune-supporting and antimicrobial properties. Ongoing breastfeeding during illness is beneficial and may help reduce the overall risk of infections over time.
Some parents ask about placing expressed breast milk into the ear. While small studies suggest breast milk has antibacterial activity, its role in treating middle ear infections is limited. The infection sits behind the eardrum, and most cases involve inflammation in the middle ear space.
For mild discomfort, breastfeeding itself is supportive. However, if your baby has persistent pain, fever, or signs of a true ear infection, breast milk should not replace a proper medical assessment. If you’re unsure, it’s always safest to check before relying on any home remedy alone.
Home care can ease discomfort while you monitor how your child progresses. The key signs to watch are improvement in pain, feeding, and overall behaviour over the next couple of days.
If symptoms worsen, fail to improve, or you feel uncertain at any stage, a proper ear examination is the safest next step.
Ear Infections in Babies and Children: Knowing When to Monitor and When to Seek Care
Ear infections in babies and children are common, especially in the first few years of life. Many begin after a cold, cause discomfort for a few days, and then improve with supportive care.
Not every baby tugging at their ear has an infection. Teething, minor congestion, and normal developmental behaviours can look similar in the early stages. The difference usually becomes more obvious when you look at the full picture: fever, feeding changes, night-time pain, and whether symptoms are improving or worsening.
Most mild ear infections settle within a few days. However, severe ear pain, persistent fever, ear discharge, or symptoms lasting more than 2–3 days should be evaluated.
If your baby or child has ear pain, fever, or unsettled nights and you’re unsure whether it’s teething or a true ear infection, you can book a sick baby or child visit at Mums & Bums for a careful ear examination and personalised advice.
Early reassurance is just as important as early treatment.
Frequently Asked Questions About Ear Infections in Babies & Children
Can Teething Cause Ear Infections?
No, teething does not cause ear infections.
Teething can cause gum pain that radiates toward the ears, which is why babies may tug at their ears. However, a true ear infection involves inflammation or fluid behind the eardrum and is usually triggered by a cold, not a tooth eruption.
Can Babies Get Ear Infections Without Fever?
Yes, babies can have an ear infection without a fever.
Although fever is common, some children present mainly with ear pain, irritability, night waking, or feeding changes. Fever increases suspicion, but its absence does not rule out infection.
Can Swimming Cause Ear Infections?
Swimming can cause outer ear infections, but it does not usually cause middle ear infections.
Middle ear infections occur behind the eardrum and are typically linked to colds. Outer ear infections affect the ear canal and are more common after water exposure.
Can Ear Infections Affect Hearing?
Yes, ear infections can temporarily affect hearing.
Fluid behind the eardrum can reduce sound transmission, making hearing seem muffled during the infection. In most cases, hearing returns to normal once the fluid clears.
Why Does My Child Keep Getting Ear Infections?
Some children are more prone to recurrent ear infections, especially in early childhood.
Frequent colds, daycare exposure, enlarged adenoids, and young age all increase risk. Most children outgrow recurrent ear infections as their ear anatomy matures.
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