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.
Check your child's symptoms to decide if and when your child should see a doctor.
Check Your Symptoms
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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.
- Breast-feed your baby. Breast-fed 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
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
|
Specialist Medical Reviewer
|
H. Michael O'Connor, MD - Emergency Medicine |
|
Last Revised
|
July 25, 2012 |