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Explained: Are some kids more susceptible to ear infections?

Posted March 11, 2014

I have one kid who got ear infections all of the time as a young child. I have another one who only ever had one that resolved without a round of antibiotics.

Are some kids more susceptible to ear infections? Or does it have more to do with where they're spending their days? 

Dr. Michael Ferguson, director of WakeMed Physician Practices' Ear Nose and Threat, Head and Neck Surgery Program, tells me that the answer is probably a little of both.

"Certainly anatomy is absolutely in play for kids that get ear disease," he said. "It's all about what we call Eustachian tube function. Everybody has a little pressure equalizing valve that lets you pop your ears or ventilate your ears. A kid's inability to do that well will lead to ear infections." 

"Now we don't really have any answer as to why one sibling gets it and why the other doesn't," he said. "That's where it runs into the dumb luck category. ... There are definitely some genetics involved and we don't know exactly what they are or how to predict."

If a child has a parent or sibling with lots of ear infections, however, they typically are more likely to have them than the general population, he said.

Other risk factors: 

  • Boys are more likely to get ear infections than girls.
  • Certain races and populations also are more prone to getting ear infections. For instance, Native Americans are at a slightly higher risk than whites.
  • Day care attendance puts kids at a higher risk for ear infections.
  • And passive smoke is a big risk factor.

"Smoke is an irritant," Ferguson explained. "Irritants probably cause inflammation of the opening of the Eustachian tube and the tube isn’t functioning as well as it should."

Ear infections happen year round, many parents of young kids can tell you, but there's typically a spike in the winter months when kids are at the most risk of getting upper respiratory infections.

"The bacteria and virus gets in the ears from the nose," Ferguson said.

Hand washing and germ prevention are key to keeping those illnesses at bay. For kids with chronic allergies, Ferguson said, it's important to treat those allergies to reduce the risk for ear infections.

But you can do everything right and still end up with a kid in pain from hurting ears. 

"Kids that are prone to get ear infections are frankly going to get ear infections," he said. "Eventually, the body outgrows it." 

And that's the good news.

The biggest peak for ear infections is between six months and 13 months of age. If your child is three and hasn't had an ear infection for a while, you're probably out of the woods, he said. Kids typically grow out of ear infections by about age 2 or 3.

Ferguson explained that Eustachian tubes become longer and have a steeper angle as the head develops. 

"As the body grows and the tube angle changes, then it begins to function more normally," he said. "The theory behind it is if you’ve got a shorter, taller Eustachian tube then the distance it takes for the bacteria to get into the middle ear, it is physically easier."

Ferguson said doctors have been quick to prescribe antibiotics to kids with ear infections, but, in many cases, they will resolve after a couple of weeks. 

"The interesting thing is that obviously in a highly functioning, highly educated society like Raleigh, Durham and Cary, you’re going to find that kids will get treated much quicker for ear infections than even some people recommend," he said. "And, what I mean by that, if you didn’t treat the majority of acute ear infections with anything and just let them run their course, most of those times, the body is going to take care of the ear infection."

But, for busy parents and kids, who can't miss work or school for 10 to 14 days as an infection resolves, antibiotics can speed up recovery.

Still, Ferguson tells me he's having more conversations with parents about whether antibiotics are really necessary to treat an ear infections.

"I present options and options are certainly you can wait and hear the pros and cons to waiting or we can choose to treat this and turn the symptoms down," he said.


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  • catcalls99 Mar 13, 2014

    Here are a couple of articles citing research about what does and doesn't increase risk of ear infections, in case anyone is interested.

  • archmaker Mar 13, 2014

    not popular to admit, but should be pointed out that having pets in the house is a risk factor for both ear and lung problems in kids.

  • Sarah Hall Mar 13, 2014
    user avatar

    I exclusively breastfed both of my girls for more than a year - one had a lot of ear infections, the other didn't. But it is true that breastfeeding can reduce the risk of ear infections ( Thanks for noting!


  • Stacy Stowe Mar 12, 2014
    user avatar

    Good point little girl was nursed exclusively, but also had some minor allergies, including a dust allergy that we think may have been responsible for at least some of the infections. There is very good research with regards to less ear infections in breastfed babies. Our situation had other factors involved, but I believe nursing is best for as long as possible to ward off countless health threats to babies. Research suggest that even a very short duration of nursing will help a child's immunity. The mother to baby biology is perfectly balanced by nature. Happy to say, my little girl is a strong, healthy 9 year old now.

  • Susan Olvera Mar 12, 2014
    user avatar

    I'm surprised this wasn't mentioned here as it's such common knowledge among pediatricians and even parents, but there's a higher rate of ear infections in children who were bottle fed ( formula and breast milk ) and a much higher for those were exclusively formula fed. The bottle theory is that it puts more pressure on the ear using a bottle to eat rather than nursing. The rates of increased ear infections in children who were formula fed are related to the nutritional content of the formula also very common knowledge in a pediatrician's office.

  • Stacy Stowe Mar 12, 2014
    user avatar

    As a mother of a child who had 4 sets of tubes by age 4, I was always concerned about the overuse of antibiotics. Sometimes her doctor would find ear infections & we never heard a peep out of her. Other times she would be sobbing in pain. My advice is to base treatment on the discomfort of the child. Ear infections are not contagious, so as long as they are not in pain, school is fine.