Ellie, who is three, has come to clinic with a suspected ear infection. Ellie’s mum says that her daughter has been rocking rhythmically and clutching her ear at the same time. There has been some moisture on her pillow in the morning and Ellie is reluctant to let her mum investigate what is wrong. Ellie is attempting to rock while she is seated on her mother’s knee and uses the same repetitive vocalisation “Don’t wanna go to the shops” over and over again. She feels hot to touch and will not let health care practitioners approach her with any equipment. Her vocalisation becomes louder and more insistent when you attempt examination.