What You Should Know About... Earache (Otitis Media) in the Child Care Setting An earache or ear infection (otitis media) is usually a complication of an upper respiratory infection, such as a cold. Otitis media usually occurs in children under 3 years of age. Symptoms include inflammation of the middle ear, often with fluid building up behind the ear drum. The child may cry persistently, tug at the ear, have a fever, be irritable, and be unable to hear well. These symptoms may sometimes be accompanied by diarrhea, nausea, and vomiting. Otitis media is common in young children whether they attend child care or are cared for at home. However, some children appear to be more susceptible to otitis media than other children. Otitis media is not contagious, but the upper respiratory illnesses that can lead to otitis media are infectious. Upper respiratory infections are spread when one person comes in contact with the respiratory secretions of an infected person which have contaminated the air or an object. Otitis media is often treated with antibiotics. Some doctors give children daily antibiotics to prevent otitis media in children who have had repeat cases. Some children with chronic infections may require an operation to insert a tube to drain the fluid from the ear. A child with an earache does not need to be excluded from the child care setting unless the child is too ill to participate in normal activities or needs more care than the provider can give without compromising the care given to the other children. To help prevent the upper respiratory infections, which may lead to otitis media: Teach children to cover their mouths with a disposable tissue when they cough and blow their noses with disposable tissues. Only use a tissue once and then immediately throw it away. Do not allow children to share toys that they put in their mouths. After a child has discarded a toy that can be put in the mouth, pick it up and put it in a bin for dirty toys that is out of reach of the children. Wash and disinfect these toys before allowing children to play with them again. (See section on "Cleaning and Disinfection" in the chapter on "Protective Practices.") Make sure all children and adults use good handwashing practices. (See section on “Handwashing” in the chapter on “Protective Practices.”)