Ear Pain in Kids: What It Looks Like, What Causes It, and When to Call
· Last updated October 2026
It’s 2 a.m., your toddler is wide awake and tugging at one ear, and you’re wondering whether this is the start of an ear infection, a new tooth, or something you can safely watch until morning. Ear pain is one of the most common reasons families call us, especially through the fall and winter cold season here in the DC, Maryland, and Virginia area.
This guide walks you through what ear pain looks like at different ages, the most common causes, how pediatricians tell a middle ear infection from swimmer’s ear, what the American Academy of Pediatrics (AAP) recommends for treatment, and the warning signs that mean your child should be seen right away.
Key takeaways
Most ear pain in children comes from a middle ear infection (acute otitis media), swimmer’s ear (otitis externa), or fluid and pressure after a cold. A proper diagnosis requires a look at the eardrum with an otoscope.
Babies and toddlers can’t tell you their ear hurts. Watch for fussiness, poor sleep, ear pulling combined with other symptoms, and trouble feeding.
Under AAP guidance, not every ear infection needs antibiotics. For some children over six months with mild symptoms, a short period of watchful waiting with good pain control is a safe, evidence-based option.
Pain relief comes first. Acetaminophen or ibuprofen (ibuprofen only for babies over 6 months) can make a big difference while the body or the medicine does its work.
Seek care immediately for a fever in a baby under 3 months, swelling or redness behind the ear, a stiff neck, unusual sleepiness, facial weakness, or an object (especially a button battery) in the ear.
How ear pain shows up at different ages
Children communicate pain very differently depending on their age and language skills. Here is what to watch for.
| Age group | What you might notice | How they may “tell” you |
|---|---|---|
| Infants0–12 months | Fussiness and crying, especially when lying flat; waking more at night; pulling away from the bottle or breast mid-feed (sucking and swallowing change ear pressure); fever; a cold that suddenly gets worse | Crying that is hard to console; rubbing the side of the head against you or the crib mattress |
| Toddlers1–3 years | Irritability, clinginess, poor sleep, decreased appetite, fever, sometimes vomiting or loose stools; seeming not to hear you as well; clumsiness | Pulling, tugging, or batting at one ear; pointing to the ear; saying “ow” or “ouchie” and touching the side of the head |
| Preschoolers3–5 years | Complaints of pain, especially at bedtime; muffled hearing; ear “popping”; fever; drainage on the pillow | “My ear hurts,” “my ear is full,” “it feels like water is in there,” or describing pain in the jaw or neck |
| School-age children6–12 years | Can usually localize pain well; may notice muffled hearing, ringing, itching, or pain when touching the outer ear | Clear descriptions: “it hurts when I chew,” “it itches inside,” “it hurts when I push here” |
| Teens | Similar to adults; swimmer’s ear, earbud or headphone use, and jaw (TMJ) pain become more common | Specific complaints, though some teens downplay symptoms until pain is significant |
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A note on ear tugging: On its own, ear pulling is not a reliable sign of infection. Babies discover their ears, self-soothe when tired, and pull during teething. Ear tugging is more meaningful when it comes with fever, a recent cold, unusual fussiness, or sleep disruption.
What causes ear pain in children?
Not every earache is an ear infection. The most common causes include:
| Cause | What’s happening | Typical clues |
|---|---|---|
| Acute otitis mediaMiddle ear infection | Fluid behind the ear drum becomes infected, usually after a cold | Ear pain, fever, recent congestion, fussiness; most common at 6–24 months |
| Otitis media with effusion | Fluid sits behind the eardrum without active infection, often after a cold or a treated ear infection | Muffled hearing, a “full” feeling, mild discomfort; often no fever |
| Acute otitis externa“Swimmer’s ear” | Infection of the skin lining the ear canal | Pain when the outer ear is touched or tugged, itching, swelling, drainage; common in summer and in swimmers |
| Eustachian tube dysfunction and pressure changes | The tube connecting the middle ear and throat doesn’t equalize pressure, often during colds, allergies, or air travel | Popping, fullness, pain on takeoff or landing |
| Referred pain | Pain from a nearby area is felt in the ear | Sore throat or strep, teething, dental infection, swollen lymph nodes, jaw (TMJ) strain |
| Earwax impaction | Hardened wax blocks the canal, often pushed in by cotton swabs | Fullness, muffled hearing, mild discomfort |
| Foreign body | Beads, food, small toys, or insects in the ear canal | Sudden pain, drainage, sometimes a bad smell; common in toddlers and preschoolers |
| Injury | Cotton swab injury, a blow to the ear, or a ruptured eardrum | Sudden pain, sometimes a small amount of bleeding |
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Otitis media vs. otitis externa: what’s the difference?
These two conditions sound alike but involve different parts of the ear and are treated differently.
| Feature | Otitis media (middle ear infection) | Otitis externa (swimmer’s ear) |
|---|---|---|
| Location | Behind the eardrum, in the middle ear | In the ear canal, outside the eardrum |
| Who gets it most | Babies and toddlers, peaking between 6 and 24 months | School-age kids and teens, especially swimmers |
| Common trigger | A recent cold or upper respiratory infection | Water exposure, humidity, cotton swabs, earbuds, eczema |
| Pain with touching the outer ear? | Usually not | Yes, pulling the earlobe or pressing the tab in front of the ear often hurts |
| Fever | Common | Uncommon |
| Drainage | Possible if the eardrum ruptures (often brings pain relief) | Common; can be thick or white-yellow |
| Usual treatment | Pain control, then either watchful waiting or oral antibiotics, depending on age and severity | Medicated ear drops; oral antibiotics are generally not needed |
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Risk factors and predisposing factors
Some children are simply more prone to ear infections. Knowing why can help you reduce the odds.
| Category | Factors |
|---|---|
| Age and anatomy | Ages 6 to 24 months (the eustachian tube is shorter and more horizontal in young children); enlarged adenoids; cleft palate or other craniofacial differences; Down syndrome |
| Environment | Group child care; older siblings at home; exposure to tobacco smoke or vaping; fall and winter months |
| Feeding and habits | Bottle feeding while lying flat; frequent pacifier use after 6 months; not being breastfed |
| Health history | Frequent colds; allergies; a family history of ear infections; an ear infection in the first 6 months of life |
| Swimmer’s ear specifically | Frequent swimming (especially lake water), humid weather, cotton swab use, eczema or other skin conditions, hearing aids or earbuds that trap moisture |
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Steps that lower the risk
The AAP recommends these evidence-based prevention measures for middle ear infections:
Keep up with pneumococcal conjugate vaccines and get an annual flu vaccine for everyone 6 months and older.
Breastfeed exclusively for at least 6 months if you are able to.
Avoid tobacco smoke exposure in the home and car.
Avoid bottle propping or bottle feeding while your baby is lying flat.
For swimmer’s ear, dry the ears gently after swimming (tilt the head, or use a hair dryer on the lowest setting held at arm’s length) and skip cotton swabs altogether.
Viral or bacterial: how can you tell?
This is one of the most common questions we hear. The honest answer is that you can’t reliably tell at home, and neither can a pediatrician without looking at the eardrum.
Most middle ear infections begin with a viral cold. The virus causes swelling and fluid behind the eardrum, and bacteria that normally live in the nose and throat (most commonly Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) can then travel up the eustachian tube and cause a bacterial infection. Viruses alone cause some ear infections, and many children have fluid behind the eardrum with no infection at all.
| Sign | More suggestive of a viral cold or simple fluid | More suggestive of a bacterial ear infection |
|---|---|---|
| Eardrum on exam | Normal, mildly pink, or fluid without bulging | Moderate to severe bulging of the eardrum, or new drainage from the middle ear |
| Pain | Mild pressure or fullness | Sudden, significant ear pain, often within 48 hours of onset |
| Fever | Low-grade or none | May be 102.2°F (39°C) or higher |
| Timing | Improves along with the cold | Ear symptoms worsen several days into a cold, or appear as the cold is improving |
| Other features | Runny nose and cough are the main symptoms | Purulent “pink eye” alongside the ear pain is often linked to H. influenzae |
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The AAP is clear that a red eardrum alone is not enough to diagnose an ear infection, since crying and fever can redden the eardrum. A diagnosis requires fluid in the middle ear plus signs of inflammation, ideally with a bulging eardrum. This is exactly why an in-person exam with a good otoscope matters, and why we bring one to your home.
Treatment options by age
Pain relief comes first
The AAP recommends treating ear pain in every child, whether or not antibiotics are used. Options include:
Acetaminophen (Tylenol) for children of any age (call your pediatrician first for babies under 12 weeks).
Ibuprofen (Motrin, Advil) for babies 6 months and older.
A warm compress over the ear and keeping your child’s head slightly elevated for sleep can add comfort.
Dose by weight, not by age, using the syringe or cup that came with the medicine. Avoid numbing ear drops containing benzocaine, which the FDA warns against in young children, and skip home remedies like ear candling or putting oil in the ear. Decongestants and antihistamines do not help ear infections and are not recommended.
Middle ear infection (acute otitis media): AAP recommendations
The AAP clinical practice guideline on acute otitis media recommends tailoring treatment to the child’s age, how severe the symptoms are, and whether one or both ears are infected. “Severe”means moderate to severe ear pain, ear pain lasting 48 hours or longer, or a temperature of 102.2°F (39°C) or higher.
| Age | Severe symptoms or ear drainage | Both ears, non-severe | One ear, non-severe |
|---|---|---|---|
| Under 6 months | Antibiotics; young infants need prompt evaluation and close follow-up | Antibiotics | Antibiotics (the AAP guideline does not extend watchful waiting to this age group) |
| 6-23 months | Antibiotics | Antibiotics | Antibiotics or watchful waiting, decided together with your pediatrician |
| 2 years and older | Antibiotics | Antibiotics or watchful waiting | Antibiotics or watchful waiting |
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What “watchful waiting” means: Your child receives pain relief and is monitored for 48 to 72 hours. If symptoms worsen or don’t improve, antibiotics are started. Many families receive a “just in case” prescription with clear instructions. Studies show many uncomplicated ear infections in children over 2 resolve on their own, and avoiding unnecessary antibiotics lowers the risk of side effects like diarrhea, rash, and antibiotic resistance. Watchful waiting is only appropriate when a reliable follow-up plan is in place.
When antibiotics are used, the AAP recommends:
| Situation | AAP guidance |
|---|---|
| First choice | High-dose amoxicillin |
| When a stronger option is preferred | Amoxicillin-clavulanate (Augmentin) if your child took amoxicillin in the past 30 days, has purulent conjunctivitis (“pink eye”) at the same time, or has a history of ear infections that didn’t respond to amoxicillin |
| Penicillin allergy (non-severe) | A cephalosporin such as cefdinir, cefuroxime, or cefpodoxime |
| Can’t take oral medicine | A ceftriaxone injection, given in one to three doses |
| Course length | 10 days for children under 2 and anyone with severe symptoms; 7 days for ages 2-5 with mild to moderate symptoms; 5 to 7 days for children 6 and older with mild to moderate symptoms |
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Children typically start to feel better within 48 to 72 hours of starting antibiotics. If they don’t, they should be re-examined, because a different antibiotic may be needed. Fluid can stay behind the eardrum for weeks to months after the infection clears. This is expected, usually resolves on its own, and does not require more antibiotics.
Frequent ear infections: For children with three or more ear infections in six months, or four or more in a year with at least one in the past six months, the AAP says ear tubes (tympanostomy tubes) may be considered, and a referral to a pediatric ENT specialist is reasonable. The AAP does not recommend daily preventive antibiotics.
Swimmer’s ear (otitis externa)
According to the American Academy of Otolaryngology–Head and Neck Surgery Foundation guideline, swimmer’s ear is best treated with prescription antibiotic ear drops (often combined with a steroid), not oral antibiotics, unless the infection has spread beyond the ear canal or a child has other health risks. Treatment also includes:
Pain relief with acetaminophen or ibuprofen
Keeping the ear dry during treatment (no swimming for several days, and a cotton ball with a bit of petroleum jelly in the ear during showers)
Gently cleaning debris from the canal, which should be done by a clinician
For children with ear tubes or a hole in the eardrum, only drops that are safe for the middle ear should be used
Most children feel better within 48 to 72 hours. Symptoms that last longer than a week should be re-checked.
Ear pressure, fluid, and other causes
Ear pain with flying: Offer a bottle, breast, or pacifier for babies during takeoff and landing; older kids can chew gum, sip water, or yawn. If your child has a significant cold or active ear infection, ask your pediatrician before flying.
Fluid without infection (otitis media with effusion): Usually watched for up to three months. If it persists or affects hearing or speech, a hearing test and ENT referral may be recommended.
Earwax, foreign bodies, and referred pain: These need an exam to sort out. Never try to remove an object from your child’s ear with tweezers or a swab at home.
When to seek care immediately
Call 911 or go to the nearest emergency department for:
A button battery or magnet in the ear (or nose), which can cause serious injury within hours
A stiff neck, severe headache, confusion, or a child who is unusually sleepy or hard to wake
Weakness or drooping of one side of the face
Trouble breathing or signs of severe illness
Call your pediatrician or arrange an urgent visit the same day for:
| Warning sign | Why it matters |
|---|---|
| Any fever of 100.4°F (38°C) or higher in a baby under 3 months | Young infants need prompt evaluation for serious infection |
| Redness, swelling, or tenderness behind the ear, or an ear that seems to stick out | Can signal mastoiditis, an infection of the bone behind the ear |
| Fever of 102.2°F (39°C) or higher with ear pain, or any fever above 104°F (40°C) | Suggests a more severe infection |
| Pus, blood, or clear fluid draining from the ear | Can mean a ruptured eardrum or a significant canal infection |
| Severe pain that isn’t relieved by acetaminophen or ibuprofen | Your child needs a direct exam |
| New dizziness, loss of balance, or sudden hearing loss | May indicate inner ear involvement |
| Swelling of the ear canal or redness spreading onto the outer ear or face | Can mean swimmer’s ear is spreading |
| No improvement after 48 to 72 hours of antibiotics or watchful waiting | Treatment may need to change |
| Signs of dehydration: fewer wet diapers, no tears, dry mouth | Kids with ear pain often eat and drink poorly |
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Trust your instincts. If your child “just doesn’t seem right,” that is always a good reason to call.
How Mama Medics can help
Ear infections rarely strike at a convenient time. Rather than packing a feverish, uncomfortable child into the car and waiting in an urgent care lobby, Mama Medics brings the visit to you. Our pediatric clinicians come to your home across the DC, Maryland, and Northern Virginia area, look in your child’s ears with a professional otoscope, and make a diagnosis based on what they actually see. Together, we’ll decide whether watchful waiting or treatment is the right fit, following AAP guidance, and we’ll stay in touch to make sure your child is improving.
Frequently asked questions
Can an ear infection go away on its own?
Yes, many can. The AAP supports watchful waiting for 48 to 72 hours in certain children 6 months and older with mild symptoms, as long as pain is treated and follow-up is in place. Babies under 6 months and children with severe symptoms should be treated with antibiotics.
Is ear pulling always a sign of an ear infection?
No. Babies tug their ears when tired, teething, or exploring. Ear pulling is more concerning when combined with fever, a recent cold, fussiness, or poor sleep.
Are ear infections contagious?
The ear infection itself is not contagious, but the cold viruses that often lead to ear infections are. Frequent handwashing and keeping vaccines up to date help.
Can my child swim with an ear infection?
Children with a middle ear infection and an intact eardrum can usually swim if they feel well. Children with swimmer’s ear, ear drainage, or a ruptured eardrum should stay out of the water until a clinician clears them.
Can my child fly with an ear infection?
Often yes, though it may be uncomfortable. Give pain relief before the flight and encourage sucking or swallowing during takeoff and landing. Check with your pediatrician first if your child has severe pain or drainage.
Why does my child keep getting ear infections?
Young children’s eustachian tubes are short and nearly horizontal, which makes fluid drainage harder. Child care, siblings, smoke exposure, and frequent colds all add to the risk. Most children outgrow frequent ear infections by school age.
Should I use ear drops for pain at home?
Avoid over-the-counter numbing drops, which are not recommended for young children. Oral acetaminophen or ibuprofen is the safest first step. Never put anything in the ear if you see drainage or suspect the eardrum has ruptured.
Sources
Lieberthal AS, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964–e999. American Academy of Pediatrics clinical practice guideline.
American Academy of Pediatrics. Acute Otitis Media. Pediatrics in Review. 2025;46(3):139.
Rosenfeld RM, et al. Clinical Practice Guideline: Acute Otitis Externa. Otolaryngology–Head and Neck Surgery. 2014;150(1 Suppl):S1–S24.
Rosenfeld RM, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update).Otolaryngology–Head and Neck Surgery. 2016;154(1 Suppl):S1–S41.
American Academy of Family Physicians. Otitis Media: Rapid Evidence Review. American Family Physician. 2019.
American Academy of Pediatrics. HealthyChildren.org, “Ear Infection Information.”
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Every child is different. Always consult your child’s pediatrician or a qualified health care provider about your child’s specific symptoms and before giving any medication. If you think your child is having a medical emergency, call 911 immediately.
