Kids commonly complain of earaches.
Some don’t necessarily complain of an earache (otalgia), but just tug at their ears or a little more fussy than usual, so you might just think that it’s their ears.
Surprisingly, an earache doesn’t always mean that your kids have an ear infection.
Why Does Your Child’s Ear Hurt?
So what else besides an actual ear infection can cause an earache?
Does your child have a new tooth coming in?
Has he been swimming? (swimmer’s ear)
Does he have a sore throat or runny nose? (although most middle ear infections come after a few days of cold symptoms, simply having a sore throat or runny nose might cause some ear pain)
As you can imagine, lots of things can cause earaches, but the most common include:
- swimmer’s ear (otitis externa) – unlike otitis media, these kids typically have outer ear pain, or pain when you move or tug on their ear lobe
- middle ear effusions – fluid that is left over in the middle ear after an ear infection (has nothing to do with swimming)
- sinus congestion – some kids associate the extra ear popping that comes with allergies or a cold/sinus infection as being painful or uncomfortable
- pharyngitis – because of referred pain, some kids with sore throats complain of ear pain instead of throat pain
And then some younger kids simply tug on their ears because they can. They are otherwise well, sleeping all night, eating well, and aren’t fussy.
What else can cause earaches? A toothache, too much earwax, or that rock your kid put in his ear a few weeks ago…
What to Do About Your Child’s Earache
Once you know why your child has an earache, which typically means a trip to your pediatrician, you need to know what to do about it.
You’re thinking a prescription for an antibiotic is coming, right?
Many parents will be happy to hear that most earaches won’t mean an automatic antibiotic prescription. Instead, your pediatrician will likely:
- recommend symptomatic care for teething
- prescribe antibiotic ear drops for swimmer’s ear
- recheck your child’s middle ear effusion in a few months, as this goes away on it’s own in most cases without any treatment
- treat underlying congestion from allergies, colds, or a sinus infection as needed
- recommend symptomatic care for a sore throat
But what if your child really does have a middle ear infection? Then he will get antibiotics, right?
Since most ear infections get better on their own, antibiotics are typically reserved for:
- children under age 6 months with acute otitis media (typically ear pain and a bulging ear drum)
- children who are at least 6 months with acute otitis media and severe signs or symptoms, including moderate or severe pain for at least 48 hours or a temperature of 102.2°F (39°C) or higher
- children who are under 24 months with “double” ear infections – both ears are infected at the same time, even if they just have mild symptoms
For most other children, instead of having you start antibiotics right away, your pediatrician might have you wait for 48 hours – the observation option. You can then start the antibiotics if your child doesn’t get better after a period of watchful waiting for two or three days. Until then, an age-appropriate dose of Tylenol (acetaminophen) or Motrin (ibuprofen) can often help control pain or fever.
In addition to your pediatrician, a pediatric ENT specialist can be helpful if your child has persistent ear pain.
What to Know About Children with Earaches
While it is sometimes obvious to know what is going on when older kids complain of ear pain, it is important to understand that not every earache means an ear infection, and even when it does, it might not mean a prescription for an antibiotic.
More on Children with Earaches
- AAP – The Diagnosis and Management of Acute Otitis Media
- AAP – Otitis Media With Effusion
- Why do ears pop?
- Otitis externa
- Otalgia in children.
- Diagnosis of Ear Pain
- Cutting Teeth, Part 1: The Fascinating History of Teething
- Teething: What is it and what should you do about it?
- When Your Child Has Tinnitus
- 7 ear infection myths every parent should know
- The Dreaded Ear Infection
- All About Ear Infections
- Can My Child Swim with an Ear Infection?
Last Updated on May 23, 2018 by Vincent Iannelli, MD