Ear pain in children is most often caused by a middle ear infection, but several other conditions can be responsible, from swimmer’s ear to something as simple as wax buildup or teething. Kids are far more prone to ear trouble than adults, largely because of how their ears are built during the first several years of life.
Why Kids Get Ear Pain More Than Adults
The eustachian tube connects the middle ear to the back of the throat. Its job is to drain fluid and equalize pressure. In infants, this tube is only about 18 mm long and sits at a shallow 10-degree angle. By adolescence, it roughly doubles in length to 36 mm and steepens to a 45-degree angle. That short, nearly flat tube in young children makes it easy for bacteria-laden secretions from the nose and throat to flow back into the middle ear, where they can trigger infection and inflammation. The tube also doesn’t drain as efficiently, so fluid sits longer than it would in an older child or adult.
Most children outgrow frequent ear problems as the eustachian tube lengthens and tilts, typically by school age.
Middle Ear Infections
Acute otitis media, or a middle ear infection, is the single most common cause of ear pain in children. It happens when fluid trapped behind the eardrum becomes infected. The infection can be viral, bacterial, or both at once. When bacteria are involved, three species account for more than 95% of cases. A viral upper respiratory infection often sets the stage by causing swelling that blocks the eustachian tube, and bacteria move in from there.
A child with a middle ear infection typically has pain that worsens when lying down. You may also notice irritability, trouble sleeping, tugging at the ear, or a mild fever. Some children develop temporary hearing difficulty because fluid behind the eardrum muffles sound. In young children especially, even short-term hearing changes matter because hearing supports language development during critical early years.
Many mild ear infections clear on their own within a few days. Your child’s doctor may recommend a “watch and wait” approach for 48 to 72 hours with pain management, or prescribe antibiotics depending on the child’s age, severity of symptoms, and whether one or both ears are affected.
Swimmer’s Ear
Swimmer’s ear is an infection of the outer ear canal rather than the space behind the eardrum. It develops when water sits in the ear canal long enough for bacteria or fungi to grow, which is why it’s common after swimming or bathing. The ear canal may also become infected after being scratched by a cotton swab, fingernail, or earbud.
There’s a quick way to tell it apart from a middle ear infection: gently tug your child’s earlobe. If the pain gets noticeably worse with that movement, swimmer’s ear is the likely culprit. Other signs include itchiness inside the ear, redness and swelling of the outer ear, fluid draining from the canal, and sometimes swollen lymph nodes near the ear or upper neck. Middle ear infections, by contrast, tend to hurt more when the child lies flat.
Swimmer’s ear is typically treated with prescription ear drops that fight infection and reduce swelling. Keeping the ear dry during treatment speeds recovery.
Foreign Objects in the Ear
Small children are remarkably creative about what they’ll put in their ears. Beads, small toy parts, pieces of food, pebbles, and bits of crayon are all common finds. Sometimes a child will tell you they put something in their ear. Other times, the only clue is unexplained pain on one side, drainage, buzzing or ringing, or hearing that seems muffled in one ear.
Some cases cause no pain at all initially, and the object is only discovered when it causes irritation or infection days later. If you suspect something is lodged in your child’s ear, resist the urge to dig it out with tweezers or a cotton swab. You risk pushing it deeper or puncturing the eardrum. A healthcare provider can remove it safely using specialized tools and direct visualization.
Earwax Buildup
Earwax is normal and actually protective. It traps dust and debris and has mild antibacterial properties. The ear canal is self-cleaning: wax gradually migrates outward on its own. Problems start when wax gets pushed deeper into the canal, usually from cotton swabs, earbuds, or a child’s fingers. This can pack it against the eardrum, causing pain, a feeling of fullness, pressure, or reduced hearing.
The American Academy of Pediatrics advises against using cotton swabs or any other objects inside a child’s ear, as this can worsen impaction, scrape the canal, or even perforate the eardrum. Safe options for impacted wax include irrigation, manual removal by a trained provider, or earwax-softening drops (including plain saline or water). All of these methods work about equally well when done properly. Ear candling, a folk remedy where a hollow cone is lit near the ear, has no proven benefit and carries a real risk of burns or further injury.
Referred Pain From Other Conditions
Sometimes a child’s ear hurts even though nothing is wrong with the ear itself. Several nerves that serve the ear also run through the jaw, throat, and teeth, so problems in those areas can register as ear pain. This is called referred pain, and it’s surprisingly common in kids.
Teething is one of the most frequent causes. As molars push through the gums, the pain can radiate to the ear on the same side, leading parents to suspect an ear infection when there isn’t one. Throat infections, including tonsillitis and strep throat, can produce the same effect. Sinus infections and swollen lymph nodes in the neck are other common sources. If your child has ear pain alongside a sore throat, swollen gums, or nasal congestion but no fever or ear drainage, referred pain is worth considering before assuming it’s an ear infection.
Pressure Changes
Airplane ear happens when rapid altitude changes during takeoff and landing create a pressure difference between the air inside the middle ear and the air outside. Adults can pop their ears by swallowing or yawning, but babies and toddlers can’t do this on command. The result is sharp, sometimes intense pain that can leave a young child screaming during descent.
For infants, nursing or bottle-feeding during takeoff and landing encourages swallowing, which helps open the eustachian tube and equalize pressure. Older children can sip water, chew gum, or try blowing gently with their mouth closed and nostrils pinched (the Valsalva maneuver). Timing matters: start these strategies as the plane begins its descent, not after pain has already set in. If your child has a cold or active ear infection, the swollen eustachian tube makes equalization harder, and the pain can be significantly worse.
Signs That Need Prompt Attention
Most ear pain in children resolves with basic care, but certain symptoms warrant a same-day or urgent visit. These include pus or discharge from the ear, especially if it’s thick, yellow, bloody, or foul-smelling. A high fever alongside ear pain, significant hearing loss in one or both ears, or swelling and redness behind the ear (over the bony bump called the mastoid) all signal that the infection may be spreading or that something more serious is going on.
For pain management while you wait for a visit, children’s ibuprofen can be given every 6 to 8 hours to children 6 months and older. Acetaminophen is an option for younger infants. A warm washcloth held against the ear also provides temporary relief for many kids. Avoid putting any drops into the ear unless a provider has confirmed the eardrum is intact.