Should Your Child See a Doctor?


This Care Guide Covers

  • Pain or ache in or around the ear
  • The older child complains about ear pain
  • Younger child acts like he did with last ear infection or cries a lot
  • Not caused by an ear injury

See Other Care Guide If

  • After an injury. See EAR INJURY.
  • Ear congestion but no pain. See EAR CONGESTION.
  • Caused by air or mountain travel. See EAR CONGESTION.
  • Earache follows lots of swimming. See EAR SWIMMER'S.

Health Information

Causes of Earaches

  • Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.
  • Swimmer's Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.
  • Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.
  • Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.
  • Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by Q-tips, the ear canal can become blocked. This pain will be worse.
  • Ear Canal Foreign Body (Object). Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.
  • Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.
  • Pierced Ear Infections. These are common. If not treated early, they can become very painful.
  • Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.

Ear Infections: Most Common Cause

  • Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common that bacterial ones.
  • Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
  • Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
  • Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
  • Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
  • Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
  • Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.

Return to School

  • An earache or ear infection cannot be spread to others. No need to miss any school or child care.

When To Call Your Doctor

Call 911 Now (your child may need an ambulance) If

  • Not moving or too weak to stand
  • You think your child has a life-threatening

Call Your Doctor Now (night or day) If

  • Severe earache and not improved 2 hours after taking ibuprofen
  • Pink or red swelling behind the ear
  • Stiff neck and can't touch chin to chest
  • Pointed object was put into the ear canal. (Such as a pencil, stick or wire)
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Your Doctor Within 24 Hours If

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

Care Advice for Earache

  1. What You Should Know About Earaches:
    • Your child may have an ear infection. The only way to be sure is to look at the eardrum.
    • It is safe to wait until your doctor's office is open to call. It is not harmful to wait if the pain starts at night.
    • Ear pain can usually be controlled with pain medicine and eardrops.
    • Many earaches are caused by a virus and don't need an antibiotic.
    • Here is some care advice that should help until you talk with your doctor.
  2. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed. See Dose Tables.
  3. Cold Pack for Pain:
    • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
    • Note: Some children prefer heat for 20 minutes.
    • Caution: A hot or cold pack kept on too long could cause a burn or frostbite.
  4. Eardrops for Pain:
    • If pain medicine does not help the pain, try eardrops. You can use plain olive oil or mineral oil (baby oil).
    • Use 3 drops every 4 hours.
    • Prescription eardrops for pain are sometimes used. (Same dose). Ask your child's doctor about these during office hours.
    • Caution: Don't use eardrops if has ear tubes or a hole in the eardrum.
  5. Ear Infection Discharge:
    • If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.
    • The pus may be blood-tinged.
    • Most often, this heals well after the ear infection is treated.
    • Wipe the discharge away as you see it.
    • Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
  6. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). See Dose Table.
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  7. Return to School:
    • Ear infections cannot be spread to others.
    • Can return to school or child care when the fever is gone.
  8. Call Your Doctor If:
    • Pain becomes severe
    • Your child becomes worse

Remember! Contact your doctor if your child develops any of the "When to Call" symptoms.


  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


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: Barton D. Schmitt, M.D.

Last Reviewed: 1/2/2014

Last Revised: 4/2/2014 6:49:26 PM

Content Set: Child Symptom Checker

Version Year: 2014

Copyright 1994-2014 Barton D. Schmitt, M.D.