Ear infections are very common in children and most likely comes with a viral cold. Your child might feel unwell with a fever, sickness, and feeling of their food. Ear infections usually affect the middle ear, which we call otitis media. The pain comes as products of infection and inflammation build up behind the eardrum, pushing it. 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 really common in the autumn and winter and 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 on to others if you have discharge, but it’s fairly low.
You can gently remove any discharge by wiping the ear with cotton wool. Make sure you don't place anything inside the ear to clean it, including cotton buds, as this can make symptoms worse.
Most ear infections get better by themselves within 3 days with rest and plenty of fluids. Treat any fever if they are distressed, and this will also provide some 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 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 they have a high fever, speak to your doctor urgently or call 111 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 and paradoxically their pain improving, 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 conditions 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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