Ear Infections in Children: What to Expect and When to Worry

Earache is one of the most common reasons a child is brought to a doctor, and one of the most common reasons a parent lies awake at 3am wondering whether to do something about it tonight. It is also one of the conditions where the instinctive response — get antibiotics — is usually the wrong one.

This article covers what normally happens, what actually helps, where a remote consultation fits, and the specific signs that mean your child needs to be examined today rather than tomorrow.

Start here: a video call cannot look inside an ear. Diagnosing an ear infection means seeing the eardrum through an otoscope. There is no remote substitute for that, and any service implying otherwise is overselling. What a remote consultation can do is take a proper history, work out how worried to be, and tell you where to go. That is genuinely useful — it is just not the same thing as an examination, and this article is written on that basis.

What usually happens

Earache in children usually comes on suddenly, and the pain can be severe. The reassuring part, as the HSE sets out, is that the severe pain generally lasts only a day or two, and earache is not usually a sign of anything serious.

The commonest picture is an ear infection following on from a cold: the tubes that drain the middle ear get blocked, pressure builds behind the eardrum, and it hurts. Often there is a fever with it. Sometimes the eardrum perforates, the pressure releases, discharge appears in the ear — and, counter-intuitively, the pain suddenly improves. That is alarming to see and usually heals on its own, but it is a reason to contact your GP.

Younger children who cannot say "my ear hurts" show it differently: pulling or rubbing at an ear, unusual irritability, not settling, off their feeds, disturbed sleep, sometimes just a fever with nothing else obvious.

Why antibiotics usually are not the answer

This is the part worth reading twice. Most earaches are caused by a virus, so antibiotics do not help — that is the HSE's own position, not a cost-saving one. Antibiotics do nothing to a virus, and giving them anyway brings side effects for your child and contributes to antibiotic resistance for everyone.

Even where the infection is bacterial, most middle-ear infections in otherwise healthy children settle without antibiotics. That is why Irish and international practice leans towards pain relief first and review, rather than an immediate prescription.

There are exceptions. The HSE notes that where a child is under 2 and has an infection in both ears, a GP may prescribe antibiotics. Other factors that push a doctor towards prescribing include a child who is very unwell, symptoms that are not settling as expected, discharge from the ear, or an underlying condition that changes the calculation. This is a clinical judgement about a specific child, which is precisely why it needs a doctor who has assessed that child rather than a rule of thumb from an article.

You may also be offered a delayed or "back-up" prescription — one you hold and only use if things have not improved after an agreed interval. It is a deliberate, evidence-based middle path, not a fob-off.

Our guide to antibiotics and when they actually help covers the wider picture.

What actually helps at home

• Pain relief is the main treatment. Age-appropriate paracetamol or ibuprofen, dosed by your child's weight and age, is what makes the difference to a child in pain. Follow the packaging or your pharmacist's advice — never adult doses, and never guess.
• A warm or cool cloth held against the ear helps some children. Use whichever your child prefers.
• Keep fluids up. Small amounts often is easier than pushing large drinks.
• Do not put anything into the ear — no drops, oil, cotton buds or remedies — unless a doctor who has examined the ear has told you to. If the eardrum is perforated, some things you might put in can do harm.
• Your pharmacist is a real resource and is free to talk to. They can advise on pain relief and will tell you if they think the child should be seen.

The HSE recommends undertheweather.ie for exactly this kind of self-care guidance on common infections.

When your child needs to be seen — and when to call 999

Contact your GP or the out-of-hours service today if:

• Your child is under 2, and particularly if both ears seem affected
• There is discharge or fluid coming from the ear, or you think the eardrum has burst
• Symptoms are not improving after two to three days, or are getting worse
• Your child has a high temperature that is not settling, or seems very unwell in themselves
• There is swelling, redness or tenderness of the bone behind the ear, or the ear is being pushed outwards
• Your child's face looks uneven or droops on one side, or they cannot close one eye properly
• Your child is very dizzy, unsteady, or says the room is spinning
• Your child has repeated ear infections, or you are worried about their hearing
• Your child has an underlying medical condition, a weakened immune system, or a grommet or other ear surgery in their history
• Something is not right and you cannot put your finger on it. Parental instinct is a recognised clinical signal, not a nuisance.

Call 112 or 999, or go to an emergency department, immediately if your child:

• Is having difficulty breathing, breathing very fast, or grunting with each breath
• Is very difficult to wake, floppy, unresponsive or confused
• Has a rash that does not fade when a glass is pressed against it
• Has a stiff neck, or is distressed by bright light, or has a severe headache with the fever
• Has a seizure
• Has blue, grey, pale or blotchy skin, lips or tongue

The HSE's page on getting urgent medical help if your child is very unwell is the authoritative version of this list and is worth reading before you need it.

Where an online consultation fits

Being direct about this, because the honest answer is more useful than the flattering one.

An online consultation can:

• Take a full history — how long, how bad, what else is going on, what you have already tried, what else your child has
• Help you judge how urgently this needs in-person assessment, which is often the actual question
• Advise on pain relief appropriate to your child's age and weight
• Discuss whether the picture sounds viral or whether it warrants examination
• Tell you clearly where to go: your own GP, the out-of-hours co-operative, an injury unit, or an emergency department
• Issue a medical certificate for a parent's absence from work where appropriate, or a school absence letter

An online consultation cannot:

• Look at the eardrum. This is the central limit. Acute otitis media is diagnosed by seeing the drum, and a camera pointed at the outside of a head does not do it.
• Feel behind the ear, check the neck, or examine the throat and chest properly
• Take a temperature, listen to breathing, or measure oxygen levels
• Safely diagnose an ear infection in a very young infant. Babies under a few months old with a fever need in-person assessment, and this is not something to work around.
• Replace emergency care. If your child is seriously unwell, do not book an appointment — ring 112 or 999.

If what you need is an ear examined, book with a practice that can see your child. A remote consultation that ends with "this needs looking at, go here" has done its job, but you can often skip straight to that step yourself.

Booking for a child on this platform

Our platform does support consultations for children, with two rules worth knowing before you try:

• A child is booked as a dependent on a parent or guardian's account, and this is available for children up to and including age 16.
• From age 17, a young person needs their own account, which they can claim with their medical history carried across.
• Child consultations are video only — not phone. Seeing a child is the minimum a doctor needs, even though video falls well short of an examination.

Common questions

How long should an ear infection last?

The severe pain typically eases within a day or two, and most ear infections settle within about a week. If your child is no better after two to three days, or is getting worse at any point, contact your GP.

My child's ear is discharging. Is that an emergency?

It is not usually an emergency, and the pain often improves once the pressure releases, but it is a reason to contact your GP rather than wait it out. Do not put anything into a discharging ear unless a doctor who has examined it has told you to.

Can I get antibiotics for my child's ear online?

Not on the basis of a description. A prescription for a child requires a doctor's clinical judgement about that child, and for ear infections that judgement normally rests on examining the ear — which a remote consultation cannot do. A GP may still prescribe remotely where they judge it appropriate on the whole picture, but it is not the expected outcome and should not be the reason you book.

Do repeated ear infections mean something is wrong?

Recurrent ear infections are common in young children and usually reflect anatomy that they grow out of. They are still worth raising with your own GP, particularly if you have any concern about hearing, speech or school performance, because that is the point at which a referral may be considered.

Should I keep my child off school?

Generally a child can return once they are well enough to take part in the day and any fever has settled. Your school may have its own policy. If you need a letter for the school or for your own absence from work, see our guide to sick certificates in Ireland.

Is it worth vaccinating against flu if my child gets a lot of ear infections?

Ear infections often follow viral illnesses, and the HSE runs a free children's flu vaccination programme. That is a conversation for your GP or pharmacist — we do not give vaccines. See our flu season guide for the current eligibility and where to go.

Where to check

• HSE — earache and HSE — ear infections
• HSE — get urgent medical help if your child is very unwell
• undertheweather.ie — HSE-recommended self-care for common infections
• HSE — find urgent and emergency care for your out-of-hours co-operative and nearest injury unit

Still not sure?

If the question is "does this need to be seen tonight, and where", you can book an online consultation with an Irish-registered GP and get a straight answer. If the question is "what does the eardrum look like", you need an in-person appointment, and we will tell you so.

If your child is seriously unwell, do not book an appointment. Call 112 or 999.

---

This article is general information about ear infections in children in Ireland. It is not medical advice, it is not a substitute for examining your child, and it cannot tell you how serious your child's illness is. If you are worried, contact your GP, your out-of-hours service or, in an emergency, 112 or 999.

---

This article was reviewed by Dr. Fasi Ullah, a General Practitioner registered with the Irish Medical Council. The information provided is for educational purposes and does not replace personalised medical advice.