The middle ear is the small space behind the eardrum; this space is usually filled with . Otitis media is an infection of the middle ear that causes inflammation and a build-up of fluid. It is often extremely painful and be be associated with high fever.

Symptoms of otitis media:

  • Earache
  • Fever may be present
  • Misery
  • Pulling, tugging or rubbing ear
  • Slight hearing loss

In most cases the symptoms of a middle ear infection develop quickly and resolve in a few days. In some cases, pus may run out of the ear, this is the fluid that had built up behind the ear drum causing a small hole in the eardrum; this tends to heal up by itself.

Causes

Most cases of earache/otitis media in young children (under 5 years of age) are caused by viral infections; your child may also have a runny nose and cough. The Eustachian tube is a small tube that links the middle ear to the back of the throat. Its main job is to regulate air pressure in the ear. Its other function is to drain any fluid or mucus that builds up. The common 'cold' can cause the Eustachian to become blocked, causing a build up of fluid or mucus and resulting in earache.

When should you worry?

If your child has any of the following:

  • Is going blue around the lips
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Too breathless to talk/eat or drink
  • Becomes pale, mottled and feels abnormally cold to touch
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the 'Glass Test')
  • Is under 1 month of age with a temperature of 38°C / 100.4°F or above






You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Has pus coming out of the ear
  • Develops swelling behind the ear or increasing pain / redness behind the ear
  • Develops dizziness or is losing their balance
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle down with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
  • Is complaining of a severe headache and neck stiffness/pain or discomfort with bright lights (photophobia)
  • Is having breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in of muscles below the lower ribs when they breath in)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Has extreme shivering or complains of muscle pain
  • Is between 1-3 months of age with a temperature of 38°C / 100°F or above; or 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations).
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Is getting worse or if you are worried






You need to contact a doctor or nurse today.

Please ring your GP surgery or contact NHS Wales 111 

If none of the above features are present







Self care

Continue providing your child’s care at home. If you are still concerned about your child, ring your GP surgery or contact NHS Wales 111 

Treatment

Most children with otitis media (earache) do no require treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side effects such as rash and diarrhoea. They will also promote the development of antibiotic resistant bacteria in your child.


Antibiotics are usually only considered if your child:

  • Is under 6 months of age and has otitis media
  • Is between 6 months and 2 years of age with infection in both ears, or with associated symptoms such as altered sleep, fever and overwhelming misery
  • Has pus draining from their ear
  • Has a serious health condition that makes them more vulnerable to serious infection

In addition, if your child has any features of severe infection (amber or red features above), they will need to be urgently assessed by a healthcare professional

You can help relieve symptoms by:

  • Giving your child paracetamol or ibuprofen to help relieve pain
  • Encouraging your child to drink plenty of fluids

Prevention

Is it not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition:

  • Ensure your child is up-to-date with their immunisations
  • Avoid exposing your child to smoky environments (passive smoking)

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

NHS 111 Wales

Website: NHS 111 Wales

NHS 111 Wales (Option 2) telephone service is available 24/7 and can be used for urgent mental health advice and support.

 

Meic

Website: www.meiccymru.org

Meic is the helpline service for children and young people up to the age of 25 in Wales. Chat online, freephone 080880 23456, or text 84001.

 

 

C.A.L.L. Community Advice Listening Line

Website: www.callhelpline.org.uk

Provides a confidential mental health listening and emotional support line which is open 24/7. Call 0800 132 737 or text ‘help’ to 81066.

 

 

Shout

Website: www.giveusashout.org

Text ‘shout’ to 85258 anytime, day or night.

 

 

Childline

Website: www.childline.org.uk

If you’re under 19 you can confidentially call, chat online or email about any problem big or small.

 

 

Samaritans

Website: www.samaritans.org/wales/samaritans-cymru/

Call 116 123 free, anytime, day or night.

 

 

Papyrus

Website: www.papyrus-uk.org

Are you, or is a young person you know, not coping with life? For confidential suicide prevention advice contact HOPELINEUK. We are open 9am–midnight every day.

 

 

Campaign Against Living Miserably (CALM) for men

Website: www.thecalmzone.net

Need help? Call our helpline 5pm-midnight, 365 days a year on 0800 58 58 58.

 

 

DAN 24/7 - Wales Drug and Alcohol Helpline

Website: www.dan247.org.uk/

Freephone 0808 808 2234, or text DAN to 81066.

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  • Try to stay calm.
  • Tell them you are there for them and that you are not upset or angry.
  • Tell them you are pleased they have told you they are having thoughts of harming themselves and that you are able to help them through this time.
  • Listen to what they are saying even if they are venting anger or other negative emotions at you.
  • Listen without interrupting.
  • Validate their thoughts and feelings – they are real and important.
  • Try to be emotionally available and present for your child.
  • Once things appear to be settling please encourage your child to relax as the day/ evening progresses and make some suggestions for things you can do together to distract them from their thoughts (see below for some ideas).
  • Try to proactively manage any potential conflicts or arguments within your immediate environment.
  • Be mindful of excessive use of mobile devices but that young people really need to feel connected to others at times of distress.

If you are concerned that your child/ young person is at risk of harming themselves, please ensure the following:

  • All medications (prescribed/ over the counter/ vitamins) are removed and/ or locked in a strong lockable medical box or locked cupboard.  Medication needs to be stored in this way in all houses where the young person stays, including grandparents, foster carers, step parents and residential homes.
  • All sharp objects, such as knives and razor blades, to be removed and/ or stored securely.
  • Ensure the young person has not got a stock of medication or sharp objects in their room or amongst their property.
  • Other environmental risks in your home should be considered, e.g. removing ropes, ties, dressing gown ties.
  • Do not allow your child/ young person to go out alone or with friends during times of distress and when they are voicing thoughts of self-harm or suicide.
  • Monitor your child/ young person’s mood and behaviour closely.
  • Increase your presence and supervision of your child at home, if needed remaining awake or checking on them during the night.
  • Ask them about thoughts of self-harm and suicide.
  • ​​​​Look out for any warning signs in your child/ young person that they might be struggling.

  • Distract yourself - watch a film or TV programme, play a computer game that absorbs your mind, or read a book you’re really interested in
  • Get creative – drawing, mindful colouring, taking photos, listening to music, singing
  • Get moving – walk, run, dance, do an exercise or yoga video
  • Comfort yourself – have bubble bath or shower, eat something you like, stroke a pet, cuddle up tightly in a blanket, rock/ hug yourself, spray a favourite perfume

 

Alternatives to self-harm when the urge to harm is very strong:

  • Hold ice in your hand for as long as you can
  • Step under a cold shower briefly
  • Run your hands under cold water
  • Snap an elastic band against your wrist
  • Hit a cushion against the wall or bed
  • Punch a punch bag or pillow
  • Go for a fast paced walk or run up and down the stairs several times
  • Tear or scrunch up paper

Improving the physical and emotional health and wellbeing of expectant mothers, infants, children and young people throughout Aneurin Bevan University Health Board Area.

(N.B: The Family and Therapies team at ABUHB is NOT responsible for the content on the webpage links that we refer to in our resource sections and linked information to external sites. All information was accurate and appropriate at the time the webpage was created.)

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