Ear Infection Concerns: When Pain and Fever Need a Review

A baby pulling at an ear may be uncomfortable, but the movement alone cannot tell you that there is an infection. Ear pain, fever, disturbed feeding, discharge or a change in hearing provide useful clues. A clinician usually needs to look inside the ear to identify the problem and choose treatment.

Arrange a medical review if you suspect an ear infection in a baby under twelve months. For an older child, ask your local primary care team or an appropriately trained pharmacist where an assessment is available. Seek help sooner when the child seems generally unwell or symptoms are worsening.

Know which changes need prompt help

Swelling around or behind the ear, discharge, a new change in hearing or significant illness needs urgent assessment. Painful swelling behind the ear that makes the ear stick out can be a sign of mastoiditis, a serious infection that needs treatment quickly. Do not wait for an ordinary appointment if this develops.

A baby in the first three months with a temperature of 38°C or higher needs immediate medical assessment. Breathing difficulty, a child who is hard to wake, blue or grey colouring, or a first seizure needs emergency help. These symptoms should not be attributed to an ear infection without assessment.

Describe more than the ear pulling

Tell the clinician when the discomfort started, whether one or both ears seem affected, and whether there has been a recent cold. Mention any fluid coming from the ear, changes in balance, or reduced response to familiar sounds. Describe feeding, wet nappies and any measured temperature.

Bring the names and doses of medicines already given. If your child has ear tubes, previous ear surgery, repeated infections or an immune condition, mention that too. These details help the clinician decide which examination and treatment are appropriate.

Why an antibiotic is not automatic

Many acute middle ear infections improve without antibiotics. A clinician may recommend pain relief and observation, an antibiotic prescription to use only under stated conditions, or immediate antibiotics. The decision depends on the examination, age, severity and risk factors. Ear discharge or infection in both ears in a child under two can change the likely benefit.

If you receive a prescription to use later, ask exactly when to start it and when to seek another examination instead. Do not use a previous prescription or someone else’s medicine. A worsening child needs reassessment even if a medicine has already been started.

Keep comfort measures appropriate

Use pain medicine only if suitable for your child’s age and health, following the actual product or prescription directions. The children’s medicine guide explains ingredient and dosing checks. Do not give aspirin under sixteen unless prescribed.

Wipe discharge gently from the outside of the ear. Do not insert cotton buds, fingers or other objects, and do not choose ear drops or oils without advice. Some drops are unsuitable when the eardrum is damaged or fluid is draining. Decongestants and antihistamines do not provide an established treatment for an ear infection.

Agree on the next review

Ask for another review if pain is not starting to improve within about three days, or earlier if symptoms worsen. Repeated infections and ongoing hearing difficulties also need attention. The guide to hearing concerns explains observations worth sharing rather than waiting for speech to be affected.

If a cold is making feeds difficult as well, include that in the care plan. Before the appointment ends, make sure you know who to contact overnight and which change should prompt immediate help.