Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear). Ear infections (otitis media) most commonly occur when cold symptoms, such as a runny or stuffy nose and a cough, have been present for a few days.

An ear infection may occur when the eustachian tube swells and closes and fluid accumulates in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection causes pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.

Middle ear infections are more common in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.

Ear infection is the most commonly diagnosed bacterial infection in children younger than age 7. Almost all children will have at least one ear infection by the time they are 7 years old. Most ear infections occur in babies between the ages of 6 months to 3 years. After age 7, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections are more common in boys than in girls, and they most often occur in children who:

• Spend time in day care settings.
• Are bottle-fed.
• Use a pacifier.
• Live in households where parents or caregivers smoke.
• Have had a previous ear infection.
• Have problems present since birth (congenital abnormalities), such as cleft lip, cleft palate, or Down syndrome.

Fluid often remains in the middle ear (serous otitis, or middle ear effusion) after an ear infection. This may cause no symptoms, or it may cause a muffling of sound, decreased hearing, and mild discomfort. The body usually reabsorbs fluid behind the eardrum within 4 to 8 weeks, and hearing returns to normal. Recurrent ear infections and persistent effusion may occur in some children.

Even though ear infections are a common cause of ear pain, not all ear pain indicates an infection. Other common causes of apparent ear pain in young children include:

• Teething.
• A sore throat.
• An accumulation of earwax.
• An object in the ear.
• Air pressure changes.
• Fluid buildup without infection (serous otitis).

When evaluating ear pain in a child, remember that ear infections commonly occur after symptoms of a cold have been present for a few days. When other symptoms are present, ear pain or drainage may be less important than the other symptoms. Signs of a serious illness may indicate a problem that requires immediate medical treatment.

Review the Check Your Symptoms section to determine if and when your child needs to see a health professional.