Ear infections in infants are among the most common infections in early childhood. The peak occurs between six and thirty months, and more than two-thirds of children will have at least one. Since 2021, the French National Authority for Health has precisely regulated antibiotic use according to the child's age and the type of ear infection.
This article brings together what French official sources say: the signs to look for, when to seek medical advice, what the recommendation provides for, and the factors that increase the risk. It does not replace medical advice.
What is an ear infection in an infant?
It is an inflammation of the middle ear, the cavity behind the eardrum. It most often occurs in the days following a cold, when inflammation spreads to the Eustachian tube and prevents the cavity from being ventilated.
Health Insurance distinguishes between two forms, which can only be differentiated by examining the eardrum.
- Congestive otitis. The eardrum is red, with no fluid buildup. The cause is viral, and it resolves on its own within a few days.
- Acute purulent otitis media. The eardrum is opaque, congested, and bulging, with pus behind it. The cause is bacterial.
This distinction is not merely theoretical. It determines whether or not an antibiotic is prescribed.
At what age does it occur most often?
French pediatric literature places the peak frequency between six and thirty months. Two reasons explain this concentration.
The first is anatomical. In infants, the Eustachian tube is short, wide, and almost horizontal, which makes it easier for germs to pass from the nose to the ear. It gradually becomes more vertical as the child grows.
The second is immune-related. This is the age when children are exposed to respiratory viruses on a large scale, often when they start attending daycare. About one-third of children experience recurrent ear infections.
How can you recognize an ear infection in a baby who cannot speak?
That is the whole difficulty: the child cannot point to where it hurts. Several signs should suggest an ear infection, especially if they occur after a cold.
- A fever that reappears while the cold was improving.
- Unusual crying, worse when lying down.
- Sudden, inconsolable nighttime waking.
- Refusing to breastfeed or eat, as sucking increases the pain.
- Repeatedly bringing a hand to the ear.
- Discharge from the ear canal, a sign of a perforated eardrum.
None of these signs is specific on its own. Only an examination of the eardrum by a healthcare professional can determine the diagnosis, making consultation essential.
When should you seek medical advice?
If otitis is suspected in an infant, medical consultation is necessary without delay. Before the age of three months, any fever warrants prompt medical advice, whatever the presumed cause.
Certain signs require urgent medical attention: a child who is extremely lethargic or difficult to wake, a stiff neck, painful swelling behind the ear, or facial asymmetry. These situations remain exceptional.
Antibiotics: recommendations from Haute Autorité de santé
Before the age of two
For a child aged three months to two years with acute purulent otitis media, HAS recommends starting antibiotics immediately. Amoxicillin is the first-line treatment, for a duration of ten days.
After the age of two
After the age of two, management depends on the intensity of the symptoms. In mild cases, initial watchful waiting is recommended, with reassessment within forty-eight to seventy-two hours.
If symptoms are severe, amoxicillin is prescribed for five days. In cases of otitis associated with conjunctivitis, Assurance Maladie indicates using amoxicillin combined with clavulanic acid.
Pain comes first
Paracetamol is the first-line painkiller. HAS specifies that nonsteroidal anti-inflammatory drugs should only be used as a second-line treatment if paracetamol is not enough, and that fever alone does not justify their use.
With appropriate treatment, Assurance Maladie indicates that symptoms improve in about three days. A perforated eardrum generally heals within around ten days.
What the French figures say about antibiotics
This rigor in prescribing is not theoretical. In May 2025, Santé publique France published the 2024 data on outpatient antibiotic consumption. They show a 4.8% increase in prescriptions compared with 2023, meaning more than 860 prescriptions per 1,000 inhabitants per year.
Consumption, expressed in defined daily doses, increased by 5.4% to reach 22.1 per 1,000 inhabitants per day. France remains the second-highest consumer of antibiotics in Europe.
One point is worth noting: among children aged zero to four, prescriptions have stabilized, whereas they were increasing significantly among those over sixty-five. The national target is 650 prescriptions per 1,000 inhabitants by 2027.
Factors that increase the risk
Several factors are documented, and some can be modified.
- Group childcare. Attending a daycare center triples the risk of acute otitis media due to viral exposure. This factor legitimately forms part of the consideration of childcare arrangements, without being the main criterion.
- Secondhand smoke. It irritates the respiratory mucous membranes and promotes ENT infections. We have compiled the official data on this topic in our article on secondhand smoke and babies.
- Winter viral infections. Most ear infections follow a cold. The same barrier measures as those for bronchiolitis apply here.
- Giving a bottle while the baby is lying down. This encourages reflux toward the Eustachian tube. Holding the child upright during feeding is a simple measure.
Conversely, breastfeeding significantly reduces the risk, according to the pediatric literature. Our article on official breastfeeding data in France details what the WHO recommends.
Pneumococcal vaccination also reduced the incidence of ear infections by around 10% in real-world settings. It is included in the infant vaccination schedule.
Finally, limiting exposure to enclosed, crowded places during viral peaks remains useful in the first few months, as we explain in our article on a newborn's first outings.
Recurrent ear infections and hearing
Fluid that persists behind the eardrum can temporarily reduce hearing. In a child learning to speak, this decrease can easily go unnoticed and may affect language development.
This is why recurrent ear infections warrant monitoring by an ENT specialist. If your child no longer reacts to familiar sounds or seems to be making no progress in their development, mention it: our article on babies' auditory development describes the normal milestones.
Can you bathe a baby who has an ear infection?
Yes, bathing is still possible. The precaution concerns water entering the ear canal, especially if the eardrum is perforated and there is discharge.
Avoid fully immersing the head and rinsing the hair with shampoo during the acute phase. A stable, semi-seated position limits splashing, making the moment easier to manage: we explain the options in detail in our guide to baby bath seats and their use.
Swimming should, however, be postponed until complete recovery, especially after a perforation.
Sources
- Assurance Maladie (ameli.fr), Consultation, Treatment and Progression of Acute Otitis Media, page updated on February 5, 2026.
- Haute Autorité de santé, Choice and Duration of Antibiotic Therapy: Acute Suppurative Otitis Media in Children, summary sheet published on August 27, 2021, updated on May 14, 2025.
- Santé publique France, Prescriptions and Antibiotic Consumption in the Community Increase in 2024, press release and report, May 2025.
- Pediatric Infectious Diseases Group and ACTIV, Acute Otitis Media in Children, review article, 2019-2020.
