Ear pain in children can have many causes — the most common are middle ear infections (otitis media), swimmer’s ear (outer ear infection), teething in infants, and referred pain from the jaw or throat. Most ear pain can be managed at home initially with pain relief. Call Spring Valley Pediatrics if ear pain is severe, persists more than 1–2 days, is accompanied by fever, or if you notice drainage from the ear.
What causes an earache?
The most common reason parents bring their children in for an earache is to see if they have an ear infection (AKA otitis media/middle ear infection), but there are other reasons why their ears may be hurting. Some examples include:
- Swimmer’s ear (AKA otitis externa)
- Fluid buildup behind the eardrum
- Earwax buildup
- Rash/skin infection around the ears
- Pain originating elsewhere that can be felt in the ears, such as pain in the mouth or throat (this is very common in teething infants and toddlers)
Ear infections often occur after viral illnesses or colds. Sinus pressure and mucus build-up from your child’s illness can cause inflammation and blockages in their nose and sinuses. Specifically, there is a small tube that connects the middle ear space to the nose called the eustachian tube (this is what enables us to pop our ears when we fly in an airplane). Anything that blocks this tube can set a child up for an earache, as obstruction can lead to accumulation of mucus behind the eardrum. The bacteria and viruses that normally live in your sinuses can then grow in that fluid without anywhere to drain out naturally. This causes the eardrum to bulge and swell, leading to the characteristic ear pain we associate with ear infections.
Ear infections are more common in kids for a few reasons. A child’s immune system is not as fully developed as an adult’s, making them more vulnerable to getting sick in general. Younger children, especially those who attend daycare, are also frequently exposed to all sorts of germs, leading to lots of colds. In addition, children have shorter, narrower eustachian tubes than adults, making it easier for these tubes to get blocked and for fluid to accumulate behind the eardrum.
How can my doctor help?
Your doctor will ask questions about how your child has been doing and what other symptoms they have such as fever, cough, or if they have had any drainage from their ears. If your child is found to have an ear infection, your doctor may prescribe an antibiotic to help treat the infection, though bear in mind that many ear infections are caused by viruses and not bacteria. Ear infections caused by viruses tend to be associated with milder symptoms than those caused by bacteria and will generally resolve without antibiotics. In some cases, your pediatrician may opt to observe your child’s symptoms for 24-48 hours with a plan to treat with antibiotics if their symptoms do not improve by then, or if their symptoms worsen.
If your child is getting frequent ear infections, your doctor may refer you to see an Ear, Nose, and Throat doctor (ENT/Otolaryngologist) for evaluation and to discuss whether your child may benefit from ear tube placement.
It’s 7pm and I can’t get in to see my pediatrician until tomorrow morning. Is there anything I can do at home to make my child feel better?
Absolutely! You can give your child ibuprofen (if they are more than 6 months old) or Tylenol as needed to help soothe their pain. You can also apply heat or ice to the ear. As long as your child’s symptoms are manageable with these supportive measures, it is ok to wait until the morning to see your doctor. Your child should be seen in the ER if they have severe pain that is not responsive to ibuprofen or Tylenol, if they have a fever higher than 105F, or if they develop other severe symptoms.
Is there any way to reduce my child’s risk of getting ear infections?
Make sure your child has received their recommended routine immunizations, including their pneumococcal vaccines (PCV) and yearly influenza vaccines. These will also help to decrease the risk of ear infections.
While ear infections are not contagious, the often-preceding viral illnesses are. Encourage your child to wash their hands frequently, especially after playing with other children. Minimize exposure to people with colds and secondhand smoke, as both are associated with an increased risk of ear infections. In addition, a child’s early nutrition has been associated with reduced risk of ear infection. Specifically, studies have shown that breastfeeding during infancy has been associated with a reduced risk of developing ear infections.
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Frequently Asked Questions
What are the most common causes of ear pain in children?
The most common cause is acute otitis media (middle ear infection) — an infection behind the eardrum, often following a cold. Swimmer’s ear (otitis externa) is an outer ear canal infection from moisture and is more common in summer. Teething in infants can cause ear pulling. Referred pain from a sore throat, jaw, or dental issue can also feel like ear pain. A foreign object in the ear canal, earwax buildup, and eardrum injury are less common causes.
How can I tell if my child has an ear infection versus swimmer’s ear?
Middle ear infections typically cause pain deep in the ear, often with a recent cold, fever, and sometimes fluid draining from the ear. Swimmer’s ear causes pain that worsens when you pull on the outer ear or press on the little bump in front of the ear canal (the tragus). The ear canal may look red and swollen. Swimmer’s ear is usually not accompanied by fever.
Do ear infections always need antibiotics?
Not always. Many ear infections in children over 2 years are caused by viruses and resolve on their own within 1–2 days. The AAP recommends a watchful waiting approach for mild cases in children over 2 years. Antibiotics are recommended for all children under 6 months, for severe cases, for both ears being infected, or when symptoms worsen or don’t improve after 2–3 days. Call Spring Valley Pediatrics and we will advise based on your child’s age and symptoms.
When should I take my child to the doctor for ear pain?
Call Spring Valley Pediatrics if ear pain is severe or getting worse, lasts more than 1–2 days, is accompanied by a fever above 102°F, if there is drainage from the ear canal, if your child seems very ill or is not eating or sleeping, or if your child is under 6 months. Go to the emergency room if you see sudden hearing loss, severe dizziness, swelling or redness behind the ear, or a drooping face.
How can I help my child’s ear pain at home?
Acetaminophen or ibuprofen (for children over 6 months) can help manage ear pain. Placing a warm (not hot) cloth or heating pad on the ear may also provide comfort. Over-the-counter ear drops for pain are available but should not be used if there is any chance the eardrum has ruptured (if you see drainage). Keep the ear dry if swimmer’s ear is suspected.
Can ear infections cause hearing loss?
Temporary hearing loss during and after an ear infection is common due to fluid behind the eardrum. This usually resolves as the infection clears. Chronic or recurrent ear infections can sometimes cause more persistent fluid buildup (called otitis media with effusion) and may affect hearing and speech development. If your child has recurrent ear infections or you are concerned about their hearing, talk with your Spring Valley Pediatrics physician.
