Childhood Ear Infections

Every year, over 10 million children in the United States are treated for ear infections. Chances are that by the time a child reaches the age of six, he will have suffered otitis media, an infection of the middle ear. Ear infections are most common in children between the ages of six months and three years.

The ear is a complex structure that consists of three sections: the outer, middle, and inner ears. The outer ear is the part we see. It is the external canal that picks up the vibrations from sound and transmits them through the eardrum to the middle ear. The middle ear contains three small bones that take these vibrations into the inner ear, which contains the nerve endings that make hearing possible. The inner ear is also involved in maintaining balance.

The middle ear is connected to the nasal cavity and the throat by means of a I passageway called the eustachian tube. This allows excess secretions from the middle ear to drain away from the ear and into the nose and throat. If the eustachian tube is not draining properly, these secretions build up in the middle ear, with the result that pressure in the ear rises and the ear becomes painful and, often, infected.

Young children are more likely than others to develop middle ear infections because in infants, the eustachian tube is oriented more horizontally than vertically, making drainage more difficult than it is in older children. Fluids can collect and become blocked, creating an ideal environment for bacterial growth.

Most children outgrow ear infections as their bodies mature and the structure
of the inner ear changes. As a child grows, the eustachian tube begins to curve
downward, allowing fluids to drain more easily. When the eustachian tube develops
its characteristic mature curve, fluids drain readily and infections are less
of a problem. When fully mature, the eustachian tube has a pronounced downward angle
(see illustrations below)

Figure A: Infant

Figure B: Older Child

Structure of the Ear: In infants, the eustachian tube extends almost horizontally from the middle ear to the nasal cavity and the throat. (figure A) As a child grows, the eustachian tube develops a downward curve. (figure B)

Ear infections are often a complication of a common cold or other upper respiratory infection, such as infection of the adenoids, tonsils, or sinuses. They are sometimes accompanied by coughing, runny nose, sore throat, and, occasionally, vomiting and diarrhea. Depending on the cause of the infection, a fever may be present.

A child who can talk will be quick to tell you, “My ear hurts!” Babies and toddlers will “tell” you by pulling or tugging on their ears, by rubbing or hitting their ears, or by fussing and crying. A young infant may simply be irritable or run a high fever for no apparent reason.

Another common symptom of ear infection, which your child may not have the words to express, is a feeling of fullness and pressure. This is caused by the excess fluid pushing against the eardrum. Your child may have a slight hearing loss in the affected ear. In most cases, this is temporary. However, if ear infection and hearing loss occur repeatedly, they can cause long-term problems. According to the American Academy of Pediatrics, recurring ear infections with hearing impairment may slow speech and learning development, even if there is no permanent hearing loss.

After initial treatment, if your child does not improve within twenty-four hours, call your doctor again. The risk of a permanent hearing loss increases if an ear infection is not properly treated or does not respond to treatment promptly. It may be necessary to try another treatment.

Emergency Treatment for Ear Infection

If your child experiences a sudden, severe pain, with drainage from the ear, it can mean that he has a perforated eardrum. When the buildup of pressure finally causes the drum to rupture, the relief from pressure can actually cause a dramatic lessening of the pain. Even if your child seems to be feeling better, take him to the doctor right away for an examination.

If your child experiences fever, chills, dizziness, or a serious hearing loss, call your doctor. These signs indicate that the infection may have worsened or traveled to the inner ear, requiring prompt medical attention.

Another potential, and
extremely serious, complication is meningitis. If your child complains of a
severe headache, stiff neck, and lethargy, contact your physician immediately
(see Meningitis).

Conventional Treatment

Antibiotics, such as amoxicillin, Bactrim, Septra, Augmentin, Ceclor, Suprax, and Pediazole, are commonly prescribed for ear infections. Most children with a first-time infection feel significantly better within forty-eight to seventy-two hours after starting a course of antibiotics, but it is important for them to continue taking the medication for the full course to be certain all infection is gone. Your health care provider will want to see your child once the full course of antibiotics is completed, to make sure the infection has cleared. Because many ear infections persist even after the symptoms have eased, it’s important to keep follow-up appointments.

While antibiotics are a common treatment for ear infections, parents should be aware that a study done in the Netherlands compared children with ear infections who were treated with antibiotics to a control group who were given a placebo. Although the antibiotic group improved somewhat faster, it is interesting to note that there was little difference between the two groups in long-term outcome.

Some ear infections may not respond to the first medication prescribed. If your child doesn’t seem to be improving after four or five days, talk with your doctor. Another of fice visit and evaluation, and possibly a change of medication, may be required.

An analgesic, such as acetaminophen (Tylenol, Tempra, and others) can help to relieve the pain of an ear infection and also bring down fever.

Note: In excessive amounts, this drug can cause liver damage. Read package directions carefully so as not to exceed the proper dosage for your child’s age and size.

If your child’s ear infection is related to sinus or nasal congestion, an antihistamine and/or a decongestant may be prescribed. Antihistamines often cause sleepiness, so if your child can’t sleep because of the discomfort, your doctor may recommend one. Research has not shown these medications to be helpful in actually curing ear infections, however.

Frequent ear infections are the most common reason for childhood surgery. If your child has had more than three ear infections within a six-month period, with resulting documented hearing loss, surgery may be recommended. Myringotomy is one of the most common operations performed in the United States. In this procedure, performed under general anesthesia, a physician inserts tiny plastic tubes into the middle ear to allow drainage of the fluid that is not draining, as it should, through the eustachian tube. Once in place, the tubes do not hurt. Your child should not even be aware of them. If infected tonsils or adenoids are causing recurring ear infections, your doctor may recommend tonsillectomy or adenoidectomy. Reports of long-term outcomes for these treatments are contradictory, however.

Some doctors prescribe a steroid, prednisone, for children with chronic ear infections. Steroids are powerful drugs with potentially serious side effects and are not suitable for long-term use. If your doctor recommends this, discuss in detail his or her reasons for thinking that this is the appropriate treatment for your child.

Dietary Guidelines

Keep your child well hydrated. If you are breastfeeding, do so frequently. Offer an older child plenty of spring water, soups, herbal teas, and diluted fruit juices.

Eliminate dairy foods. Dairy foods thicken and increase mucus, making it more difficult for an infected ear to drain.

Nutritional Supplements

For age-appropriate dosages of nutritional supplements, see Dosage Guidelines for Herbs and Nutritional Supplements.

Lactobacillus acidophilus or bifidus is valuable for a child who is taking antibiotics, who has chronic ear infections, or who has an ear infection with a stomachache. In addition to killing infectious bacteria, antibiotics strip the body of necessary friendly bacteria in the intestinal tract Replace the friendly bacteria by giving your child lactobacilli (either 1/4 teaspoon of powder, 1 teaspoon of liquid, or half of the contents of a capsule), once daily, two hours after administering the antibiotic.

Vitamin C and bioflavonoids are helpful for an ear infection. They are both mildly anti-inflammatory. Give a child over four years old one dose, six times daily. Select a product that contains mineral-ascorbate-buffered vitamin C but no sugar. For younger children, purchase a vitamin-C supplement made specifically for infants and toddlers.

Zinc boosts the immune response and helps reduce infection. Give your child zinc-based lozenges, two to three times daily, as needed, for a total of one dose of zinc a day.

Note: Excessive amounts of zinc can result in nausea and vomiting. Be careful not to exceed the recommended dosage.

Herbal Treatment

For age-appropriate dosages of nutritional supplements, see Dosage Guidelines for Herbs and Nutritional Supplements.

Echinacea and goldenseal herbal combination formula is important for clearing any type of infection. Echinacea is antiviral; goldenseal is antibacterial and soothes irritated mucous membranes. Both herbs stimulate the immune system. The liquid extract is the preferred form. Give your child one dose, every two hours, while the infection is acute. After his symptoms have eased, give him one dose, three times daily, for one week.

Note: You should not give your child echinacea on a daily basis for more than two weeks at a time, or it will lose its effectiveness.

Garlic is an antibacterial that can help heal an ear infection. Choose an odorless form of garlic capsules; with the smell missing, children don’t usually object to it. Your child can either swallow the capsule whole or take it dissolved in soup or hot water. Follow the age-specific dosage directions on the product label. Or heat a fresh garlic clove in olive oil and, with your child lying on his side, put one or two drops of warm (not hot) oil into the affected ear.

Mullein oil is a traditional Native American remedy used to reduce swelling and inflammation. Gently heat mullein oil to slightly above body temperature and, with your child lying on his side, put one or two drops into the affected ear. The heat feels comforting, while the mullein goes to work on the problem.


The symptom-specific remedies listed here should work quickly. If your child’s pain does not subside within twenty-four hours, call your physician.

If your child has a fever, a red face, dilated pupils, and hot and moist skin, give him Belladonna. This is for a child with a throbbing earache that is relieved by resting with the head elevated. Give this child one dose of Belladonna 30x or 9c, two to three times daily, for one day.

For an earache that occurs with teething, give Chamomilla. The Chamomilla baby is crying, angry, obstinant, whiny, and irritable, but is comforted when carried around. Often he has one red cheek and one pale cheek with hot, moist skin, and his pain is intolerable. Give him one dose of Chamomilla 12x, 30x, 6c, or 9c, three times daily, for one to two days.

If your child has a fever along with an ear infection, give him Ferrum phosphoricum. This homeopathic preparation can be given together with another symptom-specific remedy. Give up to four doses of Ferrum phosphoricum 12x or 6c, thirty minutes apart.

Kali muriaticum helps relieve nasal congestion and swollen glands. It will benefit the child with a blocked eustachian tube that has affected his hearing. Give one dose of Kali muriaticum 12x or 6c, three times daily, for one to two days.

For a child who has a moderate fever and an earache that comes on gradually, use Pulsatilla. An important symptom that distinguishes a Pulsatilla child is the desire for cold; this child wants to be in fresh air-near a window or outdoors-and feels better with a cold compress. Give this child one dose of Pulsatilla 30x or 9c, three times daily, for one to two days.

Mercurius dulcis often works if other remedies have failed. Give your child one dose of Mercurius dulcis 12x or 6c, three times daily, for two days.

If none of the above remedies seems right for your child, a homeopathic combination earache remedy may be helpful.

If your child has ear surgery with a myringotomy and tube placement, give him one dose of Arnica 30x or 9c, three or four times daily, for two days. Arnica helps reduce inflammation surrounding the tube and also helps the body adjust to the tube’s presence.

General Recommendations

The pain of an earache is caused by pressure as the congested middle ear pushes on the eardrum. To promote drainage, prop your child at a 30-degree angle.

Prepare and use one of the herbal oil ear drops recommended under Herbal Treatment, above. A drop or two of warm oil on the eardrum helps relax and anesthetize the membrane, lessening the pain.

If your child cannot tolerate ear drops, apply a warm compress. If the warmth is comforting, use that knowledge to guide you in choosing an appropriate symptom-specific homeopathic remedy. Some children seem to feel better with a cold compress. Experiment with hot and cold to see what helps. If your child doesn’t like the warmth, give him homeopathic Pulsatilla.

If your child has an ear infection, avoid taking him on airplane flights. A child with an earache or upper respiratory infection will be very uncomfortable traveling by air. Air travel does not necessarily injure the ear or increase your child’s risk of developing an ear infection, but the change of air pressure in the cabin on takeoff and landing can greatly increase the pain. If you must fly with a child who has an ear infection, it may be worthwhile to give him nasal decongestant drops, along with acetaminophen, before takeoff.


Do not expose your child to cigarette smoke. Studies show that children who live in households with one or more smokers suffer more ear infections than those from smoke-free households.

Do not give your baby a bottle to suck on while he is lying flat on his back. This position allows fluid to drain directly into the middle ear. Instead, hold or prop your infant at a 30-degree angle.

Massaging your child’s ear can help keep the eustachian tube open. Using gentle pressure, draw a line along the back of the ear and down the back of the jawbone. Gently push and release the flap of skin in front of the ear several times. You can also massage your child’s ear by placing the fleshy part of your palm, just belong your thumb, over your child’s ear, and rotating the ear in all directions.

Use an elimination diet to determine if food allergies are contributing to the problem. Cow’s milk tops the list of common troublemakers. Other common allergens worth deleting for a child with recurring ear infections include eggs, wheat, corn, oranges, and peanut butter.

If your child is subject to recurring ear infections, do not expose him to common irritating allergens such as pet dander. Down comforters and pillows are another possible source of trouble. Items like carpets, draperies, and stuffed toys all collect dust and are possible offenders as well.

Minor bupleurum is a Chinese herbal formula that helps to strengthen resistance to infection. It can be very helpful in preventing the recurrence of ear infections. Give your child 3 to 5 drops, five days a week, for one month. Discontinue it for three weeks, then resume giving 3 to 5 drops, five days a week, for another month. Discontinue it for another three weeks. Repeat this regimen for a six-month period.

Note: Minor bupleurum should be used as a preventive only. It should not be given to a child with a fever or any other sign of an acute infection.

If your child suffers from repeated ear infections, give him 1/3 tube of homeopathic Anas barbariae (available as a product called Oscillococcinum), once a week, during the month or two he is most susceptible to infection.

In some cases, chiropractic care and cranial-sacral work may be helpful for a child with recurrent ear infections.

If your child suffers from recurring earaches, your physician may recommend a daily low dose of antibiotic to suppress any possible developing infections. If your doctor advises this, discuss it thoroughly to find out why he or she considers it an appropriate treatment for your child. A child on such a regimen will need to be seen by the doctor every month or so. He will also need to take yogurt or a lactobacillus acidophilus or bifidus supplement every day to counteract the effect of the medication on his digestive system. This approach may be effective in a few particularly intractable cases, but it runs the risk of creating antibiotic-resistant organisms and inhibiting the development of the body’s own natural resistance. It is better to consider and try all other options before agreeing to give your child a daily dose of antibiotics. It may not be presented as such, but this is an extreme-and not necessarily health-promoting-type of treatment.

Dosage Guidelines
Herbal Medicine
Bach Flowers

From Smart Medicine for a Healthier Child by Janet Zand, N.D., L.Ac., Robert Rountree, MD, Rachel Walton, RN, ©1994. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.

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Written by Janet Zand LAc OMD

Explore Wellness in 2021