Most parents cannot diagnose their child’s source of ear pain, especially in the middle of the night. Even I can’t diagnose my own children at home because my portable otoscope, the instrument used to examine ears, died from overuse several years ago. However, there are ways to treat ear pain no matter what the cause.
Good pain relievers such as acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil and Motrin) treat pain from any source, including ear pain. Treating pain does not “mask” any physical exam findings so please go ahead and ease your child’s misery before going to your child’s doctor. I cringe when parents tell me, “We didn’t give him any pain medicine because we wanted you to see how much his ear is hurting him.”
Heat, in the form of warm wet compresses or a heating pad, can also help. Prop your child upright. If the pain is from an ear infection, the position will relieve pressure. Distraction such as a 2:00 am Elmo episode can also blunt pain.
Fewer than half of all patients seen in pediatric offices with ear pain, or “otalgia,” actually have a classic middle ear infection. Sometimes kids with cold virus get ear pain that comes and goes, perhaps from the general congestion in their sinuses and nose. Pain can stem from many sources, including the outer part of the ear. Swimmer’s ear, which is an outer ear infection, is treated differently than a middle ear “inside” infection. Nearby body parts can also produce pain. Throat infections (pharyngitis), from strep throat or viruses, often cause pain in the ears. Even pain from jaw joint strain and dental issues can show up as ear pain. Over the years I have sent several children straight from my office to the dentist’s office for treatment of tooth ailments masquerading as ear pain.
No post on ear pain would be complete without addressing “ear tugging.” Many babies by nine months of age discover their ears and then play with them simply because they stick out (I will leave to your imagination what baby boys tug on). Babies often tug on ears when they are tired. Therefore, tugging on ears alone may not indicate an ear infection, especially if not coupled with other symptoms.
Although ear infections are one of the most common ailments of childhood, and most children have at least one ear infection by age three, remember that not all ear pain is caused by ear infections. In the middle of the night, and even in the middle of the day, it IS okay to give some pain relief before seeing your child’s health care provider.
Why ear pain always seems to awaken a child in the middle of the night, I’ll never know. All I know is that I have to remember to buy a new otoscope for home.
Julie Kardos, MD and Naline Lai, MD
©2015 Two Peds in a Pod®, modified from our 2010 post