Earache
Earache occurs commonly in children and is often associated with a high temperature. They are usually caused by a viral infection – if this is the case, your child may also have a runny nose, cough or sore throat.
- If a number of people are unwell in the same household, this also suggests a viral infection (because viral infections are easily spread)
- Viral infections tend to get better on their own and do not need treatment with antibiotics. Antibiotics may actually cause side effects such as rash and diarrhoea and can increase the risk of them developing antibiotic resistance
When should you worry?
If your child has any of the following:
- Is going blue around the lips
- Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
- Too breathless to talk / eat or drink
- Becomes pale, mottled and feels abnormally cold to touch
- Has a fit / seizure
- Seems dehydrated (sunken eyes, drowsy or not had a wee or wet nappy for 12 hours)
- Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Develops a rash that does not disappear with pressure (the ‘Glass Test’)
- Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
- Is between 3-6 months of age with a temperature over 39°C
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
- Has pus coming out of their ear
- Develops swelling behind the ear, causing the ear to push forwards, or increasing pain or redness behind their ear
- Develops dizziness or is losing their balance
- Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) – especially if they remain drowsy or irritable despite their fever coming down
- Is complaining of a severe headache and neck stiffness/pain or discomfort with bright lights (photophobia)
- Is have breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in of muscles below the lower ribs when they breath in)
- Seems dehydrated (sunken eyes, drowsy or not had a wee or wet nappy for eight hours)
- Has extreme shivering or complains of muscle pain
- Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
- Continues to have a fever of 38.0°C or above for more than 5 days
- Is getting worse or if you are worried
Please ring your GP surgery or call NHS 111 - dial 111
We recognise that during the current COVID-19 crisis, at peak times, access to a health care professional may be delayed. 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, then consider taking them to your nearest Emergency Department
If none of the above features are present
Additional advice is also available to young families for coping with crying of well babies – click here
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
This guidance has been reviewed and adapted by healthcare professionals across Shropshire, Telford and Wrekin with consent from the Hampshire development groups.
Treatment
- Most children with earache do not require 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:
- Is under 6 months of age and has otitis media (a middle ear infection)
- Is between 6 months and 2 years of age with infection in both ears, or with associated symptoms such as altered sleep, fever and overwhelming misery
- Has pus draining from their ear
- Has a serious health condition that makes them more vulnerable to serious infection
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:
- Giving your child paracetamol or ibuprofen to help relieve pain
- Encouraging your child to drink plenty of fluids
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.