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Ear Problems and Injuries, Age 11 and Younger

Topic Overview

Picture of the anatomy of the ear Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear). Ear infections (otitis media) most commonly occur when cold symptoms, such as a runny or stuffy nose and a cough, have been present for a few days.

An ear infection may occur when the eustachian tube swells and closes and fluid accumulates in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection can cause pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.

Middle ear infections are more common in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.

Ear infection is the most commonly diagnosed bacterial infection in children younger than age 7. Almost all children will have at least one ear infection by the time they are 7 years old. Most ear infections occur in babies between the ages of 6 months to 3 years. After age 7, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections are more common in boys than in girls, and they most often occur in children who:

  • Spend time in day care settings.
  • Are bottle-fed.
  • Use a pacifier.
  • Live in households where parents or caregivers smoke.
  • Have had a previous ear infection.
  • Have problems present since birth (congenital abnormalities), such as cleft lip, cleft palate, or Down syndrome.
  • Have allergies.

Fluid often remains in the middle ear (serous otitis, or middle ear effusion) after an ear infection. This may cause no symptoms, or it may cause a muffling of sound, decreased hearing, and mild discomfort. The body usually reabsorbs fluid behind the eardrum within 3 months, and hearing returns to normal. Recurrent ear infections and persistent effusion may occur in some children.

Even though ear infections are a common cause of ear pain, not all ear pain means an infection. Other common causes of apparent ear pain in young children include:

  • Teething.
  • A sore throat.
  • An accumulation of earwax.
  • An object in the ear.
  • Air pressure changes, such as flying in an airplane.
  • Fluid buildup without infection (serous otitis).

When evaluating ear pain in a child, remember that ear infections commonly occur after symptoms of a cold have been present for a few days. When other symptoms, such as fever, are present, ear pain or drainage may be less important than the other symptoms.

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

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Home Treatment

When ear discomfort or pain is mild or comes and goes and occurs without other symptoms, home treatment may be all that is needed to relieve your child's discomfort. Home treatment measures include the following:

  • Encourage your child to swallow more often. The discomfort may be caused by a blocked eustachian tube that can occur with mild irritation in the ear canal. Let a child younger than age 12 months drink from a bottle or cup to try to help open the eustachian tube.
  • Some babies and children who have ear pain are more comfortable in an upright position. Allow the child to rest in the position that is most comfortable.
  • To relieve moderate to severe ear pain while waiting to see your doctor, or to relieve a red, swollen external ear:
    • Apply heat to the ear to ease pain. Use a warm washcloth. Be careful not to burn the skin around the ear. There may be some drainage when the heat melts earwax.
    • Encourage your child to rest as much as possible.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your child's fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all labels on the medicine bottle and box.
  • Give, but do not exceed, the maximum recommended doses.
  • Do not give your child a medicine if he or she has had an allergic reaction to it in the past.
  • Do not give aspirin to anyone younger than age 20 unless directed to do so by your child's doctor.
  • Do not give naproxen (such as Aleve) to children younger than age 12 unless your child's doctor tells you to.

Symptoms to watch for during home treatment

Call your child's doctor if any of the following occur during home treatment:

  • Your child's pain gets worse.
  • Your child develops a new fever.
  • New or different drainage from the ear develops.
  • Your child's symptoms become more severe or more frequent.

Prevention

There are many steps you can take to help prevent ear problems and injuries.

  • Breast-feed your baby. Breast-fed babies may have fewer ear infections.
  • Avoid exposing children to cigarette smoke. Children exposed to secondhand smoke have more frequent ear infections. If you smoke and are unable to stop, smoke outside, away from your child.
  • Do not put your baby to bed with a bottle.
  • Do not allow your baby to hold his or her own bottle.
  • When your toddler is using a bottle or sippy cup, have him or her stay seated. This can help prevent injuries that might occur if your child were to fall while walking and holding a bottle or a cup.
  • Feed babies in an upright position to prevent milk from getting into the area around the eustachian tubes. Do not allow infants to fall asleep with a bottle. (Nursing babies may fall asleep at the breast.)
  • Being in day care increases your child's chance of getting an ear infection, so:
    • Choose a day care setting with 6 or fewer children.
    • Make sure that day care workers wash their hands before and after each diaper change.
    • Have day care workers wash toys often.
  • Limit the use of a pacifier after age 6 months to moments when your child is falling asleep. Babies who use pacifiers after 12 months of age are more likely to get ear infections.
  • Teach your children to blow their noses gently. This is a good idea for adults too. Wash your hands and teach your child to wash his or her hands after blowing. This helps prevent the spread of germs that can cause infection.
  • Wash your hands before and after every diaper change and teach your child to wash his or her hands after using the toilet.
  • When possible, limit your child's contact with other children who have colds.
  • Try to keep soap and shampoo out of the ear canal. Soap and shampoo can cause itching, which can be mistaken for ear pain if the child is scratching or pulling at his or her ears.
  • If your child has tubes in his or her ears, try to keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it's okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it's okay to go back to regular water activities.
  • The Haemophilus influenzae type b (Hib) vaccine prevents ear infections caused by this bacteria. Pneumococcal vaccine also prevents some ear infections in children. For more information, see the childhood immunization schedule.
  • Do not insert anything, such as a cotton swab or a bobby pin, into the ear. Gently cleanse the outside of your child's ear with a warm washcloth.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

If you have made an appointment with your child's doctor, you can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

  • Did your child have an injury to the ear? If so, describe when and how the injury occurred.
  • When did the pain start?
  • Has the pain been constant or does it come and go?
  • Does anything make the pain better or worse?
  • What symptoms make you think your child is having ear pain?
  • Has your child ever been treated for an ear infection in the past? If so:
    • How long ago was he or she treated?
    • What medicine did you use?
    • Did your child finish all of the medicine?
    • Did you have a follow-up checkup after the medicine was finished?
  • Does your child have ear tubes in place?
  • Does your child have other symptoms, such as fever, a runny nose, a cough, or congestion? If so, how long have these symptoms been present?
  • What immunizations has your child had?
  • What home treatment measures have you used? Be sure to include nonprescription medicines you have given your child.
  • Do you suspect a hearing problem? Describe the hearing problems you have noticed. How did your child respond to sounds before and after you noticed the problem?
  • Does your child wear hearing aids?
  • Does your child have any health risks?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised July 25, 2012

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