Ear Pain in Merry Olde England

My daughter is in London, England, taking a summer college course.  She woke up last Sunday with "the whole left side" of her head hurting, particularly her ear.  She took two ibuprofens and then she and a friend went out in the unfamiliar city looking for medical care.  All the walk-in clinics were closed on Sunday so she ended up at an Emergency Department, what the british call "Accident and Emergency." An irish nurse took them in, radiating frustration.  Her attitude was "ear pain-this isn't an emergency!"  However, the young indian doctor was quite kind, diagnosed an ear infection, and prescribed Amoxicillin.  Given that England has a National Health Service paid for by the government, her visit was free.  She had only to pay 8 pounds (about 16 dollars) for her prescription at the "chemist." This story highlights several points about ear pain in particular and health care in general. First, for ear pain, try some pain medicine.  So many times a mom brings a child to Emergency and I ask, "Did you give anything for pain?" and they say no.  My daughter felt much better after taking the ibuprofen. If the pain had started at night, she would have felt good enough to sleep and find a doctor in the morning.  If you give a decent dose of ibuprofen or tylenol to your child for her pain, give it a half hour to work, you often won't need to schlep out in the middle of the night.  No one wants to wait in an Emergency waiting room at 2 am when they could have stayed in bed. The second point is England's more relaxed attitude about medical care.  Note that no walk-in clinics were open on Sunday, in the country's biggest city!  Brits aren't clamoring for care 24/7 like americans, and british doctors aren't working seven days per week.  In an Emergency, their "A and E"s are there to help.  And again, with some pain medicine in your child, you too can wait until Monday to see your doctor about that ear. When my daughter woke up with ear pain that morning, she took two ibuprofen tabs before setting out to find care.  She is an adult, but kids who weigh 90 pounds can take that much.  I had a mom yesterday question me on this- I recommended two ibuprofens for her 12 year-old boy's ankle pain and she was shocked- TWO tabs??  I did not point out that the child (his football team's lineman) weighed a hundred pounds more than me. When I see a child in the Emergency Department with ear pain, I ask "Did you give some pain medicine, like ibuprofen or tylenol?"  If mom did, often she didn't give enough.  Many parents are afraid to overdose their child.  Now this is a healthy fear: no one wants to accidentally hurt their child.  However, you do want to take care of their pain too. Kids come in different sizes and have different needs for a dose of medicine that is just enough, but not too much.  We in pediatrics use algebra all day long to calculate drug doses (our math teachers were right- we will have a real-life use for math after all!).  I don't expect parents to do that math though- it can be tricky.  However, the drug companies put doses-by-weight intructions on the package.  You can use that to know how much to give, but in the companies' zeal to be safe they sometimes end up under-dosing a bit.  If you really want to know exactly how much to give, call your doctor.  The doctor or nurse can calculate the right amount for you. So if your child wakes up with ear pain, give some pain medicine, and give enough.  Give the medicine a half hour to work and elevate the child's head on some pillows or on the couch to take pressure off the ear.  Doing this often helps your child go back to sleep so you can wait to see your doctor in the morning.  Save the Emergency Department (or in England, the "Accident and Emergency") for the emergencies.