A baby tugging at their ear can make any parent worry—but ear pulling is not automatically an ear infection. Teething, tiredness, congestion, and simple curiosity can all look similar, so the most useful clues are your baby’s temperature, feeding, sleep, gums, and overall behavior.
Teething usually causes drooling, chewing, and sore or swollen gums without a true fever, while an ear infection is more likely to cause persistent pain, fever, disrupted sleep, feeding difficulty, hearing changes, or fluid draining from the ear. Ear pulling alone cannot confirm either condition; a clinician must examine the eardrum to diagnose an infection.1 2 3
Ear Infection or Teething? How to Spot the Difference
The overlap is frustrating: both teething and ear infections can cause fussiness, nighttime waking, and ear rubbing. Babies also cannot explain where they hurt. Instead of focusing on one symptom, look for a pattern that develops over several hours.
| Clue | More consistent with teething | More concerning for an ear infection |
|---|---|---|
| Gums | Red, swollen, tender, with increased chewing | Usually unchanged |
| Drooling | Common | Not a typical sign |
| Ear pulling | May happen, especially with gum discomfort | May happen because of ear pain |
| Temperature | No fever or only a slight temperature rise | Fever, particularly (38^\circ\text{C}) / (100.4^\circ\text{F}) or higher |
| Feeding | Often mostly normal | May feed poorly or cry while sucking and swallowing |
| Sleep | Mildly unsettled | Repeated waking or marked nighttime distress |
| Ear drainage | Not expected | Yellow, white, bloody, or clear fluid needs medical advice |
| Duration | Comes and goes around tooth eruption | Persistent or worsening symptoms |
These are clues, not a diagnosis. The American Academy of Pediatrics diagnostic criteria require examination findings such as a bulging eardrum or new ear drainage unrelated to an outer-ear infection.4 A home look inside the ear cannot reliably establish this.
Understanding the Science
Teething happens when a developing tooth moves through the gum tissue. Pressure and inflammation can make the gums sore, encouraging babies to chew or rub their faces. Drooling and gum-rubbing are among the most characteristic signs.1
An acute middle-ear infection, or acute otitis media, occurs when infected or inflamed fluid becomes trapped behind the eardrum. It commonly follows a cold because congestion can interfere with the Eustachian tube, which helps ventilate and drain the middle ear.5
Ear tugging is therefore an unreliable stand-alone sign. Some babies pull their ears while teething; others do it when tired, congested, or exploring their bodies. An infection becomes more likely when ear pulling appears with fever, significant pain, poor feeding, unsettled sleep, reduced response to sounds, balance problems, or drainage.2 3
Teething should not be used to explain a high fever, a very unwell appearance, or ongoing symptoms. A mild temperature increase may occur during teething, but a measured fever—especially (38^\circ\text{C}) or above—deserves consideration of another cause.1 6
When to Call the Pediatrician
Arrange medical advice if your baby has suspected ear pain lasting more than a day, worsening symptoms, fever, difficulty feeding, or repeated nighttime crying. Seek prompt care for fluid draining from the ear, new hearing concerns, balance problems, swelling behind the ear, or unusual sleepiness.3 7
Any fever in a baby younger than 3 months requires prompt medical assessment. For older babies, the urgency depends on temperature, duration, behavior, hydration, and other symptoms. If your instincts tell you that your child is significantly unwell, contact a healthcare professional rather than trying to decide between teething and infection at home.
Tips for Parents
- Check the temperature with a thermometer. Feeling warm is not enough to confirm a fever.
- Look at the gums. Swollen, tender gums plus drooling and chewing support teething, but they do not rule out an infection.
- Watch feeding. Refusing the breast or bottle, especially with crying during sucking, can indicate pain or illness.
- Notice sleep and comfort. Persistent distress, particularly when lying down, is more concerning than occasional fussiness.
- Look for drainage, not just earwax. Fluid leaking from the ear should be assessed by a clinician.
- Offer safe comfort measures. A chilled—not frozen—teething ring and gentle gum pressure may help. Avoid amber teething necklaces because of strangulation and choking risks.
- Use medicines carefully. Ask your pediatrician or pharmacist about the correct weight-based dose of acetaminophen or ibuprofen; ibuprofen is generally not used in babies under 6 months unless a clinician advises it. Never give aspirin to a child.
- Do not put oil, cotton swabs, or unprescribed drops into the ear. These can irritate the ear or obscure important findings.
- Remember that antibiotics are not automatic. Some ear infections improve without them, while certain ages, symptoms, or examination findings make treatment more appropriate.8
Duckie’s Verdict: Is it safe?
Caution. Ear pulling with drooling, gum-rubbing, normal feeding, and no fever is often compatible with teething. Ear pulling accompanied by fever, persistent pain, poor feeding, disrupted sleep, hearing changes, balance problems, or drainage should not be dismissed as teething. Because only an ear examination can confirm acute otitis media, contact your pediatrician when symptoms are significant, persistent, or unclear.
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FAQ
Can teething cause an ear infection?
Teething does not directly cause a middle-ear infection. The symptoms can overlap, particularly ear rubbing and fussiness. A fever, feeding difficulty, drainage, or persistent pain points more toward infection and should be assessed.
Does ear pulling always mean an ear infection?
No. Babies may pull their ears because of teething, tiredness, congestion, or curiosity. Ear pulling becomes more concerning when it occurs with fever, poor sleep, feeding difficulty, reduced hearing, balance problems, or drainage.
Can a baby have teething and an ear infection at the same time?
Yes. Teething and an ear infection can occur together. Visible gum changes do not exclude illness, so monitor temperature, feeding, sleep, comfort, and any ear discharge.
When should I call a doctor about possible ear pain?
Call if symptoms are persistent or worsening, your baby has a fever, feeds poorly, seems unusually sleepy, has ear drainage, or does not respond normally to sounds. Any fever in a baby under 3 months needs prompt medical advice.
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How this article was made
This article was prepared with AI assistance and edited by Duckie. Sources are listed with the article, but source quality can vary. It has not been medically reviewed unless a named clinician reviewer is shown. Please verify health decisions with a qualified professional.
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.
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