Earache Without Infection (Child)

Image showing a cross-section of the external, middle, and inner ear, including the ear canal, eardrum, and eustachian tube.

Earaches can happen without an infection. This can occur when air and fluid build up behind the eardrum, causing pain and reduced hearing. This is called serous otitis media. It means fluid in the middle ear. It can happen when your child has a cold and congestion blocks the passage that drains the middle ear (eustachian tube). It may occur after a middle ear infection caused by bacteria. Or it may sometimes happen with nasal allergies. The earache may come and go. Your child may also hear clicking or popping sounds when chewing or swallowing.

It may take several weeks to 3 months for the fluid to go away on its own. Oral pain relievers and ear drops help with pain. Decongestants and antihistamines can be used, but they don’t always help. No infection is present, so antibiotics will not help. This condition can sometimes become an ear infection, so let the healthcare provider know if your child develops a fever or drainage from the ear or if symptoms get worse.

If your child doesn't get better after 3 months, he or she may need surgery to drain the fluid and insert ear tubes (tympanostomy). Your child may also need the tubes if he or she is at risk for speech, language, or learning problems. Or your child may need the ear tubes if he or she has hearing loss.

Home care

Your child's healthcare provider may have you keep an eye on your child (watchful waiting) for up to 3 months. This means letting the provider know if your child's symptoms don't get better or get worse.

Follow-up care

Follow up with your child’s healthcare provider as directed. It's important to make sure the fluid goes away in the future.

When to seek medical advice

Call your child's healthcare provider if any of these occur:

  • Your child has a fever (see Fever and children, below)

  • Ear pain gets worse

  • Discharge, blood, or foul odor from ear

  • Unusual decreased activity, fussiness, drowsiness, or confusion

  • Headache, neck pain, or stiff neck

  • New rash

  • Frequent diarrhea or vomiting

  • Fluid or blood draining from the ear

  • Convulsion (seizure) 

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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