Prevention is the best option

Earache in children

mal d'oïda  Vall d'Hebron

Earache is the third biggest reason for consulting paediatrics, after the common cold and periodic health check-up. 

Earache appears when there is an inflammation, otitis. There are three types of otitis:

  • External: affects the external auditory canal
  • Suppurative otitis media: produced by accumulation of fluid that normally does not lead to infection. That is, there is no pain or redness in the area, nor any symptoms.
  • Acute otitis media



When liquid accumulates in the ear but there is no pain, redness, pus or other symptoms of infection, suppurative otitis media is produced and, normally, there is no need to administer antibiotics. Normally the causes are:

  • Previous respiratory infections
  • Air pressure changes on journeys or due to changes in altitude
  • Allergies
  • Irritants, such as tobacco smoke
  • In babies, lying down face upwards

Acute otitis media is an infection that affects the inner ear and may cause pain. It is normally caused by bacteria, but it can also be caused by a virus.


How does it manifest?

While older children complain of an earache and, sometimes, they have a fever, in infants it manifests differently: they may have a fever, loss of appetite, vomiting, diarrhoea, irritability and fluid discharge through the ear canal, known as ear suppuration.



  • Children touch their ears
  • Crying and irritability, especially in babies and small children
  • Loss of balance
  • Fluid discharge
  • Trouble sleeping
  • Headache
  • Difficulty hearing


How should we act in the event of earache in children?

When a child has earache, take them to a paediatrician so that they can conduct an assessment and indicate the appropriate treatment. This does not mean you need to go to A&E.

  • Frequent nasal washes with saline solution serve to clean the middle ear and clear the ear canal.
  • Do not put anything in the ear to relieve the pain, unless indicated by a specialist
  • If the child does not want to eat, do not force them to
  • If there is any discharge, avoid getting water in the ear. Take care when bathing
  • Most cases of acute otitis media get better without antibiotic treatment. If there is pain or fever symptoms may be treated, for example by giving pain killers.


How is it diagnosed?

In order to diagnose otitis, the paediatrician needs to see the ear drum, inside the ear. To do so, they will use a device called an otoscope.

When deciding on treatment, the doctor must take into account several factors, such as age, severity of the illness and knowing whether or not there is a bacterial infection. Sometimes, antibiotic treatment will be required, but this is not always necessary.

If the symptoms continue and last longer than a month for suppurative otitis media, or more than two days for acute otitis media, the paediatrician will need to do a follow-up.


When should I go to A&E?

  • If the general condition worsens, the child is distressed or very irritable
  • If there is blood in bodily fluids
  • If they complain of an intense headache and vomit several times
  • If a red and inflamed area appears that hurts and pushes the external ear forwards
  • If the child is less than 3 months old and has a fever, it is important to see a paediatrician as soon as possible.


Can it be prevented?

Although it cannot always be prevented, you are advised to:

  • Avoid smoking or exposing children to so-called second-hand smoke
  • Keep up to date with vaccinations
  • Breastfeed babies up to 12 months old
  • Keep babies upright when bottle feeding


Bear in mind that...

  • Ear infection does not always need to be treated with antibiotics

The majority of ear infections get better within 48-72 hours and painkillers are advised to relieve pain.