Otitis externa is an infection of the skin of the ear canal and is common in children and adults. It occurs more commonly when water enters the ear canal, such as after swimming. When the ear canal is wet for long periods of time, the skin becomes soft and 'soggy' which makes it an ideal environment for infection. Otitis externa is usually one-sided.
Symptoms of otitis externa:
- Pain and tenderness in the ear canal
- Itchiness
- Foul smelling yellow or green pus in the ear canal
- Reduced hearing/'blocked ear'
- Noises inside the ear, such as buzzing, humming or ringing (tinnitus)
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
Treatment
Most children with otitis externa do not need antibiotics. That's because research has shown antibiotics make very little difference to how quickly your child gets better. If you think that your child has otitis externa, you should consider using 2% acetic acid ear drops (e.g. Earcalm), which is an effective treatment for otitis externa. These are available without a prescription from your pharmacist, for a child over the age of 12.
If your child is still no better after a week of using acetic acid drops, they should see a GP who may consider starting them on antibiotic ear drops.
If your child has redness extending to the skin around the ear (cellulitis), go and see your GP as they may need treatment with oral antibiotics. In addition, if your child has any features of severe infection (amber or red features above), they will need to be urgently seen by a healthcare professional who may decide that your child may benefit from antibiotic treatment.
You can help relieve symptoms by:
- Giving your child paracetamol or ibuprofen to help relieve pain
- Encourage your child to drink plenty of fluids
Prevention
It is not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition.
- Avoid cleaning your child's ears with cotton buds - this may damage and irritate the ear canal and also push wax further into the ear. Wax is designed to come out by itself
- Try not to let soap or shampoo get into your child's ear canal
- Try to keep your child's ears dry; if water gets in, tip it out. This can be extremely challenging in young children!
- Ensure your child is up-to-date with their immunisations
- Avoid exposing your child to smoky environments (passive smoking)
What might help
Keeping a sleep diary
A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help.
The Sleep Charity have templates you can download; one for teenagers and one for younger children.
Seeking advice and help from sleep services
There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page.
Understanding sleep cycles
The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.
As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production. Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.
Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm.
Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity
Prescriptions of melatonin
Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.
- the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
- sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
- behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.
GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist).
Further support
Click on the link below to visit a page with information about
- national websites and sleep organisations
- local community services in Shropshire, Telford and Wrekin.
