Earache in babies and children. What are the causes? What to do?

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Dr. Sandro Cantoni. Updated: 20 September 2021

In my almost thirty years of pediatric practice, earache in children is certainly the most frequent symptom I have encountered both in the clinic and in the emergency room.  

In the vast majority of cases it is nothing serious, but it is important to know what to do, because ear pain makes the child feel really sick. 

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What are the causes of earache in children?

Most children have one of these three conditions that cause them earaches: acute otitis media, catarrhal otitis or otitis externa. But there may be other causes.

Acute otitis media.

It is one of the most frequent diseases, and is the one most responsible for earache in children. The pain can be very intense and the older child reports it inside the ear. The pain is worse when the child is lying down. Usually, along with the pain, the child also has a cold and cough. There may also be a fever.

In young children, who cannot yet tell that they are in pain, the symptoms are that of a child who cries, especially at night, complains and is irritable, and eats less than usual. The diagnosis of acute otitis media is made by the doctor with otoscopic examination.

External otitis. 

After acute otitis media is the most common cause of earache. It occurs mostly in the summer, often after swimming in the sea or pool. It is an infection of the ear canal and is manifested by a vivid, stabbing pain, especially in the early part of the night.  

Catarrhal otitis (also called secretory otitis media).

In this case, there is fluid in the middle ear, basically behind the eardrum membrane, without inflammation.  The fluid collection results from a problem with the “Eustachian tube,” a canal that connects the space behind the nose to the ear. It has the function of flushing out normal ear secretion.

If your child has a cold, or allergy or enlarged adenoids, this tube can close and then fluid accumulates inside the ear. 

An insect bite in the auricle. 

In this case, the pinna will be swollen, reddened. If you look closely you can see the small puncture mark. 

Foreign body in the ear canal.

This is not an uncommon cause of earache, especially in small children, who play with small objects, which can go into the ear. The child has a pain, or there is a secretion coming out of the ear. The doctor, with otoscopic examination, finds the foreign body. 

Traumatic injury to the ear canal. 

When cleaning the ears with a Q-tip, if the child moves, it is easy to cause a small trauma with an ear canal injury. There will be pain and often a discharge of blood.  For this reason, as well as to avoid earwax plugs, it is better to avoid using it. 

The child has pain, but without an ear disease. 

Sometimes the child reports ear pain, but there is no disease. For example, the child has pharyngitis, earache, but there is no otitis. 

The reason is this. The membrane of the eardrum has many pain nerves, so it is very sensitive. These same nerves are also on the pharyngeal walls, at the back of the throat. And so if the throat is sore, the child can also feel pain in the ear. 

How do I know my baby may have an earache?

In the older child, over 3 years old, the diagnosis is quite simple. The child, often crying, will tell you that he or she has a pain and point to one or both ears with his or her finger. 

In babies it is not so simple. Earache is manifested by a change in habitual behavior.  You can guess that your child may be having earache if he has these symptoms: 

Persistent crying, especially when lying down.

Irritable, agitated.

Difficulty sleeping.

Doesn’t want to eat.

Brings his hand to his ear or head. 

Pulls his ear or hair.

Sometimes the child has difficulty walking, loses balance.

Seems not to react to sounds and noises. 

Fluid comes out of the ear.

What do I do to make my child’s earache go away?

Precise treatment depends on the likely underlying cause of your child’s earache. But it’s not necessary to make the precise diagnosis in order to immediately begin therapy to calm the pain, which can be really bad, especially in cases of acute otitis media.

The analgesic drug therapy consists in administering pain-relieving drugs, such as ibuprofen or paracetamol, associated or not with anesthetic ear drops.

While waiting for the medication to take effect, the child may feel better by placing a towel or cloth soaked in cold water on the outside of the ear for 20 minutes. A compress with warm, not boiling, water also often works, and many children prefer it. 

When should I be worried about my child’s earache?

If your child has an earache and even one of these signs or symptoms contact your doctor or take your child to the hospital. 

  • Your child is very weak and cannot stand upright.
  • Difficulty maintaining balance. 
  • Redness and swelling behind the ear. 
  • Severe earache that does not improve after two hours from acetaminophen or ibuprofen.
  • The child has placed a sharp object, such as a pencil, in the ear.
  • The pinna is swollen, red and hurts.
  • The neck is stiff (the chin cannot touch the chest).
  • Fever above 40°C (104°F)
  • The child has a weak immune system, or is taking steroid medications by mouth. 
  • The child gives the impression of being sick. He or she does not play, does not smile, is irritable, eats less than usual. 
  • For any reason you feel agitated, worried. 

References

Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014; 150:S1.

Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013; 131:e964.

Earwood JS, Rogers TS, Rathjen NA. Ear Pain: Diagnosing Common and Uncommon Causes.Am Fam Physician. 2018 Jan 1;97(1):20-27.

E Michael Sarrell, Herman Avner Cohen, Ernesto Kahan. Naturopathic treatment for ear pain in children. Pediatrics. 2003 May;111(5 Pt 1):e574-9

Harmes KM e al. Otitis media: diagnosis and treatment. Am Fam Physician. 2013 Oct 1;88(7):435-40.


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