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 daycare settings.
Are bottle-fed.
Use a pacifier.
Live in households where parents or caregivers smoke.
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:
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.
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 to 5 months
3 to 5 months
6 months to 3 years
6 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
The medical assessment of symptoms is based on the body parts you have.
If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
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.
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 your child's temperature?
This is the only way to be sure that a baby this age does not have a fever. If you don't know the 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. Rectal temperatures are the most accurate. Taking an axillary (armpit) temperature is also an option.
Yes
Temperature taken
No
Temperature taken
Is it 38°C (100.4°F) or higher, taken rectally?
This would be an axillary temperature of 37.5°C (99.5°F) or higher.
Yes
Temperature at least 38°C (100.4°F) taken rectally
No
Temperature at least 38°C (100.4°F) taken rectally
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 suspect that the injury may have been caused by abuse?
This is a standard question that we ask in certain topics. It may not apply to you. But asking it of everyone helps us to get people the help they need.
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?
NOTE: Most people have an average body temperature of about 37°C (98.6°F). But it can vary by a degree or more and still be considered normal. If a low body temperature is the only symptom, it’s usually not something to worry about. But be sure to watch for other symptoms.
High: 40°C (104°F) or higher, oral
High fever: 40°C (104°F) or higher, oral
Moderate: 38°C (100.4°F) to 39.9°C (103.9°F), oral
Moderate fever: 38°C (100.4°F) to 39.9°C (103.9°F), oral
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?
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, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products 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.
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) temperature
High: 40° C (104° F) and higher
Moderate: 38° C (100.4° F) to 39.9° C (103.9° F)
Mild: 37.9° C (100.3° F) and lower
A forehead (temporal) scanner is usually 0.3° C (0.5° F) to 0.6° C (1° F) lower than an oral temperature.
Ear or rectal temperature
High: 40.5° C (104.9° F) and higher
Moderate: 38.5° C (101.3° F) to 40.4° C (104.7° F)
Mild: 38.4° C (101.1° F) and lower
Armpit (axillary) temperature
High: 39.8° C (103.6° F) and higher
Moderate: 37.8° C (100° F) to 39.7° C (103.5° F)
Mild: 37.7° C (99.9° F) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
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.
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.
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.
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.
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.
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.
Sometimes people don't want to call 9-1-1. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 9-1-1 for medical transport to the hospital.
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 face cloth. 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 non-prescription 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 non-prescription 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.
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 second-hand 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 daycare increases your child's chance of getting an ear infection, so:
Choose a daycare setting with 6 or fewer children.
Make sure that daycare workers wash their hands before and after each diaper change.
Have daycare 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.
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 home treatment measures have you used? Be sure to include non-prescription 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?
Author: Healthwise Staff Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine Adam Husney MD - Family Medicine Kathleen Romito MD - Family Medicine H. Michael O'Connor MD - Emergency Medicine
Medical Review:William H. Blahd Jr. MD, FACEP - Emergency Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & H. Michael O'Connor MD - Emergency Medicine
