Ear pain is one of the most common reasons parents bring children to the doctor. Acute otitis media (middle ear infection) occurs in approximately 80% of children at least once by age 3.
Causes of Ear Pain
- Acute otitis media (AOM): Infection of fluid in the middle ear — most common
- Serous otitis (otitis media with effusion): Non-infected fluid buildup
- Otitis externa (swimmer's ear): Outer ear canal infection
- Earwax buildup, foreign objects
- Referred pain: teething, throat infection, jaw joint issues
Why So Common in Children?
The Eustachian tube in children is shorter, flatter, and wider than in adults, allowing bacteria to reach the middle ear easily. It usually develops after an upper respiratory infection.
Symptoms
- Older children: "My ear hurts" — sudden, severe pain
- Babies: Ear pulling/rubbing, fussiness (especially lying down), crying, sleep disturbance, fever
- Ear discharge (if eardrum ruptures) — actually relieves pain
- Temporary hearing reduction
Treatment
Pain Management (Foundation of Treatment)
Acetaminophen or ibuprofen (6mo+). Pain relief is needed for the first 24-48 hours even if antibiotics are started.
When Are Antibiotics Needed?
- Antibiotics immediately: Under 6 months, bilateral AOM in 6mo-2yr, severe symptoms (39°C+ fever, 48hr+ symptoms), ear discharge
- Watch-and-wait (48-72 hours): Over 6 months, unilateral, mild symptoms — start antibiotics if no improvement
First-choice: Amoxicillin 80-90 mg/kg/day for 10 days (under 2) or 5-7 days (over 2).
Recurrent Infections and Ear Tubes
3+ episodes in 6 months or 4+ in 12 months, or fluid lasting 3+ months may warrant ENT evaluation and ventilation tube (grommet) placement — a minor day procedure that ventilates the middle ear.
Prevention
- Breastfeeding (minimum 6 months) — proven protective effect
- Pneumococcal and flu vaccines reduce otitis risk
- Avoid tobacco smoke exposure
- Limit pacifier use after 6 months
- Feed babies upright (no bottle while lying flat)
When to See a Doctor
- Severe ear pain, especially at night
- Discharge or bloody fluid from the ear
- Fever with ear pain
- Pain not improving after 48 hours of pain medication
- Hearing reduction noticed
- Swelling/redness behind the ear (suspected mastoiditis — emergency)
Ear infections generally have a good prognosis, but recurrent episodes can affect hearing and language development. Contact our clinic when in doubt — otoscopic examination provides accurate diagnosis.
