Why Does My Kid Keep Getting Ear Infections? What to Know About Recurrent Ear Infections

“My ear hurts!” Most young kids will have this complaint at some point. Often, ear pain in children comes from a middle ear infection, called otitis media. By 3 years old, 60% of children have had at least 1 ear infection, and almost 25% have had more than 3.

But what happens if your child has back-to-back ear infections? Are recurrent ear infections the sign of a more serious problem? 

Let’s look at why kids may keep getting ear infections and what you can do to prevent them. 

Can ear infections come back after treatment with antibiotics?

Yes, ear infections can come back after treatment with antibiotics.

There are many viruses and bacteria that can cause middle ear infections. This means that after kids recover from an ear infection, they can come across a different bug and get sick again. 

If a kid gets a few ear infections throughout their early childhood, it’s usually not a cause for concern. But back-to-back episodes of otitis media can increase the risk of complications such as:

• Eardrum rupture

• Temporary hearing loss

• Tinnitus or ringing in the ears

• Spread of infection to other areas in the head and neck 

Recurrent otitis media is when a child has 3 middle ear infections in 6 months, or 4 infections in a year. 

What causes recurring ear infections?

Why do some kids get frequent ear infections and others don’t? There are a few reasons your kid may have recurrent ear infections.

Anatomy

The middle ear has three small bones that transmit sound from the ear drum (called the tympanic membrane) to the inner ear. A small tube (called the eustachian tube) drains fluid from this cavity to the back of the throat.

In young kids, the eustachian tube is shorter, narrower, and flatter, so it doesn’t drain as well. Anything that interferes with this drainage — like inflammation from a cold virus — makes it more likely for bacteria to get stuck in the middle ear space and cause infection. 

Other anatomic issues that make ear infections more likely include: 

• Large adenoids: Like the tonsils, adenoids are made of lymph tissue and help fight infection. They sit near the eustachian tubes in the back of the throat. Large adenoids can interfere with how the tubes drain, leading to more ear infections.

• Cleft palate: Some children are born with a split or separation in the roof of their mouth. This is called a cleft palate. This separation can put the muscles and tendons in the back of the throat in the wrong position and interfere with the drainage of the eustachian tube.

• Genetic conditions: Certain genetic conditions like Turner syndrome and Down syndrome affect ear development. Children with these conditions are often more prone to ear infections.

Exposure to viruses and bacteria

The more exposure your child has to viruses and bacteria, the more likely they are to get an ear infection. Children often pick up infections from kids at daycare or school, especially during colder months. Spending a lot of time indoors with other kids creates a perfect storm for more ear infections.

Not finishing antibiotics 

Ear infections caused by bacteria usually need to be treated with antibiotics. But kids don’t always do great taking antibiotics. If they don’t finish the complete course of medication, the infection may not clear. This can lead to back-to-back ear infections.

In other cases, the first choice of antibiotic may not work. For example, amoxicillin is often prescribed for bacterial ear infections. But even if the child takes the amoxicillin, the infection doesn’t always respond. This may be due to antibiotic resistance. In this case, your child may need a different antibiotic to help clear their infection.

Genetics

Parents who had many ear infections growing up also have kids who seem to get them. Studies in twins and triplets also suggest that there’s a genetic component for recurrent ear infections. 

How can genetics lead to ear infections? Researchers think there might be a few reasons, including:

• Changes in the bacterial environment in the middle ear: Kids may have different amounts of “healthy” bacteria naturally living in their ear, which may affect their chances of getting an ear infection.

• Differences in the immune system: Some kids may have a harder time fighting off the viruses or bacteria that lead to ear infections.

• Shape of the middle ear: Kids can inherit the anatomy of their middle ear. And some shapes make ear infections more likely to happen. 

How common are recurrent ear infections in children?

Many parents worry when their child has multiple ear infections. But it’s very common. Nearly 1 in 4 children will have more than 3 ear infections by the time they turn 3 years old. 

A recent study showed that you can predict how often kids may get ear infections based on two factors:

• The age of their first ear infection

• Whether or not they attend daycare 

Researchers found that children who had their first ear infection before 6 months of age and attended daycare were more likely to have back-to-back ear infections within a 6-month period.

Can you prevent ear infections in children?

There are a few steps you can take to help prevent ear infections: 

• Avoid smoke exposure: Secondhand smoke exposure can cause several health problems for children. Children who live in the home of a smoker are more likely to get ear infections. Get help quitting smoking here.

• Get your child immunized: Ear infection rates dropped after children started receiving vaccines against the pneumococcal bacteria — one of the most common bugs causing ear infections. Kids who get a yearly flu shot also seem to get fewer ear infections. 

• Breastmilk: The American Academy of Pediatrics recommends exclusive nursing for about the first 6 months of a child’s life (or bottle feeding expressed milk). Nursing has many benefits for both parents and children. One of those benefits is protection against ear infections. And this protective effect even seems to last beyond infancy.

• Wash your hands: There are many viruses and bacteria that can cause ear infections. Good hand washing can prevent your child from picking up bugs that lead to otitis media.

• Limit pacifier use: Some studies show that pacifier use protects against sudden infant death syndrome (SIDS). But other research shows it increases the risk of ear infections. This risk happens when children use pacifiers for extended periods outside of sleeping.

What should you do if your child keeps getting ear infections? 

If your child has recurrent ear infections, talk to their pediatrician. They may refer you to an ear, nose, and throat (ENT) specialist or otolaryngologist. 

At that visit, these specialists may discuss ear tube surgery, a brief procedure that involves putting small tubes in the eardrum. These tubes are called pressure equalizing tubes. That’s because they allow air into the middle ear space, which helps promote drainage and prevent fluid backup in the middle ear space.

Why trust our experts?

Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Our editorial standards

Meet our experts