Ear Pain: When to Watch, When to Worry, and What You Can Do at Home

Ear pain is one of the most common reasons parents reach out to their pediatrician—and understandably so. It’s distressing for children and parents alike. But not all ear pain is created equal. Understanding the most likely causes can help you make informed decisions about when to treat at home and when it’s worth coming in for a visit.

Let’s break it down.

Common Causes of Ear Pain in Kids

Ear pain doesn’t always mean an infection, and even when it does, that infection might not need immediate medical attention. Some of the most frequent causes include:

1. Otitis Media (Middle Ear Infection)

This is the classic ear infection that often comes on the heels of a cold or flu. Kids are especially prone to it in the winter months when viral infections are rampant.

Here’s what happens: congestion from a virus causes inflammation in the nasal passages and blocks the eustachian tube (which drains fluid from the middle ear). That fluid builds up behind the eardrum and causes pain due to pressure. Sometimes bacteria sneak in and turn that fluid into a true infection, but often the pain is just from inflammation and trapped fluid—not something that needs antibiotics.

Key signs: ear pain during or after a cold, maybe with fever, irritability, or trouble sleeping.

2. Otitis Externa (Swimmer’s Ear)

This is a skin infection of the outer ear canal—more common in the summer months when kids are in pools and lakes. The skin of the ear canal isn’t designed to handle frequent moisture, so that wet environment can break down the skin barrier and allow bacteria (or fungi) to move in.

Red flags: pain when touching or tugging the outer ear, visible swelling or narrowing of the ear canal, pain inserting a Q-tip (not that we recommend it!).

3. Other Causes (Less Common, But Important)

• Ruptured eardrum – often after a middle ear infection or trauma (like from a cotton swab). May cause sudden pain followed by drainage and relief.
  

• Fungal infections – especially after repeated antibiotic use in the ear; may cause itching and discomfort rather than sharp pain.
  

• Foreign body – common in toddlers and preschoolers. Insects, beads, and even bits of earbud covers can get lodged in the ear canal and cause pain or infection.

When to Pause Before You Panic

In most cases, ear pain doesn’t require an immediate trip to the pediatrician or urgent care—especially if it’s happening during a cold or flu.

Why? Because studies have shown that most cases of otitis media resolve on their own without antibiotics. In fact, both the American Academy of Pediatrics and CDC now recommend a “watch and wait” approach for many kids, especially those over age 2 who aren’t immunocompromised or severely ill.

A 2010 meta-analysis in JAMA showed that antibiotics only slightly shorten the duration of ear infection symptoms, and that most children recover just as well with supportive care and time. Jumping to antibiotics can lead to side effects, resistance, and more frequent recurrences.

Bottom line: Unless your child is under 6 months old, very ill, or has underlying conditions, you can often start with home care and monitor closely.

What You Can Do at Home

1. Use Ibuprofen (Advil or Motrin)
Ibuprofen is often the most effective pain reliever for middle ear infections. It doesn’t just relieve pain—it reduces the inflammation that’s causing the pressure in the first place. Acetaminophen (Tylenol) can also help with pain, but it won’t reduce inflammation. You can give your child ibuprofen up to every 6 hours, as needed for pain. Dosing is based on weight and you can use the table on the side of the bottle for dosing instructions, or ask your pediatrician for a dose specific to your child’s weight.

2. Try Garlic & Mullein Oil Drops
Garlic and mullein oil (available over the counter) have both anti-inflammatory and antimicrobial properties. When used correctly (i.e., not if there’s a suspected eardrum rupture), they can help soothe both swimmer’s ear and mild middle ear infections.

3. Use Warm Compresses
A warm washcloth held against the affected ear can provide quick comfort for pressure and pain.

4. Monitor for Red Flags
Watch for signs of worsening: high fever, persistent pain beyond 48-72 hours, drainage from the ear, or signs of hearing loss. These may signal the need for a visit.

When to Seek Medical Care Promptly

• If your child has visible drainage, especially pus or blood
  

• If your child is under 6 months old with ear pain or fever
  

• If you suspect a foreign object in the ear
  

• If there’s trauma or suspected eardrum rupture
  

• If your child is immunocompromised or has frequent infections
  

• If pain persists beyond 2-3 days with no improvement despite pain control

Final Thoughts

As a parent, your instincts matter—and we’re here to support you. But you don’t have to rush to the ER or urgent care for every earache. In fact, slowing down can often lead to better outcomes, less unnecessary antibiotic use, and a more empowered, informed approach to your child’s care.

If you’re ever unsure, that’s what your pediatrician is for. We’re happy to help you sort out which earaches need more attention—and which ones just need time, warmth, and some ibuprofen.