Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear). Ear infections (otitis media) most commonly occur when cold symptoms, such as a runny or stuffy nose and cough, have been present for a few days.

An ear infection may occur when the eustachian tube swells and closes and fluid from the throat accumulates in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection causes pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.

Middle ear infections are more common in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.

Ear infection is the most commonly diagnosed bacterial infection in children younger than age 7. By that age, approximately 93% of children in the United States have had at least one ear infection and 75% have had recurrent ear infections. After age 7, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections are more common in boys than in girls, and they most often occur in children who:

1.Spend time in day care settings.
2.Are bottle-fed.
3.Use a pacifier.
4.Live in households where parents or caregivers smoke.
5.Have had a previous ear infection.
6.Have problems present since birth (congenital abnormalities), such as cleft lip, cleft palate, or Down syndrome.