Ear Infection or Teething? How to Spot the Difference

You’re up at 2 a.m. with a crying baby, they’re tugging at their ear, and your brain is stuck on repeat: “Ear infection or teething? What if I miss something serious?” You’re not alone—these two issues overlap so much that even pediatricians sometimes need an exam to be sure.

Ear Infection or Teething? How to Spot the Difference comes down to pattern and severity: teething usually causes gum swelling, drooling, mild fussiness, and at most a low-grade temperature, while ear infections often follow a cold and bring higher fevers (over 100.4°F / 38°C), stronger pain, trouble lying flat, and sometimes fluid draining from the ear.

Understanding the Science

What’s happening with teething?

Teething is a normal developmental process where teeth push up through the gums. That pressure:

• Irritates the gum tissue → mild local inflammation
• Triggers drooling and a strong urge to chew
• Can “radiate” pain to nearby areas (jaw, cheek, even around the ear)

Large studies and reviews show teething can cause mild symptoms—drooling, gum swelling, irritability, and a very slight temperature rise—but not true high fevers or serious illness.1

What’s happening with an ear infection?

Most baby ear infections (acute otitis media) come after a viral cold:

1. A cold causes swelling in the nose and Eustachian tube (the tiny channel that drains the middle ear).
2. Fluid gets trapped behind the eardrum.
3. Bacteria or viruses grow in that fluid → painful infection and pressure.

This pressure causes deep ear pain, which is typically worse when lying down. Many babies also have higher fevers and may refuse feeds because sucking increases ear pressure.2

Ear Infection or Teething? How to Spot the Difference – key symptom patterns

Here’s a side‑by‑side comparison you can refer to when you’re trying to figure out “Ear Infection or Teething? How to Spot the Difference” in real life:

If you’re still stuck on “Ear Infection or Teething? How to Spot the Difference,” remember: you’re not failing. The overlap is real, and even professionals rely on looking inside the ear with an otoscope to be confident.2

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Safety Explained: When to Worry and When to Watch

Teething: uncomfortable but usually safe

Teething is uncomfortable, but it’s not dangerous by itself. The main safety issues come from how we treat it:

• Avoid teething gels with benzocaine or lidocaine – they’re not recommended for infants and can cause serious side effects.3
• Skip “teething tablets” with belladonna or unregulated herbs – these have been recalled in the past for safety concerns.
• Be careful with amber teething necklaces – they increase strangulation and choking risk and are not recommended by pediatric organizations.4

Ear infections: common, treatable, and usually low‑risk

Most acute ear infections clear without complications, especially with supportive care (pain relief, fluids). However:

• Babies under 6 months,
• Children with high fever or looking very unwell, or
• Persistent symptoms
  usually need a medical exam and sometimes antibiotics.2

The big safety concern is delayed treatment in a clearly sick child, which can increase the risk of complications (still rare in high‑income countries with access to care).

Tips for Parents

Quick checklist: likely teething

You can’t diagnose at home, but these clues make teething more likely:

• Normal or slightly raised temperature under 100.4°F (38°C)
• Obvious gum swelling or a white ridge where a tooth is coming
• Lots of drooling, constant chewing on hands or toys
• Fussiness that comes in waves but improves with cuddles, cold teether, or pain relief
• No recent cold or only very mild sniffles

Quick checklist: likely ear infection

Call your pediatrician the same day if you notice:

• Fever 100.4°F (38°C) or higher, especially if persistent
• Sudden, intense fussiness or crying that doesn’t respond to usual comfort
• Difficulty lying flat; baby screams when placed down
• Recent or current cold (runny nose, cough) followed by new ear pain
• Any fluid, pus, or blood draining from the ear
• Baby is less responsive to sounds or seems off‑balance (in older infants/toddlers)

When to seek urgent or emergency care

Seek urgent medical help or go to the emergency department if:

• Baby under 3 months has a temp of 100.4°F (38°C) or higher
• Your child is very lethargic, hard to wake, or not making eye contact
• Breathing is fast, labored, or you see ribs pulling in with each breath
• You’re worried something is seriously wrong—even if you’re not sure why

Trust your instincts. You know your baby’s “normal” better than anyone.

Comfort measures you can safely use for teething

• Cold washcloth or chilled (not frozen) teether for them to chew
• Firm gum massage with a clean finger
• Age‑appropriate pain relievers (acetaminophen, or ibuprofen if old enough) in correct doses, after checking with your pediatrician
• Wipe drool frequently and use a gentle, fragrance‑free barrier cream to prevent drool rash (see our guides on fragrance allergies in infants and cocamidopropyl betaine and eczema).

Comfort measures for a suspected ear infection (while you await care)

• Hold baby more upright (in your arms, carrier, or slightly elevated crib if your pediatrician says this is safe for your setup and baby’s age).
• Offer smaller, more frequent feeds.
• Use prescribed or recommended pain relief on schedule—controlling pain is important and safe when dosed correctly.2

Remember: you can’t confirm an ear infection at home. Any baby who seems very unwell, or whose pain is severe or persistent, should be seen.

Duckie’s Verdict: Is it safe?

Teething itself: Yes, generally safe. It’s a normal developmental process, although it can be miserable for everyone. The main risks come from unsafe teething remedies (certain gels, tablets, and necklaces), not from teething.

Ear infections: Caution. Most are mild and resolve with proper care, but because they’re infections, they deserve respect. If your baby has high fever, worsening pain, or looks unwell, don’t wait—get a medical evaluation. Distinguishing Ear Infection or Teething? How to Spot the Difference is helpful, but it never replaces an in‑person exam when you’re worried.

Unsure about other ingredients? Download the Duckie App to scan instantly. Duckie gives you clear, science‑based breakdowns of baby products—from teething gels to wipes and lotions—so you can avoid harsh additives and focus on soothing your little one safely.

FAQ

How can I tell if my baby’s fever is from teething or an ear infection?

Teething may cause a very slight temperature rise but typically stays under 100.4°F (38°C).1 A fever at or above 100.4°F, especially with a recent cold, severe fussiness, or ear pain, is more suggestive of an infection and warrants a call to your pediatrician.

Can teething cause ear infections?

Teething itself doesn’t cause ear infections. Ear infections usually follow viral colds that block the Eustachian tube.2 However, teething pain can radiate toward the ear, making it easy to confuse the two—another reason Ear Infection or Teething? How to Spot the Difference can be tricky.

How long should I wait before seeing a doctor for ear pain?

If your child has ear pain plus fever 100.4°F (38°C) or higher, is very fussy, or has ear drainage, call your pediatrician the same day. For mild discomfort without fever or cold symptoms, you can monitor for 24 hours, but seek care sooner if anything worsens.

Is it safe to use over‑the‑counter teething gels?

Most pediatric and dental groups advise against benzocaine or lidocaine teething gels in infants due to rare but serious side effects.3 Safer options are cold teethers, gum massage, and age‑appropriate pain medicine as directed by your pediatrician.

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