Ear Pain

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momma kissing baby's earEar pain is a frequent childhood complaint. Ear pain is not a medical emergency. If your child complains of ear pain after your doctor’s office is closed for the day, focus on their comfort and pain control and call the office during normal business hours. Your child may need to be seen by his/her doctor in order to discover the cause of the pain, and the diagnosis is most often not one that can be made over the phone. Tips for getting through the night can be found at the end of this section.

Why do children get ear pain?
If the ear canal is irritated or blocked this will cause ear pain. Anything that puts pressure on the eardrum will also cause pain or discomfort. Occasionally pain in the ear is actually referred pain from somewhere else – most commonly the mouth/teeth.

Common causes of Ear Pain:

Swimmer’s Ear (Outer Ear Infection/Otitis Externa)
This is caused by irritation from moisture/water contact. Symptoms include ear pain (often with a history of swimming recently, hence the name), sometimes swelling and itching, and occasionally drainage of pus from the ear. To prevent swimmer’s ear avoid the use of q-tips which often scratch and irritate the ear canal, dry the ears as thoroughly as possible after immersion in water, and use swimmer’s ear drops after swimming to help evaporate any water lodged in the canal. If you suspect your child has swimmer’s ear, call your pediatrician during normal business hours to schedule an appointment. If your child has otitis externa s/he will likely be given antibiotic eardrops and instructions to stay out of the water for 7-10 days.

Middle Ear Infection (Acute Otitis Media)
Causes: When fluid, for any reason, pools behind the eardrum for a period of time it creates an ideal environment for an infection to grow. The fluid puts pressure on the eardrum and this pressure causes pain. The cause of the initial fluid collection is usually allergies or a virus. Contact with water has no effect on a middle ear infection. Children are more prone to middle ear infections than adults because they get colds more often and the drainage from their ears, because of their anatomy, is less efficient.

Signs and symptoms If your child has had cough and congestion, and after a few days develops a fever, difficulty sleeping or feeding, becomes fussy, or, in older children, complains of ear pain, then an ear infection should be considered. If your child has pus or fluid draining, occasionally blood tinged, from his/her ear do not put any drops in the ear. The drainage is not a cause for concern and in the case of a middle ear infection you should notice your child’s pain relieved somewhat by the drainage. You can call your doctor during regular office hours.

What should you do? Follow the guidelines below to control your child’s pain, and call your doctor’s office during normal office hours.

Treatment If your child is over the age of two and his/her pain can be controlled your pediatrician might recommend you wait a few days before being seen. If your child is less than two years old it is likely your pediatrician would want to have you seen within a couple of days. This is because in a child less than two years of age it is more likely that an ear infection is bacterial and so will be treated with both pain control measures and antibiotics. In children over the age of two the likelihood of the infection resolving without antibiotics is greater than 75%. Because of this your pediatrician might recommend pain control alone, with a re-check or a prescription for antibiotics only if the pain is not controlled, or if your child still requires pain control after 3-5 days.

Contagiousness Ear Infections are not contagious. The colds that precede them pass from person to person, but each child’s body will handle the cold, and the fluid that follows, in a different way.


Referred pain is when pain from one area is felt in a different area. This is very common with tooth and ear pain. A teething child might bat at his/her ears because a young child has difficulty localizing pain. If your child is between the ages of 3 months to 2 years, teething is usually a consideration. Often a teething infant will be drooling, chewing on just about, and might be fussier than normal with more nighttime awakenings. Teething does not cause a fever over 101 degrees.


Getting through the night/ Pain Control
If you suspect the pain is caused by teething follow above instructions. If this seems to be true ear pain, pain control should be your priority. Antibiotics do not improve the pain in a true bacterial ear infection for at least 24-48 hours, so all children, whether or not you suspect a true bacterial infection, should be treated with pain control and made to feel comfortable when they have ear pain!

-Monique Araya, MD, FAAP

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