Ear Pain in Kids: Ear Infections and When to Get Seen

It's ten at night, your son has had a runny nose and a cough for three days, and suddenly he wakes up crying with his hand pressed over one ear. The baby goes through something similar: she pushes the bottle away, rubs her head against the mattress and simply won't settle. Plenty of families in Aldine know that scene well, along with the question that follows it: can this wait until morning, or do we need to go now?

Here's what usually causes that pain, what helps at home and when the ear needs to be looked at.

Why the ear hurts so much after a cold

Behind the eardrum there's a small air-filled space connected to the back of the nose by a very thin tube. In children that tube is shorter and flatter than in adults, so it clogs easily during a cold, the flu or allergy congestion. Fluid gets trapped, presses on the eardrum and, if germs grow there, you get acute otitis media, which the CDC lists as the most common ear infection of childhood.

That's why it typically arrives a few days into the cold, right when parents thought the worst was over.

How it shows in a child who can't tell you yet

A four- or five-year-old will point and say "it hurts here." A baby can't, so you look for other clues:

• Tugging, scratching or grabbing one ear more than usual.
• More crying when laid down, because lying flat raises the pressure inside the ear.
• Refusing the breast or bottle, since sucking and swallowing hurt.
• Several bad nights in a row, or being much fussier than normal.
• A fever, or not reacting the same way when you speak from the sore side.
• Yellowish fluid leaking from the ear; sometimes the pain eases suddenly when that happens, because the eardrum let the pressure out.

A word of caution: many babies tug their ears while teething or when they're sleepy. What matters is the whole picture: a recent cold, fever, poor sleep and a change in mood.

Middle ear infection vs. swimmer's ear

There's a second common kind of ear pain in kids that has nothing to do with colds: otitis externa, better known as swimmer's ear. It's irritation or infection of the canal that runs from the outer ear to the eardrum, and it starts when water stays trapped inside after the pool, the splash pad or even a long soak in the tub.

Until someone checks it: safe relief at home

• Treat the pain. AAP advice for families stresses that easing the pain comes first. Use only a children's pain reliever you've already been told to use, and follow the weight-based dose you were given; if you're not sure which one or how much, ask before giving anything. Never give a child aspirin.
• A warm compress over the ear, wrapped in a towel, comforts many kids.
• Raise the head of the bed slightly if the pain gets worse lying down.
• Plenty of fluids and rest, just as with any cold.
• Put nothing inside the ear: no cotton swabs, no oil, no garlic, no drops a neighbor swore by, no ear candles. If the eardrum has a hole, some drops can cause harm, and a swab pushes wax deeper and scrapes the canal.

Does every ear infection need antibiotics?

Not always. The CDC explains that many middle ear infections clear up on their own within two or three days, since a good share are caused by viruses. For older kids with mild symptoms, pain relief and watching is sometimes enough; for babies, severe pain, high fever or a draining ear, an antibiotic is often part of the plan.

That call can't be made over the phone or with the leftovers from a sibling's prescription. Telling whether there's an infection means looking at the eardrum, and the clinic's medical team decides, after checking the ear, whether your child needs an antibiotic or just close watching. If one is prescribed, finish the full course even if your child feels better after two days.

Don't wait until morning if you see this

These signs call for the emergency room or 911, not a clinic visit:

• Fever in a baby under 3 months old (100.4 °F or higher), even if the baby seems calm.
• Swelling, redness or pain behind the ear, especially if the ear looks pushed outward.
• A stiff neck, a very bad headache, unusual drowsiness or confusion.
• Bloody discharge from the ear, or pain that began after a blow to the head or after pushing an object in.
• Weakness or drooping on one side of the face, or dizziness so strong your child can't stand.

When to book a visit

For everything that isn't an emergency, it's worth having your child checked if:

• The pain lasts past two days, or comes back after getting better.
• A fever won't come down, or the ear has started to drain.
• Your child is under two and has a cold with ear pain.
• The throat hurts along with the ear: a sore throat is often felt in the ear, and the strep test gives a result in a few minutes.
• You suspect swimmer's ear after swim lessons.

During the respiratory illness visit, the medical team checks the throat, ears and lungs, and treats the ear pain that comes along with the flu. If allergy congestion is what keeps plugging your child's ears, that's reviewed in an allergy visit. Did your child get drops or an antibiotic? When the visit ends, you buy what the medical team prescribed on the spot at the pharmacy inside the clinic, and staff explain how to give it before you go.

If ear infections keep coming back several times a year, or your child seems to hear less or is slower to talk than other kids the same age, a specialized evaluation may be needed as a general rule; bring it up during the visit.

Keeping it from coming back

• Wash hands at home, especially after school or daycare.
• Don't smoke inside the house or the car: smoke raises the rate of ear infections in children.
• Don't give the bottle while your baby lies flat on their back.
• Keep vaccines up to date; the CDC recommends a flu shot every year from 6 months of age. The adults at home can also get their flu shot at the clinic.
• After swimming, dry the outer ears with a towel and tilt the head to each side so the water runs out.

Flying for the holidays

If the family is flying to Mexico or Central America for Christmas, the pressure change on landing can really hurt an ear that's already plugged. Offer the breast, a bottle or a drink to the baby during the descent, and gum to older kids. If there's an ear infection right before the flight, get it checked before you leave.

If your child's ear starts hurting late in the evening, the clinic on Airline Drive, near 77037, lets you walk in or call to book, weekends included. Bring a note with how many days the cold has lasted, the highest reading on the thermometer and what you've already given for the pain; if you don't have insurance, you pay directly at the visit.