Ow! My child has an earache!
2/27/2025 by Jason (Jay) Homme, M.D.
As a parent, how you respond to your child’s ear pain depends a lot on their age and ability to tell you what hurts. Your 9-year-old can say, “My left ear hurts,” while your 2-month-old may just be fussy or unable to sleep.
It’s uncommon for infants younger than two months old to develop ear infections. After three or four months of age, infections become more common. Why? There are two key factors:
- Infections usually affect the middle ear space, which is smaller at this age. The Eustachian tube, which helps drain the area, is flatter and not as effective in draining away fluids.
- Children 3 and younger tend to get a lot of colds. Fluid builds up, which can cause pressure and pain, and sometimes becomes infected.
Infants and toddlers may show symptoms of ear pain that include fussiness, pulling on their ears, running a fever, or not sleeping or eating well. The only way to tell if they’re suffering from an infection is to have their ears examined at a clinic.
If your child is less than a year old, you should bring them in to be checked. If your child is diagnosed with an ear infection, there are several things your healthcare clinician should consider when determining if an antibiotic is necessary. If your child is six months or younger, an infection likely will be treated with an antibiotic, typically amoxicillin. After six months, getting an antibiotic will depend on how the ear looks, whether both ears are infected, and how high your child’s fever is and how long it has lasted.
If your child is 2 or older and only one ear is infected, there’s a 75-80% chance the infection will go away on its own. Just watch them and treat the pain. If two or three days go by and they are getting worse or not showing signs of improvement, an antibiotic may be helpful.
Home remedies for ear pain include:
- Using acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) according to instructions on the box.
- Propping your child up for better sleeping since lying down can increase the pressure and pain in the ear.
- Applying a warm, moist compress, such as a washcloth, to the ear hasn’t been proven to help but likely won’t cause harm.
These infections are more common in the first three years of life (up to 3 years old isn't unusual). But after age 3, they become less common. However, if your child has recurring ear infections — up to three in a single season or four in a year — talk with your clinician about whether ear tubes, which drain fluid from the middle ear, would be an option for your child.
Ways to reduce the chance of your child getting an ear infection include:
- Breastfeed.
- Keep them away from second-hand smoke.
- Make sure their routine immunizations are up to date.
An infection in the middle ear isn’t the only cause of earaches. The pain may be the result of a jaw or tooth issue, teething, infected lymph node, sore throat, wax build-up or swimmer’s ear. Swimmer’s ear is an infection of the outer ear canal often caused by water remaining in the ear after swimming or bathing. The ear canal becomes inflamed and red; gently pulling on the earlobe is painful. Swimmer’s ear is usually treated with prescription ear drops.
No matter your child's age, ear pain is rarely an emergency. So rather than bundling them up and heading to the ER in the middle of the night, make them comfortable with home remedies and wait until morning.
Jason (Jay) Homme, M.D., is a Community Pediatric and Adolescent Medicine physician. His main areas of practice and interest are pediatric and adolescent medicine, inpatient medicine, office-based procedures and medical education. He’s the father of six children.