Expert Health Articles


Andrew Reid, MDAndrew Reid MD

What are the symptoms of earaches in children?

An earache is the most common medical problem among children. Most earaches are a middle ear bacterial infection, but some are caused by teething and sore throats. In infants and toddlers, there may be rubbing or pulling of the ear, acting irritably or crying, showing a fever or ear drainage, and having trouble sleeping, often starting soon after being put to bed. Hearing loss and imbalance may be noticeable in toddlers but difficult to detect in infants. Older children have fewer symptoms, but will still have pain, hearing loss and possibly mucous drainage from the ear. Pain is usually worse after a child has been lying down for 20 minutes as the tissue swells and pressure increases.

What causes ear infections?

An ear infection is caused by a blocked Eustachian tube, which connects the back of the nose with the middle ear. In children, the blockage results most commonly from a viral infection, allergies, or a bacterial infection in the adenoids. When the tube is blocked, fluid is drawn into the middle ear, which produces an environment favorable to bacterial growth. A severe infection can cause a pin-point rupture of the eardrum, which relieves the pressure and pain. Although alarming to a parent, a rupture actually starts the healing process by draining the pus. Drainage is a natural event and can speed recovery, with the perforation usually repairing within a day. 

How can I prevent an ear infection?

Almost every child has at least one ear infection by the age of five. To help prevent your child’s chances of an ear infection, ask about having your child immunized with the Prevnar vaccine. In addition, avoid second-hand smoke and prolong breastfeeding. A large study funded by the NIH identified that ear infections often run in families, indicating that a stronger inflammatory response, a weaker immune system, and an allergic tendency may all interact to cause some children to have more infections than others.

How is an ear infection treated?

Ear infections should be treated with oral antibiotics. If symptoms develop, it is best to visit a doctor’s office during the day, rather than taking the child to the emergency department in the middle of the night when the prescription cannot be filled. The child’s immediate first need is for pain relief, provided by Children’s Motrin or Tylenol in the correct dosage, so everyone can sleep. You should seek medical attention immediately if any of the following severe complications develop: mastoiditis (evidenced by red swelling behind the ear), high fever, and facial nerve weakness. If your child has had more than 3 infections in a year, you should talk to your health care provider to determine if ventilation tubes are recommended.