Ear Pain in Children: Teething, Ear Infection, or Something Serious?

Your toddler wakes up at 11 pm crying, pulling at their ear, and refusing to settle. Your mind races: Is it an ear infection? Teething? Something stuck in there? Do we need to go to the emergency room tonight?

As a primary healthcare nurse, I have seen this exact situation countless times. Ear pain in children is one of the most common reasons parents lose sleep.

This guide will help you answer one question tonight:
Do I wait, go in the morning, or go now?

When Should You Worry About Ear Pain in a Child? (Quick Answer)

You should seek urgent medical care if your child:

• Is under 6 months with ear pain
• Has a fever above 38.5°C that is not settling
• Has swelling or redness behind the ear
• Has discharge (pus or fluid) from the ear
• Is very sleepy or hard to wake
• Has a stiff neck or seizure

Quick Ear Pain Checklist (Save This)

🔴 GO NOW:

• Swelling behind the ear
• Severe drowsiness
• Stiff neck or seizure
• Baby under 6 months

🟡 Go in the morning:

• Pain lasts more than 2–3 days
• Fever not improving
• Hearing seems reduced
• Recurrent ear infections

🟢 STAY HOME:

• Mild pain
• No fever or low-grade fever
• The child is still drinking and responsive

 Ear Pain vs Teething – How to Tell the Difference

Teething:

• Drooling
• Chewing on objects
• Mild fussiness
• Fever below 38.5°C

Ear Infection:

• Fever above 38.5°C
• Pulling at the ear
• Poor sleep (worse lying down)
• Cold symptoms (runny nose, cough)

Key rule:
If there is a high fever + cold symptoms + ear pulling → think ear infection, not teething.

The 3 Main Causes of Ear Pain in Children

 1. Middle Ear Infection (Most Common)

Usually follows a cold. Fluid builds up behind the eardrum.

Signs:

• Fever
• Night waking
• Ear pulling
• Irritability

2. Glue Ear (Fluid Without Infection)

No pain, but it affects hearing.

Signs:

• Not responding to sounds
• Turning the volume up
• Speech delay (if long-term)

3. Swimmer’s Ear (Outer Ear Infection)

Infection in the ear canal.

Signs:

• Pain when touching the ear
• Itching
• Redness

Simple Home Checks You Can Do

• An ear tug hurts, likely an outer ear infection
• No pain on touch, likely a middle-ear infection

How to Manage Ear Pain at Home

When your child has ear pain, it can be distressing for both of you—especially at night when the pain often feels worse. The good news is that many ear infections can be managed comfortably at home while the body heals.

Start with pain relief, because controlling pain is the most important step. Medications like paracetamol or ibuprofen can help reduce both pain and fever. These should be given according to your clinic’s advice or the correct dose for your child’s age and weight. Once the pain is under control, children usually settle, eat better, and rest more easily.

Positioning also makes a difference. Try to keep your child upright or slightly elevated, especially during feeds or sleep. Lying completely flat can increase pressure in the middle ear, which may worsen the discomfort. Even holding your child against your chest in an upright position can bring noticeable relief.

A simple warm compress can be surprisingly soothing. Placing a warm (not hot) cloth over the affected ear may help ease the pain and provide comfort. It’s not a cure, but it can calm a distressed child, especially when combined with pain medication.

Don’t underestimate the value of fluids and rest. Encourage your child to drink regularly—whether it’s water, breastmilk, or formula—because swallowing can help the ear naturally drain and equalise pressure. Rest is just as important; the body needs energy to fight off the infection, so allow your child to sleep as much as they need.

Finally, it’s important to avoid putting anything into the ear. This includes cotton buds, oils, or home remedies. The ear is delicate, and inserting anything can cause irritation or even injury, especially if the eardrum is inflamed.

With these simple measures, most children start to feel better within a couple of days—even without antibiotics.

 When to Visit the Clinic

Go to your GP or clinic if:

• Pain lasts more than 2–3 days
• The fever continues
• Discharge from the ear
• Hearing seems reduced
• Child under 6 months

Red Flags – When to Go to the Emergency Room

• Swelling behind the ear
• Stiff neck
• Very sleepy child
• Seizure
• Breathing difficulty

Why Ear Pain Is Worse at Night

Ear pressure increases when lying down.
This makes the inflamed eardrum more painful.

It feels worse—but it does NOT always mean it’s getting worse.

Can Ear Infections Go Away on Their Own?

Yes. Most ear infections start to improve within 2–3 days without antibiotics, although full recovery may take a little longer.

 Prevention Tips

• Breastfeed if possible
• Avoid smoke exposure
• Keep vaccines up-to-date.
• Reduce dummy use after 6 months

Frequently Asked Questions

Does my child need antibiotics?

Not always. Many infections are viral and clear on their own.

Can teething cause ear pain?

Yes, but not a high fever.

Can my child swim?

Yes, for middle ear infections; no, if discharge is present.

Should I use cotton buds?

Never.

If you enjoyed this article, you might like:

Baby Won’t Stop Crying: Causes, Soothing Tips & When to Worry

Fever in Children: The “Wait or Worry” Checklist

Baby Symptoms Guide: What’s Normal & When to Worry (A Nurse’s Guide for Parents)