Ear infections and night waking
They screamed at two in the morning and pulled at one ear. Ear infections are among the most common causes of sudden night waking in the first two years, and they are routinely blamed on teeth for a week first.
3 min read
The tube connecting the middle ear to the throat is shorter and more horizontal in babies than in adults, which drains less effectively and makes infection more likely - particularly after a cold. Fluid builds up, pressure increases, and it hurts.
It hurts more lying down. Pressure in the middle ear rises when horizontal, which is why a baby can be reasonably cheerful all day and inconsolable the moment they are put down. That pattern is the single most useful clue.
Signs to look for
Sudden, sharp night waking. A baby who was sleeping well, waking screaming rather than grumbling.
Pulling, rubbing or batting at an ear. Though plenty of babies with ear infections do not touch their ears at all, and plenty who do have nothing wrong.
Refusing to lie flat, or on one side. Settling only upright, or turning away from one side consistently.
A recent cold. Most ear infections follow one by a few days.
Fever, reduced feeding, discharge from the ear. Discharge means the eardrum may have perforated - that needs seeing promptly, though it often relieves the pain.
What to do
See your GP. Ear infections need looking at, and an examination takes seconds. Many resolve without antibiotics, but that is a decision for a clinician who has seen the eardrum rather than for a parent working from symptoms.
Meanwhile, pain relief appropriate for their age helps considerably, and holding them upright for a while before putting them down can take the edge off. Do not put anything into the ear - no drops, no oil, nothing - without medical advice.
Fine all day, screaming the moment they lie down. That combination is worth an appointment, not another week of teething gel.
Afterwards
Sleep usually recovers within a few days of the pain resolving. Habits formed during the illness come apart quickly if you return to normal within a week.
Recurrent ear infections - three or more in six months - are worth raising, as is any suspicion about hearing afterwards. Persistent fluid can affect hearing and, in turn, speech development.
Why they cluster after colds
The tube between the middle ear and the throat is shorter and flatter in babies, and a cold makes it swell and drain poorly. Fluid collects, bacteria grow in it, and pressure builds - which is why an ear infection so often arrives three or four days into what looked like an ordinary cold, just as the child seemed to be improving.
That timing is worth knowing. A baby who was getting better and has suddenly become much worse at night, four days into a cold, is a familiar pattern in a GP surgery, and it is worth going in rather than assuming the cold has simply taken a turn.
What happens at the appointment
A GP will look in both ears with an otoscope, which takes seconds and tells them what they need to know. Many ear infections resolve without antibiotics and a delayed prescription is common - a script to use only if things have not improved in a few days.
That is a reasonable approach and it does not mean the visit was unnecessary. Getting the ear looked at is what distinguishes an infection from teething, and it is also what catches the small number of cases that need treating promptly. Pain relief appropriate for their age is the main thing that helps in the meantime.
When to stop troubleshooting
See a GP urgently for a high fever, a stiff neck, swelling or redness behind the ear, a baby who is very unwell or difficult to rouse, or discharge from the ear. Any fever in a baby under three months needs same-day medical advice.
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