Physiological causes include sweating caused by too much heat, or hunger dreams, or unclean head; pathological causes can be infectious such as inflammation making the local skin itchy, while in acute purulent otitis media, the baby may feel discomfort in the ear and shake his head and scratch his ear. Sometimes physiological or pathological oesophageal reflux can also be seen. The causes are numerous and need to be carefully identified on a case-by-case basis.