- Is this your child’s symptom?
- When to Call for Earache
- Seattle Children’s Urgent Care Locations
- Care Advice for Earache
- Kids and ear infections: What to look for and when to see a doctor
- Ear infections
- Who is at higher risk for ear infections?
- How do I know if my child has an ear infection?
- How is an ear infection diagnosed?
- How is an ear infection treated?
- When do children need tubes in their ears?
- When should I call the doctor?
- How can I prevent my child from getting an ear infection?
- More information from the CPS:
- Reviewed by the following CPS committees:
- Earache Symptoms and Treatment
- Symptoms and Signs of Earaches
- Treatment for Earaches
- Causes of earache
- Earache symptoms
- Does your child need to see a doctor about earache?
- Treatment for earache
Is this your child’s symptom?
- Pain in or around the ear
- The older child complains about ear pain
- Younger child acts like he did with last ear infection or cries a lot
- Not caused by an ear injury
Causes of Earaches
- Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.
- Swimmer’s Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.
- Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.
- Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.
- Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by cotton swabs, the ear canal can become blocked. This pain will be worse.
- Ear Canal Foreign Object. Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.
- Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.
- Pierced Ear Infections. These are common. If not treated early, they can become very painful.
- Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.
Ear Infections: Most Common Cause
- Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common that bacterial ones.
- Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
- Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
- Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
- Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
- Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
- Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.
When to Call for Earache
Call 911 Now
- Not moving or too weak to stand
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Severe earache and not improved 2 hours after taking ibuprofen
- Pink or red swelling behind the ear
- Outer ear is red, swollen and painful
- Stiff neck (can’t touch chin to the chest)
- Walking is not steady
- Pointed object was put into the ear canal (such as a pencil, stick, or wire)
- Not alert when awake (“out of it”)
- Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
- Fever over 104° F (40° C)
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
- Earache, but none of the symptoms above. Reason: could be an ear infection.
- Pus or cloudy discharge from ear canal
Seattle Children’s Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
Care Advice for Earache
- What You Should Know About Earaches:
- Your child may have an ear infection. The only way to be sure is to look at the eardrum.
- It is safe to wait until your doctor’s office is open to call. It is not harmful to wait if the pain starts at night.
- Ear pain can usually be controlled with pain medicine.
- Many earaches are caused by a virus and don’t need an antibiotic.
- Here is some care advice that should help until you talk with your doctor.
- Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
- Cold Pack for Pain:
- Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
- Note: Some children prefer heat for 20 minutes.
- Caution: Heat or cold kept on too long could cause a burn or frostbite.
- Ear Infection Discharge:
- If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.
- The pus may be blood-tinged.
- Most often, this heals well after the ear infection is treated.
- Wipe the discharge away as you see it.
- Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
- Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
- Return to School:
- Ear infections cannot be spread to others.
- Can return to school or child care when the fever is gone.
- Call Your Doctor If:
- Pain becomes severe
- You think your child needs to be seen
- Your child becomes worse
And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 02/01/2020
Last Revised: 03/14/2019
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
Kids and ear infections: What to look for and when to see a doctor
Here are some steps that you can take to help prevent colds and ear infections:
- Good hand hygiene helps prevent the spread of germs that cause illness. It’s never too soon to start toddlers down the road of proper hand washing techniques. Teach kids to wash their hands for the amount of time it takes to sing “Happy Birthday” or the “ABCs.”
- Avoiding secondhand smoke exposure is critical for minimizing childhood illness. If you smoke, quitting will not only improve your health but also your child’s.
- Influenza and pneumococcal vaccines have also been shown to reduce ear infections in children.
- If a mother chooses to and is able to, breastfeeding can help. Breastfed infants are less likely to have bacterial or viral infections, including ear infections.
- If you don’t already have one, go pick up a nasal aspirator, otherwise known as a “snot sucker.” When your child starts to develop nasal congestion, use this suction device along with some nasal saline spray to remove those boogers. Trust me, it looks gross but it works incredibly well!
- You can also run a humidifier in your child’s room to help improve the nasal congestion.
Benjamin Landgraf, MD Pediatrician Southwest Pediatrics Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.
Even newbie parents can spot diaper rash or a runny nose with no problem, but ear infections may come with only a whisper of symptoms. Yet three-quarters of children will get one by age 3.
“An ear infection happens when you get infected fluid or pus behind the eardrum,” says Jennifer Shu, MD, FAAP. She is a pediatrician in Atlanta and editor of American Academy of Pediatrics Baby & Child Health. The most common cause? Colds. When secretions get trapped in the middle ear, viruses or bacteria can cause an infection and result in a bulging or reddened eardrum.
Children under 3 are most susceptible to ear infections, Shu says. “They don’t have strong immune systems. They haven’t been exposed to many of these germs before, so it takes them a little longer to fight them off.” Young kids also have more horizontal Eustachian tubes (channels that connect the middle ear to the throat), allowing fluid to collect instead of drain.
Fever may come with an ear infection, but not always, Shu says. Parents might spot other symptoms, such as earaches, ear drainage, trouble hearing or sleeping, ear tugging, poor appetite, vomiting, and diarrhea. But “for many children, it’s just fussiness, crying more than usual, being clingy,” Shu says.
If your child seems ill or has a fever, see a pediatrician. Babies under 6 months usually require antibiotics, Shu says, to prevent the spread of infection to other parts of the body. From 6 months to 2 years, the AAP recommends considering observation without antibiotics, as long as the child isn’t severely ill. But at this age, if the diagnosis of ear infection is certain, it’s usually best to treat with antibiotics. If your child is 2 or older, don’t be surprised if the doctor recommends holding off on antibiotics.
“We try not to treat if it’s a very mild infection or if they’re not complaining that much,” Shu says. According to the AAP, parents may choose to wait 48 to 72 hours and then start their child on antibiotics if there’s no improvement.
Middle ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age. They are usually not serious and aren’t contagious. Most ear infections happen when a child has already had a cold for a few days.
Viruses or bacteria (germs) cause middle ear infections. The eustachian tube connects the middle ear with the back of the throat. Germs travel from the back of the throat when the eustachian tube is swollen from a cold, causing infection in the middle ear.
Who is at higher risk for ear infections?
- Children less than 5 years old, because they have shorter eustachian tubes.
- Children who attend daycare, because they tend to have more colds.
- Children with allergies.
- Children who are exposed to cigarette smoke. Smoke causes inflammation of the eustachian tube, making ear infections more likely.
- Children who were not breastfed. Breast milk has antibodies that help fight infections.
- Babies who are being bottle fed, especially if they swallow milk while lying too flat. Milk can enter the eustachian tube and cause inflammation, which increases the risk of an ear infection. Children should be held upright while drinking a bottle. When they are old enough to hold their own bottle well, they should be taught to drink from a regular cup (not a “sippy cup”) and no longer given a bottle.
- Children with cleft palates, as their eustachian tubes are often inflamed.
- Children of First Nations and Inuit descent, though it’s not clear why.
How do I know if my child has an ear infection?
Older children will usually complain of an earache. While younger children might not be able to say they have an earache, they may:
- have an unexplained fever,
- be fussy,
- have trouble sleeping,
- tug or pull at their ears, or
- have trouble hearing quiet sounds.
Some children with an ear infection may also have fluid draining from the ear.
How is an ear infection diagnosed?
Doctors diagnose ear infections by looking at the ear drum (tympanic membrane) with a special light called an otoscope. They look for fluid in the middle ear, at the colour and position of the ear drum, and monitor the pressure in the middle ear. Common viral infections can make the ear drum look red, but antibiotics are not needed.
How is an ear infection treated?
- If a child doesn’t have too much discomfort or a high fever, the doctor will likely wait 24 to 48 hours (1 to 2 days) to see if the ear infection gets better on its own. If the child does not improve or gets worse, you should take him back to the doctor.
- You child’s doctor will prescribe antibiotics if:
- your child is moderately to severely ill with a high fever (more than 39◦C),
- your child has severe pain,
- the condition has not improved for 48 hours, or
- the ear canal has new fluid.
For an uncomplicated ear infection, children between 6 months and 2 years usually take an antibiotic for 10 days. Children over 2 years of age will take an antibiotic for 5 days.
The doctor might suggest acetaminophen or ibuprofen to reduce the child’s pain. Only give ibuprofen if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months old without first talking to your doctor.
Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children under 6 years without first talking to your doctor. The only exceptions are medications used to treat fever, such as ibuprofen and acetaminophen.
Children usually feel better within 1 day of starting an antibiotic. Your doctor might want to see your child again to be sure the infection has cleared up completely. Fluid can remain in the middle ear without inflammation for a few weeks.
When do children need tubes in their ears?
If your child has frequent ear infections, or if he has trouble hearing because of ongoing fluid in the middle ear, he may need a tube inserted through the ear drum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps fluid drain from the middle ear.
Putting tubes in requires a brief operation by an ear, nose and throat surgeon. Children usually go home the same day.
When should I call the doctor?
Call your doctor if you think your child has an ear infection AND:
- has other serious medical problems,
- seems ill,
- vomits over and over,
- is younger than 6 months old,
- is older than 6 months old and has had a fever for more than 48 hours,
- has swelling behind the ear,
- is very sleepy,
- is very irritable,
- has a skin rash,
- isn’t hearing well or at all,
- remains in a lot of pain despite at least one dose of acetaminophen or ibuprofen, or
- still has an earache after 2 days of treatment with acetaminophen or ibuprofen.
How can I prevent my child from getting an ear infection?
- Wash your child’s hands and your own often to reduce the chance of catching a cold.
- Breastfeed your baby.
- Avoid bottle-feeding your baby when she is lying down. Never put your baby to bed with a bottle.
- Transition your baby from a bottle to a cup by 1 year of age.
- Don’t use a pacifier (soother) too often.
- Don’t smoke, and keep your child away from any secondhand smoke. Exposure to smoke can increase the risk of ear infections.
- Ensure your child gets the pneumococcal vaccine (if they are at least 2 months of age, and have not already had this shot).
- Ensure your child gets a flu shot every year.
More information from the CPS:
- Colds in children
- Influenza in children
- Using over-the-counter drugs to treat cold symptoms
- Management of acute otitis media (position statement)
Reviewed by the following CPS committees:
- Infectious Diseases and Immunization Committee
Last Updated: January 2016
Earache, No Infection (Adult)
Earaches can happen without an infection. This occurs when air and fluid build up behind the eardrum causing a feeling of fullness and discomfort and reduced hearing. This is called otitis media with effusion (OME) or serous otitis media. It means there is fluid in the middle ear. It is not the same as acute otitis media, which is typically from infection.
OME can happen when you have a cold if congestion blocks the passage that drains the middle ear. This passage is called the eustachian tube. OME may also occur with nasal allergies or after a bacterial middle ear infection.
The pain or discomfort may come and go. You may hear clicking or popping sounds when you chew or swallow. You may feel that your balance is off. Or you may hear ringing in the ear.
It often takes from several weeks up to 3 months for the fluid to clear on its own. Oral pain relievers and ear drops help if there is pain. Decongestants and antihistamines sometimes help. Antibiotics don’t help since there is no infection. Your doctor may prescribe a nasal spray to help reduce swelling in the nose and eustachian tube. This can allow the ear to drain.
If your OME doesn’t improve after 3 months, surgery may be used to drain the fluid and insert a small tube in the eardrum to allow continued drainage.
Because the middle ear fluid can become infected, it is important to watch for signs of an ear infection which may develop later. These signs include increased ear pain, fever, or drainage from the ear.
The following guidelines will help you care for yourself at home:
- You may use over-the-counter medicine as directed to control pain, unless another medicine was prescribed. If you have chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your doctor before using these medicines. Aspirin should never be used in anyone under 18 years of age who is ill with a fever. It may cause severe liver damage.
- You may use over-the-counter decongestants such as phenylephrine or pseudoephedrine. But they are not always helpful. Don’t use nasal spray decongestants more than 3 days. Longer use can make congestion worse. Prescription nasal sprays from your doctor don’t typically have those restrictions.
- Antihistamines may help if you are also having allergy symptoms.
- You may use medicines such as guaifenesin to thin mucus and promote drainage.
Follow up with your healthcare provider or as advised if you are not feeling better after 3 days.
When to seek medical advice
Call your healthcare provider right away if any of the following occur:
- Your ear pain gets worse or does not start to improve
- Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
- Fluid or blood draining from the ear
- Headache or sinus pain
- Stiff neck
- Unusual drowsiness or confusion
Date Last Reviewed: 10/1/2016
Earache Symptoms and Treatment
The most common cause of earache is a middle ear infection (acute otitis media) that results from an infection in the upper respiratory tract, similar to a cold. The infection causes the mucus membranes in the Eustachian tube (the tube that connects the middle ear to the back of the throat) to swell, and the pressure behind the eardrum increases. The low pressure in the ear then leads to a build-up of fluids and middle ear infection. When a child has a cold or a fever, he may experience pain in one or both ears. A younger child may not yet be able to tell you that he is in pain and where the pain is located, but he may give you nonverbal signs: sudden screaming fits, irritability, and holding or pulling on the affected ear.
Symptoms and Signs of Earaches
Once the middle ear is infected, pus builds up behind the eardrum and, as a result, increased pressure on the eardrum causes pain. At the same time, the eardrum itself becomes thick and swollen and may rupture, leading the pus to run into the ear canal and out the ear.
Treatment for Earaches
For children 2 years old or older who are not seriously ill and have no fever, simply monitor the condition for 1 to 2 days. Many cases of middle ear infection will get better after a few days.
You can give your child the following treatments to ease the earache:
- Have your child lie down with her head slightly elevated. This will help ease the earache.
- Give your child some decongestant nose drops if she has a stuffy nose. This will make it easier to breathe and to eat. Don’t use these drops for more than 2 to 3 days.
- Give your child pain relievers such as acetaminophen (Children’s Tylenol) or ibuprofen (Children’s Advil) to lessen the ear pain. Follow the dosage instructions on the package.
- Place a warm compress carefully over your child’s ear for approximately 20 minutes. This may ease the earache considerably.
- Schedule a check-up with your child’s doctor 2 to 3 weeks after the ear infection so the doctor can make sure that your child’s eardrums are normal.
- Don’t expose your child to cigarette smoke, which has been shown to increase the frequency and severity of ear infections.
Call 911 or the doctor immediately if your child:
- Is younger than 1 year old and has an ear infection.
- Is older than 1 year old and has an earache and a fever.
- Has something stuck in his ear.
- Has an earache along with a stiff neck.
- Has an earache along with swollen and red skin behind the ear.
- Has an earache along with dizziness or difficulty balancing.
- Has an acute earache that causes crying, and pain relievers are not working.
- Has pus or blood is running out of his ear, an indication that the eardrum has ruptured.
- Still has an earache or fever after two days of treatment with antibiotics.
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Causes of earache
The most common cause of earache is infection, like a middle ear infection or an external ear infection.
Children will sometimes put foreign objects in their ears, which can cause pain.
A build-up of ear wax can block the ear canal and also give your child a sore ear.
Less commonly, the cause of the earache might be a burst eardrum because of an accident, or because a cotton bud or something similar has been pushed too far into your child’s ear.
Your child might also have an earache because there’s an injury or infection somewhere near her ear, and she feels the pain in her ear. This could happen with sinusitis or tonsillitis, for example.
Ear ache can also be caused by teeth grinding or other dental issues.
Earache usually happens only on one side.
Your child might also have a runny nose, fever or vomiting. He might have quite severe pain.
A young baby with an earache might pull or tug the affected ear. She might also seem generally irritable and have trouble sleeping.
Does your child need to see a doctor about earache?
Yes. If your child says he has an earache or sore ear, you should take him to see your GP.
Treatment for earache
Earache treatment depends on the cause of the earache.
If your child has a sore ear because of an ear infection, your GP will consider what’s causing the infection before deciding on treatment. Most infections are caused by viruses, so antibiotics won’t help. Your GP will prescribe antibiotics only if the infection is caused by bacteria.
You can give your child paracetamol or ibuprofen at the recommended doses to help with a sore ear caused by an ear infection.
For things stuck in a child’s ear, the treatment will usually depend on what the object is. If it’s something soft like a corn kernel, the doctor might use fine forceps or a special spoon to get it out. If it’s hard – for example, a plastic bead from a necklace – the doctor might use a special syringe to flush out the object.
Never try to remove an object from your child’s ear yourself.
If the earache is caused by a burst eardrum, the eardrum will usually fix itself. It’s still important that your GP checks your child.
If the sore ear is caused by a nearby infection like tonsillitis or sinusitis, your GP will tell you what to do about these conditions.