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Ear pain in children: ear infection symptoms, relief and why the eardrum must be seen

Ear pain in children is often caused by a middle ear infection, especially after a cold. Confirming that infection means looking at the eardrum with an otoscope, which cannot be done by video, so we cannot diagnose an ear infection on a video call. We can help ease the pain and fever and tell you how urgently your child needs to be seen in person.

Can we help by telehealth? Sometimes: it depends on the evaluation.

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Swelling, redness or pain behind the ear, or the ear pushed outward
  • A stiff neck or severe headache
  • Fluid or pus draining from the ear with a high fever in a child who seems ill
  • Very listless or hard to wake
  • A baby under 3 months with a fever

Help lines:

Warning signs: when to go to the ER

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Symptoms of ear infections in children

A middle ear infection often shows up during or after a cold. The most common symptoms are:

  • Ear pain, either sharp or a dull, throbbing ache.
  • Fever.
  • Trouble hearing.
  • Fluid or pus draining from the ear.
  • Headache.
  • In babies and toddlers: fussiness, crying, trouble sleeping or feeding.

Why can't an ear infection be confirmed by video?

To diagnose a middle ear infection, a doctor has to look at the eardrum with an otoscope. A red, bulging eardrum means infection. The American Academy of Pediatrics guideline requires seeing that bulge to make the diagnosis, and a phone camera cannot see it.

That is why we do not confirm ear infections in children by video. Prescribing antibiotics for an ear infection without seeing the eardrum can lead to unnecessary treatment. If your child needs that exam, the doctor will tell you and explain how urgently.

What can a video visit do for ear pain in children?

Even without confirming an ear infection, an online doctor visit can help you:

  • Decide whether your child needs the ER, an urgent care center (CDT) or their regular doctor, and how soon.
  • Ease pain and fever with the right dose for your child's weight.
  • Consider other causes, such as a cold, a sore throat or swimmer's ear.

A visit costs US$79. The doctor is a general practice physician and is not a pediatrician, and a parent with patria potestad or a legal guardian must be on camera for the whole visit. See the child doctor visit.

Easing ear pain at home

While you arrange an evaluation:

  • Acetaminophen or ibuprofen ease pain and fever. Dose by weight and use the device that comes with the medicine. Do not give ibuprofen to babies under 6 months.
  • Never give aspirin to a child unless their doctor says so.
  • Do not put cotton swabs in the ear, or drops or oils unless a doctor told you to.
  • Offer fluids and let your child rest.

Does an ear infection always need antibiotics?

Not always. Many childhood ear infections clear up on their own, without antibiotics. For older children with mild symptoms, the doctor who examines the ear may choose to watch and wait for a few days. For children under 2, with severe symptoms or if things do not improve, antibiotics are more likely. That decision is made after the eardrum is seen. See also antibiotics by telehealth.

Ear pain in babies

Ear pulling on its own does not mean an ear infection: many babies do it to soothe themselves. But a baby 6 to 12 months old who pulls at the ear and has a fever, is fussy or is feeding poorly needs to be seen in person. We do not see babies under 6 months; a baby under 3 months with a fever needs the ER. See fever in children.

Warning signs by age

Go to the ER or call 911 for the signs marked urgent. The others mean a doctor should see your child in person soon, because the ear needs to be examined.

  • Babies 6 to 12 months: urgent if the cry is weak, high-pitched or nonstop, the soft spot bulges, or the baby is very listless. In person soon if the baby pulls at the ear and has a fever, is feeding poorly, or the fever lasts more than 24 hours.
  • Children 1 to 5: urgent if they drool or cannot swallow, have a stiff neck or are very hard to wake. In person soon for ear pain with fever.
  • Children 6 to 17: urgent for a severe headache with a stiff neck, or swelling and redness behind the ear. In person soon if ear pain comes with fever or fluid draining from the ear.
  • At any age: urgent for a fever with spots that do not fade when pressed, a seizure, or an ear that is pushed outward.

Swimmer's ear in older children

With so many beaches and pools in Puerto Rico, older children often get ear pain from swimmer's ear, an infection of the ear canal rather than the middle ear. It is common in children who swim a lot. Read swimmer's ear.

Preventing ear infections

A few steps lower the risk:

  • Keep your child's vaccines up to date.
  • Keep your child away from cigarette smoke.
  • Breastfeeding helps protect babies.
  • Wash hands often to cut down on colds.

Video visit: US$79 · Pay by card · See the price and what is included

Before you book

  • You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
  • We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
  • Real-time video only; we do not do phone-call visits.
  • We do not prescribe controlled substances.

What we don't do by telehealth

Frequently asked questions

Can an ear infection be diagnosed on a video call?
No. Confirming a middle ear infection means seeing the eardrum with an otoscope. By video we can ease the pain, advise on the fever and tell you how urgently your child should be seen in person.
What can I give my child for ear pain?
Acetaminophen or ibuprofen, dosed by your child's weight with the device that comes with the medicine. Do not give aspirin, and do not put drops or oil in the ear unless a doctor told you to.
Does ear pulling mean my baby has an ear infection?
Not necessarily: many babies touch their ears to soothe themselves. If your baby also has a fever, is very fussy or is feeding poorly, a doctor should see them in person.
When is ear pain an emergency?
Go to the ER for swelling or redness behind the ear, an ear that is pushed outward, a stiff neck, or fluid draining from the ear with a high fever in a child who seems ill.

Sources

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