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
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:
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:
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.
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.
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
Armpit (axillary) temperature
Note: For children under 5 years old, rectal temperatures are
the most accurate.
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and
illness. Some examples in children are:
You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.
Based on your answers, you may need care soon. The
problem probably will not get better without medical care.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
If you're not sure if a child's fever is high, moderate, or
mild, think about these issues:
With a high fever:
With a moderate fever:
With a mild fever:
Pain in children 3 years and older
Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:
A baby that is extremely sick:
A baby that is sick (but not extremely
Based on your answers, the problem may not improve without medical
Based on your answers, you need
or other emergency services now.
Symptoms of an external ear infection
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:
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.
Call your child's doctor if any of the following occur during home
There are many steps you can take to help prevent ear problems and injuries.
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
July 25, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& H. Michael O'Connor, MD - Emergency Medicine
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