Pulling at Ears (Ear Tugging) in Babies and Toddlers

Why babies pull at their ears

Ear tugging starts around 4 to 6 months, when babies gain enough hand control to explore their bodies. The ear is easy to reach and interesting to touch, so many babies simply play with it. Others use it like thumb-sucking, as a way to calm down.

Pediatric ear tugging is therefore mainly a behavior to interpret in context. Studies of children seen for possible ear infection show that ear pulling by itself is a weak sign. It becomes meaningful when other symptoms appear with it.

Common causes of ear tugging

Self-soothing and tiredness

A tired baby often rubs the eyes and ears, yawns and gets fussy. Tugging that happens mainly at nap time, bedtime or during feeds, and stops when the child is asleep or distracted, is usually a comfort habit. It typically fades by age 2 to 3.

Teething

Pain from erupting molars can spread along shared nerves to the ear and jaw. Clues are drooling, chewing on fingers and toys, red swollen gums and rubbing the cheek on the same side. Teething does not cause a high fever. See teething for what helps.

Ear infection (acute otitis media)

Middle ear infection is most common between 6 and 24 months. It usually follows a cold, when fluid trapped behind the eardrum becomes infected. Suggestive signs:

• fever, often 38 to 39 °C (100.4 to 102.2 °F)
• tugging one ear more than the other
• crying when lying down, waking repeatedly at night
• crankiness, poor feeding and sucking that stops suddenly (sucking changes middle ear pressure and hurts)
• fluid or pus from the ear if the eardrum bursts, often followed by less pain
• muffled hearing, or not responding to quiet sounds

Fluid in the ear without infection

After an ear infection or a cold, fluid can stay behind the eardrum for weeks. This is called otitis media with effusion, or glue ear. It is not painful, but the ear may feel full, so children rub it. The main concern is muffled hearing, especially if it lasts more than 3 months.

Itchy or irritated skin

Eczema often affects the skin behind and in the creases of the ears, which can crack and weep. Cradle cap can spread there too. Look for red, dry or flaky skin and scratching elsewhere.

Other causes

• Swimmer's ear (otitis externa): pain when the outer ear is touched or pulled, after swimming or bathing.
• Earwax: normal wax rarely bothers children, but impacted wax can cause fullness.
• Something in the ear: a bead, small toy or food may be pushed in by older babies and toddlers.
• New sensations: pressure changes on a flight, a new hat, or water in the ear after a bath.
• Developmental and sensory reasons: persistent ear pulling or hitting can be a sensory-seeking behavior in some children with autism or other developmental differences. Raise it at a well-child visit if it comes with other concerns.

Ear tugging: how to tell what is going on

Toddler pulling on ears at night

Night-time ear pulling is common because tired children self-soothe more. It points more toward an ear infection when the child wakes crying, especially after a few hours of sleep, has a temperature, seems to hurt more when lying flat, or has had a cold in the past week. A child who settles quickly when picked up and is happy in the morning is less likely to be unwell.

What a doctor will do

The doctor will ask about fever, colds, feeding, sleep and how long the tugging has gone on. They will look at both eardrums with an otoscope. A red, bulging eardrum confirms acute otitis media. A dull eardrum with fluid behind it suggests glue ear. They may also check the throat, gums and skin. Hearing tests are arranged if fluid persists or there are speech concerns.

Treatment and home care

• Pain relief: acetaminophen (paracetamol) from 2 to 3 months, or ibuprofen from 6 months if the child weighs enough and is drinking well. Follow the label dose for weight or age. Do not give aspirin to children or teenagers.
• Ear infections: many clear up within 2 to 3 days without antibiotics. Doctors usually prescribe antibiotics for babies under 6 months, children under 2 with infections in both ears, a high fever, discharge from the ear, or symptoms not improving after 48 to 72 hours.
• Teething: chilled (not frozen) teething rings and gum massage. Avoid teething gels containing benzocaine and amber teething necklaces.
• Skin causes: fragrance-free moisturizer, and treatment for eczema or cradle cap as advised.
• Do not put cotton swabs, oils or drops into the ear unless a doctor recommends them.

Prevention of ear infections

• Keep children away from tobacco smoke.
• Breastfeed if possible, and feed bottles with the baby semi-upright rather than flat.
• Keep up with routine vaccines, including pneumococcal and flu vaccines.
• Cutting back on pacifier use after 6 months may reduce ear infections.

Frequently asked questions

Does ear pulling always mean an ear infection?

No. Most ear tugging in babies and toddlers is from tiredness, self-soothing, teething or curiosity. Ear pulling is much more likely to mean an infection when it comes with fever, a recent cold, poor sleep, crying when lying down or fluid from the ear. Only an ear exam can confirm it.

Why does my toddler pull on their ears at night?

Usually because they are tired and soothing themselves to sleep. If your toddler also wakes crying, has a fever, seems worse lying flat or has had a cold, an ear infection is more likely. Book a doctor visit if this lasts more than a day or two.

What are the symptoms of an ear infection in a baby?

Look for fever, irritability, waking at night, crying during feeds, ear tugging on one side, reduced appetite and sometimes vomiting or fluid from the ear. Symptoms often start a few days into a cold. Babies under 3 months with any fever of 38 °C (100.4 °F) need same-day medical care.

Can teething cause ear pulling?

Yes. Pain from erupting back teeth can be felt in the ear and jaw, so babies rub or pull that ear. Teething does not cause a high fever or ear discharge, so those signs point toward an infection instead.

When should I take my baby to the doctor for ear tugging?

See a doctor if ear pulling comes with fever, fluid from the ear, unusual crying, poor feeding, or lasts more than 2 to 3 days. Go the same day for any fever in a baby under 3 months, or swelling behind the ear.

Should I stop my baby from pulling their ears?

There is no need if it is a comfort habit and the skin is not damaged. If scratching is breaking the skin, keep nails short, use soft mittens at night and treat any eczema. Most children grow out of it by 2 to 3 years.