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:
Spend time in day care settings.
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.
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.
Baby is sick (sleepier than usual, not eating or drinking like usual)
Do you think your baby has a 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.
Rectal temperature taken
Rectal temperature taken
Is it 100.4°F (38°C) or higher?
Temperature at least 100.4°F (38°C)
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.
Do you think that the injury may have been caused by abuse?
Injury may have been caused by abuse
Injury may have been caused by abuse
Does your child have 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?
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.
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.
which are used to treat a variety of conditions.
after organ transplant.
Chemotherapy and radiation therapy for
Not having a spleen.
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
104°F (40°C) and
100.4°F (38°C) to
100.3°F (37.9°C) and
Armpit (axillary) temperature
High: 103°F (39.5°C) and higher
99.4°F (37.4°C) to
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
May not respond at all to being held, touched, or talked
May be hard to wake up.
A baby that is sick (but not extremely
May be sleepier than usual.
May not eat
or drink as much as usual.
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
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.
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
Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.
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
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.
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
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.
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
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
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
Do not put your baby to bed with a bottle.
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
Being in day care increases your child's chance of getting
an ear infection, so:
Choose a day care setting with 6 or fewer
Make sure that day care workers wash their hands before
and after each diaper change.
Have day care workers wash toys
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
Wash your hands before and after every diaper change and
teach your child to wash his or her hands after using the
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.
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.
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.
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.
How this information was developed to help you make better health decisions.