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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 can cause 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.
  • Have allergies.

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 3 months, 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 means 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, such as flying in an airplane.
  • 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, such as fever, are present, ear pain or drainage may be less
important than the other symptoms.

Ear problems caused by an injury to the ear can occur at any
age. Common injuries include the following:

  • A fall or a forceful, direct blow to the side of
    the head can
    burst the eardrum or damage the tiny bones in the
    inner ear that send sound to the brain.
  • An injury during contact sports can cause an injury, such as “cauliflower” ear from wrestling.
  • Loud noises or explosions
    can damage the eardrum (acoustic trauma).
  • Atmospheric pressure changes (barotrauma) can cause
    problems with the
    eustachian tube and trap air in or keep air out of the
    middle ear. Middle ear problems can be severe (for example, the eardrum can
    burst or the middle ear can fill with blood or pus) or mild and only be felt as
    changes in pressure.
  • Cuts or scrapes may injure the outside of the
    ear or ear canal. For more information, see the topic
    Ear Canal Problems (Swimmer’s Ear).
  • Cleaning the ear canal too
    often, too forcefully, or with a cotton swab, bobby pin, or sharp fingernail
    can cause irritation or injury.
  • Burns or frostbite can cause ear
    injuries (thermal injuries).
  • Objects placed in the ear can cause
    injury to the ear canal or the eardrum (tympanic membrane).

Check your child’s symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

Does your child have an ear problem?
This includes problems like pain, hearing loss, and possible infection.
Yes
Ear problem
No
Ear problem
How old are you?
Less than 3 months
Less than 3 months
3 months to 3 years
3 months to 3 years
4 to 11 years
4 to 11 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Has your child had a recent head injury?
Yes
Recent head injury
No
Recent head injury
Does your baby seem sick?
A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.
Yes
Baby seems sick
No
Baby seems sick
How sick do you think your baby is?
Extremely sick
Baby is very sick (limp and not responsive)
Sick
Baby is sick (sleepier than usual, not eating or drinking like usual)
Do you think your baby has a fever?
Yes
Fever
No
Fever
Did you take a rectal temperature?
Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don’t know the rectal temperature, it’s safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.
Yes
Rectal temperature taken
No
Rectal temperature taken
Is it 100.4°F (38°C) or higher?
Yes
Temperature at least 100.4°F (38°C)
No
Temperature at least 100.4°F (38°C)
Has your child had an injury to the ear in the past week?
The ear can be injured by a direct hit, a very loud noise (like a gunshot or firecracker), or an object being pushed into the ear.
Yes
Ear injury
No
Ear injury
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Does your child have ear pain?
Yes
Ear pain
No
Ear pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
How long has your child had pain?
Less than 12 hours
Pain for less than 12 hours
12 to 48 hours (2 full days)
Pain for 12 to 48 hours
More than 48 hours (2 full days)
Pain for more than 48 hours
Yes
Symptoms of external ear infection
No
Symptoms of external ear infection
Is there any drainage from the ear that you do not think is earwax?
Yes
Drainage from ear
No
Drainage from ear
Is there any bleeding from the ear that’s not coming from an obvious cut?
Yes
Bleeding from ear
No
Bleeding from ear
How much blood has there been?
More than a few drops or streaks, or steady bleeding of any amount
More than a few drops or streaks, or steady bleeding of any amount
A few drops or few streaks of blood
A few drops or a few streaks of blood
Do you think your child has a fever?
Yes
Fever
No
Fever
Did you take your child’s temperature?
Yes
Temperature taken
No
Temperature taken
How high is the fever? The answer may depend on how you took the temperature.
High: 104°F (40°C) or higher, oral
High fever: 104°F (40°C) or higher, oral
Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Mild: 100.3°F (37.9°C) or lower, oral
Mild fever: 100.3°F (37.9°C) or lower, oral
How high do you think the fever is?
High
Feels fever is high
Moderate
Feels fever is moderate
Mild or low
Feels fever is mild
How long has your child had a fever?
Less than 2 days (48 hours)
Fever for less than 2 days
From 2 days to less than 1 week
Fever for more than 2 days and less than 1 week
1 week or longer
Fever for 1 week or more
Does your child have shaking chills or very heavy sweating?
Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.
Yes
Shaking chills or heavy sweating
No
Shaking chills or heavy sweating
Do you think your child has a hearing problem?
Yes
Possible hearing problem
No
Possible hearing problem
Has your child had a sudden and complete hearing loss?
Yes
Sudden and complete hearing loss
No
Sudden and complete hearing loss
Does your child have vertigo?
Yes
Vertigo
No
Vertigo
Is the vertigo making it hard for your child to stand or walk?
Your child may seem more unsteady or clumsier than usual.
Yes
Loss of balance
No
Loss of balance
Does your child have a health problem or take medicine that weakens his or her immune system?
Yes
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Has your child had any ear symptoms for more than a week?
Yes
Ear symptoms for more than 1 week
No
Ear symptoms for more than 1 week

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

  • Your age. Babies and older
    adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
    disease, you may need to pay closer attention to certain symptoms and seek care
    sooner.
  • Medicines you take. Certain
    medicines, herbal remedies, and supplements can cause symptoms or make them
    worse.
  • Recent health events, such as surgery
    or injury. These kinds of events can cause symptoms afterwards or make them
    more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
    use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

  • Try home treatment to relieve the
    symptoms.
  • Call your doctor if symptoms get worse or you have any
    concerns (for example, if symptoms are not getting better as you would expect).
    You may need care sooner.

Temperature varies a little depending on how you measure it.
For children up to 11 years old, here are the ranges for high, moderate, and
mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

  • High:
    104°F (40°C) and
    higher
  • Moderate:
    100.4°F (38°C) to
    103.9°F (39.9°C)
  • Mild:
    100.3°F (37.9°C) and
    lower

A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.

Armpit (axillary) temperature

  • High: 103°F (39.5°C) and higher
  • Moderate:
    99.4°F (37.4°C) to
    102.9°F (39.4°C)
  • Mild: 99.3°F (37.3°C) and lower

Note: For children under 5 years old, rectal temperatures are
the most accurate.

A baby that is extremely sick:

  • May be limp and floppy like a rag
    doll.
  • May not respond at all to being held, touched, or talked
    to.
  • May be hard to wake up.

A baby that is sick (but not extremely
sick):

  • May be sleepier than usual.
  • May not eat
    or drink as much as usual.

If you’re not sure if a child’s fever is high, moderate, or
mild, think about these issues:

With a high fever:

  • The child feels very hot.
  • It is likely
    one of the highest fevers the child has ever had.

With a moderate fever:

  • The child feels warm or hot.
  • You are
    sure the child has a fever.

With a mild fever:

  • The child may feel a little warm.
  • You
    think the child might have a fever, but you’re not sure.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and
illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle
    cell disease, and congenital heart disease.
  • Steroid medicines,
    which are used to treat a variety of conditions.
  • Medicines taken
    after organ transplant.
  • Chemotherapy and radiation therapy for
    cancer.
  • Not having a spleen.

Symptoms of an external ear infection
may include:

  • Moderate to severe pain in the outer
    ear.
  • Pain with chewing.
  • Redness and swelling of the ear, ear canal, or the skin around
    or behind the ear.

Vertigo is the feeling that you or
your surroundings are moving when there is no actual movement. It may feel like
spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and
you may have trouble standing, walking, or keeping your balance.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The
    pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
    constantly no matter what you do. The baby may kick, make fists, or
    grimace.
  • Moderate pain (5 to 7): The baby is
    very fussy, clings to you a lot, and may have trouble sleeping but responds
    when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
    when you try to comfort him or her.

Pain in children 3 years and older

  • Severe pain (8 to 10): The pain
    is so bad that the child can’t stand it for more than a few hours, can’t sleep,
    and can’t do anything else except focus on the pain. No one can tolerate severe
    pain for more than a few hours.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt the child’s normal activities and
    sleep, but the child can tolerate it for hours or days.
  • Mild pain (1 to 4): The child notices and may complain of the pain,
    but it is not bad enough to disrupt his or her sleep or activities.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms
    and arrange for care.
  • If you cannot reach your doctor or you don’t
    have one, seek care today.
  • If it is evening, watch the symptoms and
    seek care in the morning.
  • If the symptoms get worse, seek care
    sooner.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and
    arrange for care.
  • If you cannot reach your doctor or you don’t have
    one, seek care in the next hour.
  • You do not need to call an
    ambulance unless:

    • You cannot travel safely either by driving
      yourself or by having someone else drive you.
    • You are in an area
      where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical
care.

  • Make an appointment to see your doctor in the
    next 1 to 2 weeks.
  • If appropriate, try home treatment while you
    are waiting for the appointment.
  • If symptoms get worse or you have
    any concerns, call your doctor. You may need care sooner.
Head Injury, Age 3 and Younger
Head Injury, Age 4 and Older
Ear Problems and Injuries, Age 12 and Older

Home Treatment

When ear discomfort or pain is mild
or comes and goes 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 try to help open the eustachian tube.
  • Some babies and children who have 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.
Medicine you can buy without a prescription
Try a nonprescription
medicine to help treat your child’s fever or pain:

Talk to your child’s doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these
safety tips when you use a nonprescription medicine:
  • Carefully read and follow all labels on
    the medicine bottle and box.
  • Give, but do not exceed, the maximum
    recommended doses.
  • Do not give your child a medicine if he or she
    has had an
    allergic reaction to it in the past.
  • Do not give aspirin to anyone younger than age 20 unless directed to do so
    by your child’s doctor.
  • Do not give naproxen (such as Aleve) to children younger than age 12 unless your child’s
    doctor tells you to.

Symptoms to watch for during home treatment

Call your child’s doctor if any of the following occur during home
treatment:

  • Your child’s pain gets worse.
  • Your
    child develops a new fever.
  • New or different drainage from the ear
    develops.
  • Your child’s symptoms become more severe or more
    frequent.

Prevention

There are many steps you can take to help prevent ear problems and injuries.

  • Breastfeed your baby. Breastfed babies may 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.
  • When your toddler is using a bottle or sippy cup, have him or her stay seated. This can help prevent injuries that might occur if your child were to fall while walking and holding a bottle or a cup.
  • Feed babies in
    an upright position to prevent milk from getting into the area around 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, so:

    • 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. Babies who use pacifiers after 12 months of age are more likely to get ear infections.
  • 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.
  • Try to keep soap and shampoo out of the
    ear canal. Soap and shampoo 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, try to 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. For more information, 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 immunizations has your child had?
  • 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

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Adam Husney, MD – Family Medicine

Current as ofApril 7, 2017