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If your child has fluid in the ear, there is a good chance that he or she will get better without any treatment.

About 4 in 10 children with fluid in the ear get better without treatment within three months.¹

But in some children, especially younger ones, fluid stays in the ear for much longer. About 1 in 20 children who have fluid in the ear when they are younger than school age have it for a year or more.²

Even if fluid in the ear does clear up, it may come back. Between 3 in 10 and 4 in 10 children who get fluid in the ear once keep getting it again.²

And the younger your child is the first time he or she has an ear infection, the more likely he or she is to have more ear infections followed by fluid in the ear.³

Researchers don't know why children who have ear problems early in life are more likely to have these troubles come back. It may be that these children are having problems with their eustachian tubes (the tubes leading from the middle ears to the back of the nose). Or it may be that they have a problem with their immune system (the parts of the body that fight infection).³

It's hard to say how your child will be affected by fluid in the ear in the long term. If the fluid clears up after a few weeks or months, your child's hearing will go back to normal, and he or she will probably not be affected at all.

But if the fluid stays for a long time or comes back often, it may affect how your child develops. Having fluid in the ear during the first few years of life could affect:

• How soon your child talks
• How well he or she uses language
• How he or she behaves
• How well he or she does in school.

This is because a child with fluid in the ear may not be able to hear properly. The fluid stops the eardrum and the small bones in the middle ear from moving freely, so they can't carry sounds to the inner ear properly. Your child's hearing loss will probably be worse if both of his or her ears are affected.¹

To learn to talk and use language, your child needs to hear people speaking. If your child can't hear properly at an age when he or she is learning to talk, it could slow the development of his or her speech and language.¹ One large study of children aged 10 and under found that fluid in the ear was linked to delays in learning how to use language.⁴

There may be other problems, too. If your child can't hear the teacher, it may affect how well he or she does in preschool or school. And if your child can't hear properly at school or at home, he or she will feel frustrated and may start to misbehave.

But doctors and researchers are still unsure about all of this. For a start, they don't know just how long a child has to have fluid in the ear, or how much hearing loss it has to cause, for speech and language to be affected.⁵

And the amount of hearing loss caused by fluid in the ear varies. Usually, the hearing loss is mild.² But your child's hearing may change from day to day.

Also, it's not clear how fluid in the ear affects a child's use of language. Some studies have found that children who have repeated bouts of fluid in the ear get lower scores in language tests. But in other studies, having fluid in the ear for a long time didn't make any difference to how well children used language.² So it may be that some children have more problems from fluid in the ear than others do.⁶

Doctors usually recommend a period of watchful waiting to see if the fluid in the ear clears up on its own. (Watchful waiting is when your doctor regularly checks on your child rather than using a treatment.) If the fluid doesn't clear up and your child has a loss of hearing in both ears, then your doctor may recommend treatment. For more information, see What treatments work for fluid in the ear?.

If your child has fluid in the ear, it's wise to keep an eye on him or her to make sure that the condition clears up quickly. If you think the fluid isn't clearing up, or if it keeps coming back, take your child to the doctor. It's also a good idea to ask your child's teacher to keep an eye on your child.⁴

If your child has Down's syndrome, cleft palate or another disability, then even a short period of hearing loss from fluid in the ear can be a serious problem. Your doctor should make sure that your child is treated right away.¹

Once fluid in the ear clears up, your child's ears and hearing should return to normal. But in a very few children, this condition can cause further problems. For more information, see Complications of fluid in the ear.

There are several steps you can take to help keep your child's ears free of fluid and infection. For more information, see How to keep your child's ears healthy.

As children get older, fluid in the ear normally goes away completely. Problems with fluid in the ear don't normally continue after age 6.⁶

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.