You’re up at 2 a.m. with a crying baby, and they keep tugging at their ear. Is it just another tooth coming in, or is this the ear infection everyone warns you about? Feeling unsure here is completely normal—and with a few clear signs, you can confidently decide when it’s teething and when it’s time to call the pediatrician.
Ear Infection or Teething? How to Spot the Difference comes down to a few key clues: gum changes and drooling usually mean teething, while higher fever, cold symptoms, ear drainage, or worsening pain when lying down point toward an ear infection.2 6 9 11 When in doubt, a doctor’s exam is the only way to know for sure.2 12
Understanding the Science
Teething and ear infections both cause pain around the ears, but they’re very different processes in your baby’s body.
What’s happening during teething?
Teething is a normal developmental process where baby teeth push through the gums.6 9 As the tooth erupts, it causes local inflammation and discomfort in the gums, which can radiate pain to the jaw and ear area.6 9
Common teething features include:2 5 6 9 13
- Swollen, red gums
- Heavy drooling and sometimes a mild “teething rash” on the chin
- Strong urge to chew on hard objects
- Mild, low-grade fever (under 100.4°F / 38°C), if any
- Irritability that improves with comfort measures (feeding, cuddling, teething toys)
Pediatric sources note that fever and major sleep trouble are rarely from teething alone; if these are prominent, doctors look for another cause.13 6
What’s happening in an ear infection?
Most baby ear infections are middle ear infections (otitis media), often following a viral cold.9 10 A cold can cause swelling and fluid buildup behind the eardrum; bacteria or viruses then infect that trapped fluid, creating pain and pressure.9 10
Common ear infection features include:3 5 9 11 13
- Higher fever (often above 100.4°F, sometimes up to 40°C)5 9 11
- Ear pain or persistent ear pulling
- Worsening pain when lying down due to pressure changes in the middle ear2 6 12
- Recent cold symptoms (runny nose, cough, congestion)5 9 11
- Possible ear drainage or decreased response to sounds5 8 10 13
- Poor sleep, irritability, and sometimes poor feeding3 11 13
According to pediatric and ENT specialists, teething does not cause ear infections; they may happen at the same time, but ear infections are driven by respiratory infections and bacteria/viruses.7 9 10
Ear Infection or Teething? How to Spot the Difference
Because both can cause fussiness and ear-tugging, experts recommend looking at the whole picture, not just one symptom.
Key differences doctors look for
Pediatric guidance consistently highlights these “big clues” when asking Ear Infection or Teething? How to Spot the Difference:2 3 5 6 9 11 13
| Feature | More likely Teething | More likely Ear Infection |
|---|---|---|
| Fever | None or low-grade, under 100.4°F / 38°C5 6 | Often higher fever; may exceed 100.4°F and can be quite high5 9 11 |
| Drooling & gums | Heavy drooling; swollen, red gums; visible or bulging tooth1 2 5 6 9 13 | Gum changes not prominent; drooling not a central feature2 5 9 13 |
| Cold symptoms | Usually absent; may have minimal clear nasal mucus2 5 9 | Frequently preceded by a cold; stuffy nose with yellow/green mucus is common2 5 9 11 |
| Ear drainage | Not typical | Fluid draining from ear suggests infection and needs medical care5 8 10 13 |
| Pain pattern | Discomfort more constant through the day, but often soothed by teething remedies and cuddling2 4 6 | Pain often worse when lying down, causing night-time fussiness and sleep disruption2 6 12 |
| Chewing behavior | Strong desire to chew on firm objects, fingers, toys5 6 9 13 | Not a hallmark sign; baby may be more focused on rubbing or pulling ear3 11 13 |
| Response to comfort | Usually improves with nursing, rocking, teething toys, or appropriate pain relief4 6 | Severe pain can remain even with comfort measures; inconsolable crying for hours warrants evaluation4 |
In plain terms, Ear Infection or Teething? How to Spot the Difference means paying special attention to fever level, cold symptoms, ear drainage, and how the pain behaves when lying down—these are the red flags for infection.2 4 5 6 9 11 13
Why you can’t diagnose it at home with 100% certainty
Every pediatric source emphasizes that the only definitive way to tell is a doctor examining the ears with an otoscope.2 12 13 They check for:12 13
- Color and position of the eardrum
- Fluid behind the eardrum
- Signs of inflammation or pus
So your role is not to diagnose, but to spot patterns and decide when to seek medical care.
Tips for Parents
Practical ways to compare Ear Infection or Teething? How to Spot the Difference
-
Check the temperature carefully
Use a reliable thermometer. Low or no fever leans toward teething; higher fever (especially above 100.4°F) makes ear infection more likely and deserves a call to your pediatrician.4 5 6 11 13 -
Look in the mouth, not just at the ears
Gently feel and inspect the gums. Swollen, red gums or a visible tooth are strong teething clues.2 5 6 9 13 -
Notice drooling and chewing
Heavy drooling plus constant chewing on hands or toys points to teething rather than infection.1 2 5 6 9 13 -
Think about the week leading up to this
Was there a cold, cough, or congestion first? Ear infections are “almost always preceded by a cold,” while teething usually isn’t.5 9 11 -
Watch what happens when they lie down
If crying and discomfort get significantly worse when lying flat, especially at night, doctors consider ear infection more likely.2 6 12 -
Track how they respond to comfort
If nursing, cuddling, teething toys, or appropriate pain medicine bring noticeable relief, teething is more probable.4 6 If nothing helps and your baby seems in severe, unusual pain, seek care.4 -
Know the urgent signs
Call your pediatrician promptly if your baby has:4 5 11 13- Fever ≥100.4°F in a baby under 3 months
- Fever ≥102°F with severe fussiness at any age
- Ear drainage
- Signs of dehydration or unusual lethargy
- Pain or crying that feels “different” and doesn’t respond to comfort
Duckie’s Verdict: Is it safe?
For most babies, teething is safe and normal, though uncomfortable, and can be managed with supportive care (cool teething toys, gentle gum massage, and pediatrician-approved pain relief).6 9 13 Ear infections, while common, are not “dangerous” if treated promptly, but they do require professional evaluation and sometimes antibiotics or close monitoring.9 10 11 13
So on Ear Infection or Teething? How to Spot the Difference, Duckie’s verdict is: Caution. Teething itself is safe, but because ear infection symptoms can overlap and sometimes escalate, any high fever, ear drainage, or worrying change in behavior should be checked by your pediatrician.
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FAQ
Does teething cause ear infections?
No. Teething is a normal process of tooth eruption, while ear infections are caused by bacteria or viruses in the middle ear, often after a cold.7 9 10
Can teething cause a high fever like an ear infection?
Evidence suggests teething may cause at most a low-grade fever; high fevers are more consistent with infection, not teething alone.5 6 9 11
Should I see a doctor if I can’t tell Ear Infection or Teething? How to Spot the Difference?
Yes. If you’re unsure and your baby has significant pain, high fever, or ear drainage, a doctor visit is recommended. Only a physical ear exam can confirm infection.2 12 13
Is ear pulling always a sign of infection?
Not always. Babies can pull their ears when teething or exploring their bodies. It’s more concerning when combined with fever, cold symptoms, poor sleep, or ear drainage.3 6 11
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How this article was made
This article was researched and written with AI assistance and reviewed by the Duckie editorial team for accuracy. All claims are supported by citations to peer-reviewed research, government health agencies, and established medical institutions.
Medical disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for guidance specific to your child.