Bachon Ke Kaan Ka Dard (Earache): Why Nothing Goes in the Ear

Nothing goes into a child’s ear at home. Not warm oil, not onion juice, not garlic, not a drop of anything, however many aunties swear by it. Here is what actually eases bachon ke kaan ka dard (earache) tonight, and how to tell a passing ache from an infection that needs a doctor.

Bachon ke kaan ka dard: why nothing goes in the ear, ever

The old nuskha for kaan dard is warm sarson oil, or the juice of a lightly heated onion, dripped into the ear. The trouble is that a parent at home has no way of seeing the eardrum. An earache in a child is very often a middle-ear infection, and in a fair number of those the drum has already developed a small hole from the pressure behind it. You will not know. The child cannot tell you. If the drum has a hole, whatever you pour in goes straight through into the middle ear, where it does not belong, and the risk of a worse or longer infection goes up.

Onion and garlic juice sting raw skin. Oil coats the canal so the doctor cannot see the drum the next morning, and the appointment is wasted.

Cotton buds are out too: they push wax deeper, scratch the canal, and a squirming toddler with a stick in the ear is an accident waiting to happen. Wax works its way out on its own.

What is usually behind a child’s earache

Small children get earache far more than adults because the tube that drains the middle ear into the back of the nose is short, narrow and nearly horizontal in them, so a cold blocks it, fluid collects behind the drum, pressure builds and it hurts. Sometimes that fluid gets infected. This is the classic middle-ear infection, most common between 6 months and 3 years, often a few days into a runny nose.

• Outer-ear infection after swimming or repeated water in the canal. The pain is worse when you gently pull the ear or press the little flap in front of it. The canal itself looks red.
• Referred pain from a sore throat, a new tooth or a jaw. The ear itself is fine, but the child points at it.
• Something in the ear. One-sided pain with a smell or discharge and no cold beforehand points to a bead or a seed. Do not fish it out. That pushes it deeper.

Safe comfort at home, by age

Under 6 months

Any earache or ear-pulling with fever in this band means a doctor the same day, and under 3 months with any fever at all means the emergency department, not tomorrow. Nothing but breast milk or formula goes in the mouth. No pain syrup unless a doctor has said so for this child.

6 to 12 months

Comfort measures below are fine. Paracetamol is usually the only medicine used at this age, dosed by weight from the pack or by a pharmacist. A baby who is feeding less because sucking hurts should be offered smaller, more frequent feeds. See a doctor within a day if pain and fever are together, or sooner if the baby is not settling at all.

1 to 3 years

The peak years for middle-ear infections. Most settle on their own inside two to three days with pain relief and time. Doctors in many places wait 48 hours before deciding on antibiotics in an otherwise well child over 2, because the body usually clears it. Under 2, or with both ears involved, or with discharge, they tend not to wait.

From 3 years up

The same 48-hour rule. A child who says the world sounds muffled for more than a couple of weeks after the pain has gone needs the ear looked at, because leftover fluid behind the drum dulls hearing at exactly the age they are learning to read.

1. Keep the child upright while awake, on your shoulder or sitting up, because lying flat makes the pressure worse. For sleep a baby under 1 still goes down flat on the back in a bare cot: no propping, no wedge, no pillow. Hold them upright for a while first.
2. Warm a small dry towel with an iron for a few seconds, well away from the child, test it on the inside of your wrist for 5 seconds, then hold it against the outside of the ear for 10 minutes. Repeat every couple of hours. A warm compress soothes; it does not treat, and it must never be hot.
3. Offer drinks often, in small amounts, because swallowing opens the drainage tube a fraction; for an older child, chewing soft roti or sipping through a straw does the same.
4. Give paracetamol at the dose for the child’s weight, taken from the pack or worked out by a pharmacist, spaced as the pack says. Do not combine it with any other syrup that also contains paracetamol (many “cold and flu” mixtures do). Ibuprofen is a doctor’s or pharmacist’s call for a child over 6 months who is drinking well. Never aspirin under 16.
5. Clear the nose. A blocked nose keeps the ear tube blocked. Two or three saline drops in each nostril, then gentle wiping or a bulb for a baby, is safe at any age.
6. Keep the ear dry until it is better. No swimming.
7. Check the ear morning and bedtime for fluid, a smell, or redness behind the ear, and note the time the pain started so you can count the 48 hours honestly.

The eardrum and discharge: what you are looking at

A child with a middle-ear infection sometimes wakes with a wet pillow: the drum has given way under the pressure and the fluid behind it has drained out, and the pain often drops sharply at that moment, so parents think it is over. It is not. That hole nearly always closes on its own within a couple of weeks, but the ear needs to be seen the same day so the doctor can decide about antibiotic drops or a course by mouth, and so the ear can be checked again later to confirm the drum has closed.

What comes out tells you something.

Discharge that carries on past a week needs an ear specialist.

When it is an infection that needs treating

A doctor today, not tomorrow, if any of these are true:

• The child is under 2 and has ear pain with a fever.
• Pain has lasted more than 48 hours, or is severe despite paracetamol.
• Anything is coming out of the ear.
• Both ears hurt.
• Fever over 39 °C with the child clearly unwell, or any fever lasting more than 3 days.
• The pain keeps returning every few weeks, or hearing seems muffled after the pain has passed.
• You suspect something has been pushed into the ear.

Emergency care now if the skin behind the ear is red, swollen or tender, or the ear itself looks pushed outward and forward, because the infection may have spread into the bone behind it. Go now, too, for a stiff neck, a child who is drowsy, floppy or hard to wake, a fit, a rash that does not fade when a glass is pressed on it, or any fever at all in a baby under 3 months. In a baby, watch breathing as well: fast breathing, the chest sucking in under the ribs, grunting, or blue lips means hospital immediately, whatever the ear is doing.

A smoke-free house and car, propped-up bottle feeds, the routine vaccines and early saline for a blocked nose (see our saline rinse guide and the baby version in blocked noses in babies and toddlers) all cut how often it comes back. For the fever that so often comes with earache, our guide to a child’s fever by age covers sponging, fluids and the under-3-months rule, and the adult version is in fever at home. More children’s home-care topics are collected under Bachon Ki Sehat.

Questions parents ask