Middle Ear Infection in Children

A painful infection behind the eardrum, usually after a cold. Very common in young children: most have at least one before school. Most get better within about 3 days without antibiotics, so pain relief is the main treatment.

The ear infection ladder

Pain relief for everyone. Antibiotics for children who are very unwell or more likely to benefit. Grommets for frequent infections.

1. Step 1 · Self-careRegular pain relief (paracetamol or ibuprofen)Dosed for your child’s age or weight, given regularly for the first day or two.

   Works

   The main treatment: it eases pain while the infection settles. Most children improve within 3 days and nearly all within a week

   Cost

   About $5–15

   How long

   A few days

   Watch for

   Check the dose on the pack. No aspirin for children.

   Treat the pain, not the panic. Most ears sort themselves out.

2. Step 2 · GPGP check and “wait and see”Your GP looks in the ear and checks your child over. Some families get a back-up script to use only if things aren’t improving.

   Works

   Without antibiotics, about 84 in 100 children no longer have ear pain by day 2–3

   Cost

   GP visit often bulk billed for children, or about $40–80 gap

   How long

   Fill the back-up script if not starting to improve after 2–3 days, or sooner if worse

   Watch for

   Return sooner if your child becomes more unwell, has ear discharge, or isn’t drinking.

   Waiting isn’t doing nothing. It’s doing the right amount.

3. Step 3 · PrescriptionAntibiotics (usually amoxicillin)For children who are very unwell, under 2 with both ears infected, with fluid draining from the ear, or at higher risk of complications, including many Aboriginal and Torres Strait Islander children.

   Works

   For every 20 children treated, about 1 has less pain at day 2–3 because of the antibiotic, and about 1 in 14 gets vomiting, diarrhoea or a rash. The benefit is bigger in the higher-risk groups

   Cost

   Under the $25 PBS co-payment ($7.70 concession)

   How long

   Usually 5–7 days, as prescribed

   Watch for

   Rash, diarrhoea, thrush. Tell your GP about any penicillin allergy.

   Great when needed. Tummy chaos when not.

4. Step 4 · SpecialistEar, nose and throat surgeon (grommets)Tiny tubes in the eardrum for frequent infections, or for glue ear that’s affecting hearing.

   Works

   In small, older studies, children with grommets had about 1–1.5 fewer ear infections over the next 6 months. Low-quality evidence

   Cost

   Free in public hospitals (waits apply); private costs vary

   How long

   A short day procedure under general anaesthetic. Grommets usually fall out by themselves

   Watch for

   Needs an anaesthetic. Ask about hearing tests first if fluid lingers.

   Small tubes, big difference for some ears. Not a first move.

Costs are rough Australian prices in November 2026 and vary by provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

• Decongestants and antihistaminesTrials show they don’t help ear infections, and cough and cold medicines shouldn’t be given to children under 6.
• Ear candlingDoesn’t remove anything and can burn the ear canal or damage the eardrum.
• Oil, garlic or homeopathic ear dropsNo good evidence for middle ear infections. The infection is behind the eardrum, out of reach.

What you can do

• Give regular pain relief at the right dose, and offer plenty of fluids.
• Don’t put anything in the ear, including cotton buds or drops, unless a doctor suggests it.
• Keep your child away from cigarette smoke, at home and in the car.
• Keep vaccinations up to date, including flu and pneumococcal vaccines.
• Breastfeed if you can, feed babies upright, avoid bottles in bed and limit dummy use.
• Worried about hearing or speech after repeated infections? Ask for a hearing check.

See your GP if

• Ear pain with fever, or your child seems unwell
• Not starting to improve after 2–3 days, or getting worse
• Fluid or pus draining from the ear
• Babies under 6 months with a suspected ear infection
• Frequent ear infections, or worries about hearing or speech
• Aboriginal and Torres Strait Islander children with ear pain or discharge: see a doctor early

Go to emergency or call 000 (Australia) or your local emergency number for redness, swelling or pain behind the ear or an ear that sticks out, a stiff neck, a child who is floppy, drowsy or hard to wake, weakness on one side of the face, or a baby under 3 months with a temperature of 38°C or more.

Helpful resources

• Healthdirect: Middle ear infectionSymptoms, treatment and prevention, plus a 24/7 nurse line on 1800 022 222. Free, Australia.
• Queensland Children’s Hospital: Ear infectionParent fact sheet on pain relief, antibiotics and when to come back. Free, Australia.
• Hearing AustraliaFree hearing checks for eligible children, including the Hearing Assessment Program – Early Ears for Aboriginal and Torres Strait Islander children. Australia.

Evidence and more information

• NICE: Otitis media (acute) antimicrobial prescribing (NG91)
• Cochrane (2023): Antibiotics for acute otitis media in children
• AAFP: Antibiotics for otitis media in children (Cochrane summary)
• Cochrane (2018): Grommets for recurrent acute otitis media in children
• Healthdirect: Otitis media

Reviewed 1 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

maladywise.com/ear-infection/