Which of the following symptoms is most commonly observed in children with acute otitis media?

Tugging at the ear is a common behavior observed in children with acute otitis media, which is an infection or inflammation of the middle ear. This symptom is particularly significant because it reflects the discomfort or pain that the child is experiencing due to the condition. Children, especially younger ones who may not have the language skills to articulate their feelings, often instinctively pull or tug at their ears when they are experiencing ear pain.

While persistent cough, high fever, and runny nose can accompany acute otitis media, they are not as directly indicative of the ear pain associated with the condition. Persistent cough may be related to a respiratory infection or allergies, while high fever, although a potential symptom, varies in occurrence and can indicate various illnesses. Similarly, a runny nose is more commonly associated with upper respiratory infections rather than specifically indicative of acute otitis media. Therefore, tugging at the ear serves as a clear and common behavioral signal of discomfort specifically related to middle ear issues in children.