Teething vs. Ear Infection: How to Tell the Difference
Is your baby pulling at their ears, fussy, drooling, and struggling to sleep? It could be teething — but it could also be an ear infection, and the two overlap enough to leave any parent guessing at 2 AM. Knowing the key differences helps you decide whether to reach for a teether or the phone to call your pediatrician. Here's how to tell them apart.
Quick Background: What's Actually Happening
Teething is the normal process of teeth pushing through the gums. It usually starts around 4–7 months (though anywhere from 3 to 12 months is normal), often beginning with the bottom front teeth. The discomfort comes and goes as different teeth move, and it's a months-long, on-and-off companion of the first couple of years.
An ear infection (otitis media) happens when fluid builds up and becomes infected behind the eardrum, usually causing painful pressure. It frequently follows a cold or congestion, because the tubes that drain the middle ear are short and easily blocked in babies. Unlike teething, it's an illness that often needs to be evaluated and sometimes treated.
Key Differentiator: Fever
This is the single most useful clue.
- Teething: May cause a slight rise in temperature, but it does not cause a true fever of 100.4°F (38°C) or higher. If your baby has a real fever, don't blame teeth. Not sure how to handle a fever? See our guide to your baby's first fever.
- Ear infection: Often accompanied by a moderate to high fever, though not always.
Symptom Comparison
| Symptom | Teething | Ear Infection |
|---|---|---|
| Fever | None or very slight | Often moderate to high |
| Fussiness | Comes and goes, often worse at night | More constant, worse when lying down |
| Ear pulling | Tugs at ear to soothe referred jaw pain | Tugs at ear directly from pain inside |
| Appetite | May refuse solids but still nurse/bottle | Often refuses to suck — sucking hurts the pressure |
| Sleep | Disrupted, more frequent night wakings | Very hard to settle; cries when laid flat |
| Recent illness | Not related to a cold | Often follows a cold, congestion, or cough |
| Other signs | Drooling, chewing on hands, swollen/red gums | Ear drainage, tugging one specific ear, general "sick" look |
| Duration | On and off over days as a tooth moves | Tends to worsen over a day or two without improving |
The "Pressure Test"
Gently press on the tragus — the small flap of cartilage in front of the ear canal. A sharp cry or pulling away can suggest an ear infection, especially if it's consistently the same ear. A teething baby often won't react, or may even find gentle pressure soothing. This isn't a diagnosis (only an exam of the eardrum can confirm one), but it's a helpful clue.
What Else Could It Be?
Ear-pulling and fussiness overlap with plenty of other everyday issues:
- Self-soothing. Many babies simply discover their ears and tug at them out of curiosity or comfort, with no pain at all.
- Reflux or gas. If the crying clusters in the evenings and centers on feeds, read about colic vs. reflux.
- An off sleep schedule. If disrupted sleep is the main symptom, the culprit may just be timing — our free nap calculator helps you check age-appropriate wake windows, and teething itself can trigger a temporary teething sleep regression.
Soothing Teething Discomfort
If you're fairly confident it's teeth, these gentle measures help:
- Something to chew: A clean, chilled (not frozen) teething ring or a cold, damp washcloth.
- Gum pressure: A clean finger rubbed firmly on the gums can bring relief.
- Cold foods: For babies already on solids, chilled purees or an appropriate feeder can soothe.
- Extra comfort: More cuddles, patience, and calm. Discomfort disrupts sleep, so protecting the daytime schedule matters.
- Skip risky remedies: Avoid amber teething necklaces (a strangulation and choking hazard) and numbing gels containing benzocaine, which the FDA warns against for infants. Ask your pediatrician before giving any pain reliever.
Keep a Simple Symptom Log: When did the fussiness start? Any temperature readings? Changes in feeding or sleep? A short log gives your pediatrician a far clearer picture than memory alone. Track health notes, temperatures, and symptoms with a free MyBabyTracker account — and ask the built-in AI parenting assistant a quick question anytime (free accounts include 3 AI messages a day).
Frequently Asked Questions
Can teething cause a runny nose or diarrhea? This is debated. Mild drooling-related loose stools and a slightly runny nose are commonly reported during teething, but a clear cold, significant diarrhea, or a fever are more likely signs of an actual illness — not teeth. Don't let "it's just teething" delay care for a genuinely sick baby.
Do ear infections always need antibiotics? Not always. Many clear on their own, and pediatricians sometimes recommend watchful waiting with pain relief. But an ear infection should be diagnosed by an exam, so it's worth a call rather than a guess.
My baby pulls both ears but seems totally happy — is that an infection? Probably not. Happy, playful ear-tugging with no fever or feeding trouble is usually just a baby exploring their body.
When to Talk to Your Pediatrician
Call your pediatrician if your baby:
- Has a fever over 100.4°F (38°C), or any fever in a baby under 3 months.
- Is inconsolable, and nothing seems to help.
- Has any fluid draining from the ear.
- Seems to be in significant or worsening pain, or is tugging consistently at one ear.
- Has symptoms that follow a cold and get worse rather than better.
If sleep is the biggest struggle through it all, our guide to why babies fight sleep may help you rule out timing issues.
This article is for informational purposes only and is not a substitute for professional medical advice.