When you see wax at the opening of a child’s ear, it is tempting to wipe it away. But wax has a job, and cotton swabs can sometimes make things worse. This article covers what earwax does, safer care, and when to see a clinician.
Why It Happens
Earwax (cerumen) is a mix of secretions from glands in the ear canal and shed skin cells. It is thought to help trap dust and germs and keep the canal lubricated. Chewing and talking move wax slowly toward the opening, so most children never need it dug out.
The AAO-HNSF guideline describes “cerumen impaction” as an accumulation that causes symptoms, or one that blocks the clinician’s view of the ear canal or eardrum. Seeing some wax is not impaction by itself. The guideline advises clinicians to counsel people not to clean ears with cotton swabs or other small objects, and it reports that impaction has been described more often in children whose ears were cleaned with cotton-tipped swabs. It also says the evidence behind this is fairly limited.
How It Differs by Age
The guideline applies to people older than six months, so wax in a younger baby is best discussed with a pediatrician. Infants and toddlers have narrow, short ear canals, so a little wax can look like a lot or hide the eardrum from view. Toddlers exploring the world may also push objects into their own ears. School-age children who wear earbuds, hearing aids, or earplugs for long periods may pack wax inward. Young children cannot always say their ear hurts, so watch for tugging at the ear or less response to sound.
Care at Home
Wiping the outer folds of the ear with a damp washcloth is usually enough. Letting a little bath water run in and out can help soften wax so it works its way out. Cotton swabs, hairpins, and ear picks are best left out of the ear canal, since they can push wax deeper or scratch the canal and eardrum. The guideline also advises against ear candling for treating or preventing wax.
The guideline lists wax-softening drops (cerumenolytics), irrigation, and removal with instruments as treatment options. Management can differ if there has been a hole in the eardrum, ear tubes, or drainage from the ear, so check with a clinician before using store-bought products.
Common Misunderstandings
First, that visible wax means a dirty ear; wax is considered protective. Second, that wax will damage hearing; heavy buildup that fully blocks the canal can muffle sound, but most wax does not. Third, that gentle swabbing is fine; a sudden movement can cause injury even with care. Fourth, that a lot of wax means an ear infection; the two are separate, though wax can hide the eardrum and make an exam harder.
Signs That Need Emergency Care Right Away
Seek emergency care right away if your child has bleeding from the ear after something was put in it, sudden loss of hearing, severe dizziness with vomiting, or swelling and redness behind the ear with a high fever. If it is not an emergency but your child has ear pain, pus or drainage, keeps pulling at the ear, or seems to hear less, contact your pediatrician. A clinician can remove wax safely with the right tools. Consider talking with a pediatrician if you are unsure. This information reflects general guidance for the United States; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.