Should Your Child See a Doctor?

Earache

Definition

  • Pain or discomfort in or around the ear
  • Child reports an earache
  • Younger child acts like he did with previous ear infection (e.g., crying or fussy)

Cause  

  • Usually due to an ear infection
  • Ear infections can be caused by viruses or bacteria. Usually, your child's doctor can tell the difference by looking at the eardrum.
  • Ear infections peak at age 6 months to 2 years
  • The onset of ear infections peaks on day 3 of a cold

Return to School  

  • An earache or ear infection is not contagious. No need to miss any school or child care.

When to Call Your Doctor for Earache

Call 911 If…

 
  • Your child is not moving or too weak to stand
 

Call Your Doctor Now (night or day) If

 
  • Your child looks or acts very sick
  • Earache is severe and not improved 2 hours after taking ibuprofen
  • Pink or red swelling behind the ear
  • Stiff neck (can't touch chin to chest)
  • Pointed object was inserted into the ear canal (e.g., a pencil, stick or wire)
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc.)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • Earache, but none of the symptoms described above (Reason: possible ear infection)
  • Pus or cloudy discharge from ear canal
 

Home Care Advice for Suspected Ear Infection (until your child can be seen)

  1. Reassurance:
    • Your child may have an ear infection. The only way to be sure is to examine the eardrum.
    • Diagnosis and treatment can safely wait until morning if the earache begins after your child's doctor's office is closed.
    • Ear pain can be controlled with pain medicine and eardrops.
     
  2. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief or for fever above 102° F (39° C).
  3. Local Cold: Apply a cold pack or a cold wet wash cloth to the outer ear for 20 minutes to reduce pain while the pain medicine takes effect. (Note: Some children prefer local heat for 20 minutes.)
  4. Ear Drainage: If pus or cloudy fluid is draining from the ear canal, the eardrum has ruptured from an ear infection. Wipe the pus away as it appears. Avoid plugging with cotton (Reason: Retained pus causes irritation or infection of the ear canal).
  5. Eardrops: 3 drops of olive oil (or prescription eardrops) will usually relieve pain not helped by pain medicine. If your child has ear tubes or a hole in the eardrum, don't use them.
  6. Contagiousness: Ear infections are not contagious.
  7. Call Your Doctor If:
    • Your child develops severe pain
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Clinical Practice Guideline: Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1462.
  2. Bolt P, et al. Topical lidocaine eardrops reduce pain in AOM. Arch Dis Child. 2008;93:40-44.
  3. Canto RM. Otitis externa and otitis media: A new look at old problems. Emerg Med Clin North Am. 1995;13:445-455.
  4. Hoberman A, et al. Efficacy of Auralgan for treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med. 1997;151:675-678.
  5. Licameli GR. Diagnosis and management of otalgia in the pediatric patient. Pediatr Ann. 1999;28(6):364-368.
  6. Maxson S and Yamauchi T. Acute otitis media. Pediatr Rev. 1996;17:191-195.
  7. McWilliams DB, Jacobson RM, Van Houten HK. A program of anticipatory guidance for the prevention of emergency department visits for ear pain. Arch Pediatr Adolesc Med. 2008;162(2):151-156.
  8. Pirozzo S, Del Mar C. Otitis media. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 238-247

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 10/1/2010 1:52:18 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.