Children and Earaches

Earaches in children are usually caused by an infection of the middle ear (otitis media), a pea-sized chamber located directly behind the eardrum. Parents should not become alarmed if their children develop this painful ailment, because it rarely poses a significant health threat and is quite common among kids. Two out of three children will experience at least one earache before they reach their third birthday.

In most cases, earaches occur after a child develops an upper respiratory infection (a "cold") that sends bacteria or a virus into the eustachian tube, a drainage passageway from the middle ear to the throat. This passageway also serves to equalize air pressure between the middle ear and the air outside the eardrum. If the eustachian tube becomes swollen as a result of infection, it can cause fluids to accumulate in the chamber of the middle ear. The resulting reservoir then becomes a fertile breeding ground for bacteria. More than 85 percent of childhood earaches are caused by bacteria (such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, although the incidence of otitis caused by S. pneumoniae has decreased since pneumococcal vaccine became a routine childhood immunization ).

Because their eustachian tubes are smaller and more horizontally positioned than those of adults, children are more prone to the swelling that triggers the fluid accumulation in the middle ear. If the fluid becomes infected, it will often trigger middle-ear inflammation, swelling and painful pressure against the eardrum -- all typical symptoms of otitis media-related earache.

A second type of earache in children takes place in front of the eardrum, inside the canal that leads to the outer opening of the ear. This condition is usually caused by an external ear infection that attacks the ear canal. This condition is called otitis externa and, frequently referred to as "swimmer's ear," occurs mostly in older kids, and is far less common than the middle-ear infections that typically affect small children.

Although a child's eustachian tube usually becomes blocked because of a cold, the obstruction can also result from enlarged adenoids, an allergy, a sinus or throat infection, or even irritation from tobacco smoke.

The key signs of earache in small children include local pain and a sensation of pressure or fullness in the ear, fever, temporary and partial hearing loss and complaints of "fullness" or "stuffiness" in the head and drainage from the ear if the eardrum perforates. Among infants, the signs to look for are loss of appetite, irritability and crying (especially when the baby is lying down), as well as rubbing or tugging at one or both ears.

The most common form of middle ear infection (acute otitis media) was, at one time, almost universally treated with antibiotics but typically now is treated conservatively with decongestants and time since most of these infections resolve on their own, and in most cases disappears in five to 10 days without damaging the child's health or hearing.  A complication of middle ear infection, (otitis media with effusion) can persist much longer, with fluid remaining in the middle ear for six weeks or more. Another complication is chronic otitis media in which  the infection lingers in the middle ear.  This more severe form of earache can result in significant damage to both the middle ear and the eardrum.

What to Do

Children who have symptoms of earache -- including pain in the ear and fever -- should receive prompt medical attention. Call your child's health care provider immediately if the child's ear begins to discharge blood, or white or yellow pus. Such a discharge could signal that his or her eardrum has burst from pressure caused by swelling and fluid-buildup. Also call your child's provider if sharp pain in the child's ear and fever are both present. It's important to remember that an untreated earache can cause permanent hearing loss and other significant health complications resulting from the growth and spread of infection.

Use Medicine Effectively

Many kids with earache require a 5 or 10-day course of antibiotics under a doctor's supervision. If your child's provider prescribes an medication, make sure the child takes it as directed. Measure doses carefully, and be certain the child receives the full dose. Take pain relievers (typically acetaminophen or ibuprofen) based on your child's provider's advice.

Self-care Steps for Kids/Earache

• Be sure to act on your health care provider's recommendations for follow-up care.

• For additional pain relief, place a warm washcloth over the child's affected ear.

• Provide plenty of liquids in the form of water or juices.

• To prevent the spreading of infection in the event of a draining ear, wash bedding or clothing that has come into contact with pus from the child's ears.