Earache
Lots of children get earache and often this is with a high temperature. It is usually due to a viral infection. Your child may also have a runny nose, cough, and sore throat.
Viral infections spread very quickly and often affect other people in your house.
Viruses get better on their own and do not need treatment with antibiotics.
Antibiotics may cause side effects such as rash and diarrhoea. The more antibiotics we use the more chance of antibiotic resistance.
When should you worry?
If your child has any of the following:
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Breathing very fast, too breathless to talk, eat or drink
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Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
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Breathing that stops or pauses
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Is pale, blue, mottled or feels unusually cold to touch
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Difficult to wake up, very sleepy or confused
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Weak, high-pitched cry or can’t be settled
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Has a fit (seizure)
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Has a rash that does not go away with pressure (the ‘Glass Test’)
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Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
Scenario 1 - if your child has any of the following:
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Behind the ear there is pain, redness or swelling
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Severe headache persisting despite regular painkillers
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Dizziness or is losing their balance
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Breathing a bit faster than normal or working a bit harder to breathe
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Dry skin, lips or tongue
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Not had a wee or wet nappy in last 8 hours
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Poor feeding in babies (less than half of their usual amount)
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Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
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Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
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Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
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Temperature less than 36°C in those over 3 months
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Getting worse and I am still worried
Scenario 2 - if your child has any of the following:
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Aged 1 year or older
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None of the above amber features BUT does have
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Pus coming out of their ear
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Scenario 1 - you need to contact a doctor or nurse today.
Please ring your GP surgery or call NHS 111 - dial 111
If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features
Scenario 2 - please use pharmacy first
To find your nearest pharmacy click here
If none of the above features are present
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Watch them closely for any change and look out for any red or amber symptoms
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If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways.
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Additional advice is also available to young families for coping with crying of well babies – click here.
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If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
What should you do?
Most children with earache do not need treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side effects such as rash and diarrhoea. They will also promote the development of antibiotic resistant bacteria in your child.
Antibiotics are usually only considered if your child:
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Is under 6 months of age and has otitis media (a middle ear infection)
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Is between 6 months and 2 years of age with infection in both ears, fever and overwhelming misery
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Has pus draining from their ear
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Has a serious health condition that makes them more likely to get a serious infection
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Complications of a bacterial infection such as spread to another part of the body
If your child has any features of severe infection (amber or red features above), they will need to be urgently assessed by a healthcare professional.
You can help relieve symptoms by:
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Giving your child paracetamol or ibuprofen to help relieve pain (always follow the instructions for the correct dosage)
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Encouraging your child to drink plenty of fluids
Ear wax does not generally cause earache but if you are worried about build up of ear wax please follow this link.
How long will your child’s symptoms last?
The chart below shows how long earaches take to get better in children. The faces represent 10 children who have seen their GP with an earache. Green faces are those children whose earache has got better within that time period.
After a week, more than three quarters of those with earache will be better whether they take antibiotics or not. Most (14 out of 15) who take antibiotics will get better just as quickly as if they hadn’t taken them.
The diagrams above are taken from www.whenshouldiworry.com
Prevention
It is not possible to prevent ear infections; however, you can do things that may reduce your child’s chances of developing the condition.
- Avoid cleaning your child’s ears with cotton buds – this may damage and irritate the ear canal and pushes wax further into the ear. Wax is designed to come out by itself
- Try not to let soap or shampoo get into your child’s ear canal
- Try to keep your child’s ears dry; if water gets in, tip it out as soon as possible. However, this can be extremely challenging in young children!
- Ensure your child is up-to-date with their immunisations
- Avoid exposing your child to smoky environments (passive smoking)
Where should you seek help?
If it is non-urgent, speak to your local pharmacist or health visitor.
If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111.
You should only call 999 or go your nearest A&E department in critical or life threatening situations.
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.
Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.
Contact them by phoning your Health Visitor Team or local Children’s Centre.
Sound advice
Health visitors also provide advice, support and guidance in caring for your child, including:
- Breastfeeding, weaning and healthy eating
- Exercise, hygiene and safety
- Your child’s growth and development
- Emotional health and wellbeing, including postnatal depression
- Safety in the home
- Stopping smoking
- Contraception and sexual health
- Sleep and behaviour management (including temper tantrums!)
- Toilet training
- Minor illnesses
For more information watch the video: What does a health visitor do?
School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.
Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.
There is also a specialist nurse who works with families who choose to educate their children at home.
Sound Advice
Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.
They all have a role in preventing disease and promoting health and wellbeing, by:-
- encouraging healthier lifestyles
- offering immunisations
- giving information, advice and support to children, young people and their families
- supporting children with complex health needs
Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.
If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.
Sound advice
Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.
For information on common childhood illnesses go to What is wrong with my child?
A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.