Ear infections are prevalent in children and most likely come with a viral cold. Your child might feel unwell with a fever, sickness, and loss of appetite. Ear infections usually affect the middle ear, which we call otitis media. The pain comes as a result of infection and inflammation build-up behind the eardrum. They may complain that hearing comes and goes, or they may feel pain on the cheek side of the ear or under it, which might be worse when eating. It’s usually just one ear affected.
Sometimes infections affect the outer part of the ear. This may be the case if you have symptoms of wetness with white or yellow discharge, and the ear may feel itchy or sore just inside. This points more towards otitis externa, where the ear canal leading to the eardrum is infected.
Ear infections are most commonly caused by a virus, which can give your child cold - or flu-like symptoms – a runny nose, cough, sore throat, and fever alongside ear pain. These are very common in the autumn and winter and are easily picked up at nursery or school. Viral respiratory infections are contagious, so if your child is well enough for school, they should have good hand hygiene and try to sneeze or cough into tissues (or at least their elbow!).
Bacteria can infect the ears, especially with otitis externa, and there is the possibility of passing it on to others if you have discharge, but it’s fairly low.
You can gently remove any discharge by wiping the ear with cotton balls. Ensure you don't place anything inside the ear to clean it, including cotton buds, as this can worsen symptoms.
Most ear infections get better by themselves within 3 days with rest and plenty of fluids. Treat any fever if they are distressed; this will also provide pain relief. Symptoms may last for up to a week, but hopefully, they will improve in this time.
Viral infections don’t respond to antibiotics, and bacterial ear infections usually get better on their own. It would only be in exceptional circumstances that your doctor would consider prescribing antibiotics for this.
If their ear pain has not improved after 3 days, if they have an infection in both ears or discharge coming out, if they are not keeping up with fluids, or if they have a high fever, speak to your doctor urgently or call 911 outside of working hours. Any baby under 3 months old with a fever should be assessed urgently.
If their hearing has suddenly reduced, and this may be accompanied by discharge. Paradoxically their pain is improving, but their eardrum may have burst (perforated): it’s worth getting this checked with your doctor. If they experience severe pain on pressing the bony bit of the skull just behind the ear or there is swelling, seek urgent help.
If your child is immunocompromised because of medication or a condition, or they have needs that may make them more vulnerable to complications, such as prematurity or cystic fibrosis, speak to your doctor.
If pain is well controlled, they are well and without a fever, and they are eating and drinking, they can attend nursery or school as usual. If they are not themselves or appear unwell, they may benefit from staying home for a day or two to rest and recuperate.
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