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Red symptoms

Amber symptoms
Green symptoms
How long will your child’s symptoms last?
Where to seek help
Useful links


Earache occurs commonly in children, and is often associated with a high temperature.

Earache is usually caused by a viral infection – if this is the case, your child may also have a runny nose, cough or sore throat.

If a number of people are unwell in the same household, this also suggests a viral infection (viral infections are easily spread).

Viral infections tend to get better on their own and do not need treatment with antibiotics. Antibiotics may actually cause side effects such as rash and diarrhoea, and can increase the risk of your child developing antibiotic resistance.

Red Symptom image


Check if your child has any red symptoms:
  • Your child 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.
  • Is complaining of a severe headache and neck stiffness / pain or discomfort with bright lights (photophobia).
  • Develops double vision or blurred vision.
  • 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’).
Actions to take if your child has any red symptoms
  • Your child may require emergency treatment.
  • You should call 999 or take them to your NEAREST Emergency Department where they can be assessed.

Amber Symptoms section


If there are no red symptoms, check if your child has any amber symptoms:
  • Your child has pus coming out of their ear.
  • Develops swelling behind the ear, causing the ear to push forwards, or increasing pain or redness behind their ear.
  • Severe headache persisting despite regular painkillers (ibuprofen and paracetamol) or worse on lying down / in the morning.
  • Develops dizziness or is losing their balance.
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with cuddles, toys, TV or food) – especially if they remain drowsy or irritable despite any fever coming down.
  • Is having breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in the muscles below the lower ribs when they breathe in).
  • Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours).
  • Has extreme shivering or complains of muscle pain.
  • Is three to six months of age with a temperature of 39°C / 102.2°F or above (please note fever is common in babies up to two days after they receive vaccinations) – how to take your child’s temperature.
  • Continues to have a fever of 38.0°C or above for more than five days.
  • Is getting worse or if you are worried.
Options if your child has any amber symptoms

Your child does not need to be taken to the Emergency Department immediately, but you should seek medical advice today.

You can:

  • ring your GP surgery during their usual opening hours
  • contact the out of hours GP if the surgery is closed

If symptoms continue for four hours or more and you have not been able to speak to your GP or the out of hours GP, consider going to your nearest Emergency Department. 

If your child develops any of the red symptoms above, go to your nearest Emergency Department.

Green Symptom image


If no red or amber symptoms are present:
  • your child does not seem to have any symptoms of serious illness or injury
  • you can get general advice on the NI Direct website or from your local pharmacy

If your child develops any of the red or amber symptoms above, follow the advice in these sections.

How you can help manage your child’s earache at home
  • To make your child more comfortable, you may want to give them paracetamol (Calpol) and / or ibuprofen. This not only helps with fever but also reduces pain.
  • Most children with viral infections do not require treatment with antibiotics. Viral infections generally improve without the need for antibiotics in otherwise healthy, vaccinated children.
  • You should not use antibiotics when they are not needed. This will only lead to the development of antibiotic resistance in your child, which will make it more difficult to treat your child in future. Antibiotics can also cause side effects and they should only be used when the benefits are greater than the potential harm from the side effects. The Public Health Agency has this information on antibiotic awareness.


  • If your child is having hearing problems or fluid is coming out of their ear, you should contact your GP surgery.
  • If your child has a fever for more than three days and doesn’t seem to be getting any better, you should also take them to see a GP – how to take your child’s temperature.

How long will your child’s symptoms last? 

After a week, more than three quarters of children with earache will be better, whether they take antibiotics or not. The vast majority will get better just as quickly with or without antibiotics.

Where to seek help

Useful links

Community pharmacists in Northern Ireland
How to take your baby’s temperature
Health visiting