Topic Overview
Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear). Ear infections (otitis media) most commonly occur when cold symptoms, such as a runny or stuffy nose and a cough, have been present for a few days.
An ear infection may occur when the eustachian tube swells and closes and fluid accumulates in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection causes pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.
Middle ear infections are more common in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.
Ear infection is the most commonly diagnosed bacterial infection in children younger than age 7. Almost all children will have at least one ear infection by the time they are 7 years old. Most ear infections occur in babies between the ages of 6 months to 3 years. After age 7, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections are more common in boys than in girls, and they most often occur in children who:
- Spend time in day care settings.
- Are bottle-fed.
- Use a pacifier.
- Live in households where parents or caregivers smoke.
- Have had a previous ear infection.
- Have problems present since birth (congenital abnormalities), such as cleft lip, cleft palate, or Down syndrome.
Fluid often remains in the middle ear (serous otitis, or middle ear effusion) after an ear infection. This may cause no symptoms, or it may cause a muffling of sound, decreased hearing, and mild discomfort. The body usually reabsorbs fluid behind the eardrum within 4 to 8 weeks, and hearing returns to normal. Recurrent ear infections and persistent effusion may occur in some children.
Even though ear infections are a common cause of ear pain, not all ear pain indicates an infection. Other common causes of apparent ear pain in young children include:
- Teething.
- A sore throat.
- An accumulation of earwax.
- An object in the ear.
- Air pressure changes.
- Fluid buildup without infection (serous otitis).
When evaluating ear pain in a child, remember that ear infections commonly occur after symptoms of a cold have been present for a few days. When other symptoms are present, ear pain or drainage may be less important than the other symptoms. Signs of a serious illness may indicate a problem that requires immediate medical treatment.
Review the Check Your Symptoms section to determine if and when your child needs to see a health professional.
Check Your Symptoms
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review health risks that may increase the seriousness of your child's symptoms.
If your child has any of the following symptoms, evaluate those symptoms first.
- An ear problem after a head injury: Go to the topic Head Injury, Age 3 and Younger.
Has your child had an injury to the ear?
See significance of injury to the ear if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
| Note: |
Hearing problems can be very difficult to assess in children, especially in children age 3 and younger. The following may help you evaluate your child's hearing at age: |
Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Has your child developed sudden, complete hearing loss?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Does your child have some hearing loss?
Does your child have drainage or bleeding from the ear?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Has your child had gradual and persistent symptoms for longer than 24 hours?
Have your child's mild symptoms continued with no improvement for longer than 1 week?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Does your child have drainage from the ear that you do not think is earwax?
See significance of drainage from the ear if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
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Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Does your baby younger than age 3 months have any drainage from the ear?
Does your child age 3 months or older have unexplained bleeding from the ear?
Call your child's health professional today if you answer "Yes" to the following question.
Does your child age 3 months or older have drainage from the ear that looks like pus or fluid that is white, yellow, or bloody?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Has your child had minimal bleeding for 24 hours or longer from a scratch or from cleaning the ear?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
See significance of fever if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
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Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Does your baby younger than 3 months old have a temperature of 100.4° (38°) or higher?
Do you think your baby younger than 3 months old has a fever, but you are unable to measure his or her temperature?
Does your child older than age 3 months have a temperature of 105° (40.6°) or higher?
Do you think your child older than age 3 months has a high fever, but you are unable to measure his or her temperature?
Does your child have a disease or take medicine that causes problems with his or her immune system?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Does your child older than age 3 months have a temperature of 102° (38.9°) or higher?
Do you think your child older than age 3 months has a moderate fever but you are unable to measure his or her temperature?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Does your child older than age 3 months have a temperature of 100.4° (38°) or higher that has not come down after 24 hours of home treatment and medicine?
Do you think your child has a fever that has not come down after 24 hours of home treatment and medicine?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you think your child has ear pain? See evaluating pain in a child.
See significance of ear pain if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional immediately if you answer "Yes" to the following question.
Call your child's health professional today if you answer "Yes" to the following question.
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Has your child had continuous mild ear pain for 24 to 48 hours?
Has your child had mild ear pain that comes and goes (intermittent) for 1 week or longer?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Does your child have redness, swelling, or pain in the external ear or behind the ear?
See significance of redness, swelling, or pain in the external ear or behind the ear if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Does your child have a disease or take medicine that causes problems with his or her immune system?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Does your child have redness, swelling, or pain around or behind the ear?
Is most of the outside of your child's ear (external ear) red or swollen?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Has your child had some redness or mild swelling on part of the outside of his or her ear (external ear) for 24 hours or longer?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Is your child taking an antibiotic for an ear infection without an improvement in symptoms, or have new symptoms developed?
See significance of symptoms that do not improve with antibiotic treatment if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional today if you answer "Yes" to any of the following questions.
| Note: |
If you answered Yes to any of the following questions, call your health professional for a possible change in medicine or reevaluation. An appointment may not be necessary. |
Are your child's symptoms worse after 48 hours of antibiotic treatment?
Have your child's symptoms not improved after 72 hours of treatment?
Does your child have new drainage from his or her ear?
Has your child developed a rash while taking antibiotics for an ear infection?
Does your child have severe diarrhea?
Have your child's symptoms returned within 10 days of completing treatment with antibiotics?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you think your child may have a hearing problem?
See significance of a hearing problem if you need information to help you answer the question below.
Review health risks that may increase the seriousness of your child's symptoms.
Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.
Do you think your child may have a hearing problem (especially after an ear infection)?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Other Symptoms to Watch For
Does your child have the following symptom?
- A cut: Go to the topic Cuts.
If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment
When ear discomfort or pain is mild or comes and goes (intermittent) and occurs without other symptoms, home treatment may be all that is needed to relieve your child's discomfort. Home treatment measures include the following:
- Encourage your child to swallow more often. The discomfort may be caused by a blocked eustachian tube that can occur with mild irritation in the ear canal. Let a child younger than age 12 months drink from a bottle or cup to help open the eustachian tube. A child age 2 or 3 may get the same benefit from chewing gum. Be sure to supervise your toddler when he or she chews gum.
- Some babies and children with ear pain are more comfortable in an upright position. Allow the child to rest in the position that is most comfortable.
- To relieve moderate to severe ear pain while waiting to see your doctor, or to relieve a red, swollen external ear:
- Apply heat to the ear to ease pain. Use a warm washcloth. Be careful not to burn the skin around the ear. There may be some drainage when the heat melts earwax.
- Encourage your child to rest as much as possible.
| Try a nonprescription medicine to help treat your child's fever or pain: |
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Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen to treat a fever. When you switch between two medicines, there is a chance your child will get too much medicine. |
| Be sure to follow these safety tips when you use a nonprescription medicine: |
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Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.
- Your child's pain gets worse.
- Your child develops a fever.
- Swelling develops around the ear.
- New or different drainage from the ear develops.
- Mild intermittent pain continues after 1 week of home treatment.
- Your child's symptoms become more severe or more frequent.
Prevention
- Breast-feed your baby. Breast-fed babies have fewer ear infections.
- Avoid exposing children to cigarette smoke. Children exposed to secondhand smoke have more frequent ear infections. If you smoke and are unable to stop, smoke outside, away from your child.
- Do not put your baby to bed with a bottle.
- Do not allow your baby to hold his or her own bottle.
- Feed babies in an upright position to prevent milk from getting into the eustachian tubes. Do not allow infants to fall asleep with a bottle. (Nursing babies may fall asleep at the breast.)
- Being in day care increases your child's chance of getting an ear infection.
- Choose a day care setting with 6 or fewer children.
- Make sure that day care workers wash their hands before and after each diaper change.
- Have day care workers wash toys often.
- Limit the use of a pacifier after age 6 months to moments when your child is falling asleep. Do not continue to use a pacifier after age 10 months.
- Teach your children to blow their noses gently. This is a good idea for adults too. Wash your hands and teach your child to wash his or her hands after blowing. This helps prevent the spread of germs that can cause infection.
- Wash your hands before and after every diaper change and teach your child to wash his or her hands after using the toilet.
- When possible, limit your child's contact with other children who have colds.
- Keep soap and shampoo out of the ear canal. These products can cause itching, which can be mistaken for ear pain if the child is scratching or pulling at his or her ears.
- If your child has tubes in his or her ears, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
- The Haemophilus influenzae type B (Hib) vaccine prevents ear infections caused by this bacteria. Pneumococcal vaccine also prevents some ear infections in children. See the childhood immunization schedule.
- Do not insert anything, such as a cotton swab or a bobby pin, into the ear. Gently cleanse the outside of your child's ear with a warm washcloth.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment
If you have made an appointment with your child's doctor, you can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- Did your child have an injury to the ear? If so, describe when and how the injury occurred.
- When did the pain start?
- Has the pain been constant or does it come and go?
- Does anything make the pain better or worse?
- What symptoms make you think your child is having ear pain?
- Has your child ever been treated for an ear infection in the past? If so:
- How long ago was he or she treated?
- What medicine did you use?
- Did your child finish all of the medicine?
- Did you have a follow-up checkup after the medicine was finished?
- Does your child have ear tubes in place?
- Does your child have other symptoms, such as fever, a runny nose, a cough, or congestion? If so, how long have these symptoms been present?
- What home treatment measures have you used? Be sure to include nonprescription medicines you have given your child.
- Do you suspect a hearing problem? Describe the hearing problems you have noticed. How did your child respond to sounds before and after you noticed the problem?
- Does your child wear hearing aids?
- Does your child have any health risks?
Credits
| Author | Sydney Youngerman-Cole, RN, BSN, RNC |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Tracy Landauer |
| Primary Medical Reviewer | William M. Green, MD - Emergency Medicine |
| Specialist Medical Reviewer | Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics |
| Last Updated | February 23, 2006 |
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