Ear Infection vs. Teething - How to Tell the Difference
The short answer
Ear pulling is one of the most commonly confused symptoms in babies - it can indicate either teething or an ear infection, and telling the difference can be tricky. Teething causes referred pain to the ear area (especially when molars are coming in), leading babies to pull or rub their ears. An ear infection typically follows a cold and is associated with fever, disrupted sleep, and increased fussiness. The key differences: teething ear pulling is usually without fever and is accompanied by drooling and gum swelling, while ear infections typically cause fever, follow a cold, and may cause more intense pain when lying down.
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By Age
What to expect by age
0-12 months
Ear infections are common in babies 6-12 months, peak at the same time as teething, making it hard to tell them apart. Signs more suggestive of an ear infection include: fever over 100.4 degrees F, fussiness that worsens when lying down (fluid pressure on the eardrum increases), recent cold or congestion, yellow or green ear discharge, trouble sleeping (especially worse on one side), and pulling at one specific ear repeatedly. Signs more suggestive of teething include: drooling, gnawing on objects, visible swollen gums, irritability that improves with teething remedies, and no fever above 100.4 degrees F.
1-3 years
Toddlers can more clearly indicate if they have ear pain - they may point to their ear or say "owie." Ear infections in toddlers often follow upper respiratory infections and present with fever, ear pain (worse at night), and sometimes temporary hearing reduction. Teething-related ear discomfort from molars (which come in between 13-33 months) causes generalized jaw and ear area discomfort but typically without fever, without following a cold, and with visible gum changes. If you cannot tell the difference, a quick visit to the pediatrician for an ear exam is the most reliable way to know.
What Should You Do?
When to take action
- Occasional ear rubbing during teething with no fever or signs of illness
- Mild ear pulling that resolves when your baby is distracted
- Ear rubbing at bedtime as a self-soothing habit
- Your baby is pulling at their ears and you are unsure if it is teething or an ear infection
- Ear pulling with a low-grade fever (could be either - worth checking)
- Ear pulling that has been ongoing for several days
- Your baby is recovering from a cold and is now fussy and pulling at ears (more suggestive of ear infection)
- Ear pulling with a fever over 102 degrees F (39 degrees C)
- Yellow, green, or bloody discharge coming from the ear
- Your child is in significant pain - crying inconsolably, especially when lying down
- Ear pain with a stiff neck (rare but needs urgent evaluation)
- Swelling or redness behind the ear (possible mastoiditis - seek immediate care)
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
Baby Pulling or Tugging at Ears
Baby ear pulling is one of the most common concerns parents bring up, but it is rarely a sign of an ear infection on its own. Babies discover their ears around 4-6 months and often pull, rub, or tug at them out of curiosity, self-soothing, teething discomfort, or tiredness. Ear pulling is concerning for infection mainly when accompanied by fever, fussiness, disrupted sleep, or cold symptoms. Without other symptoms, ear pulling is almost always harmless exploration.
Does Teething Really Cause Fever?
Research shows that teething may cause a slight increase in body temperature, but it does NOT cause true fever (temperature at or above 100.4 degrees F / 38 degrees C). A large systematic review of studies found that teething may cause temperatures up to about 100 degrees F (37.8 degrees C), along with drooling, gum irritation, and fussiness. If your baby has a temperature of 100.4 degrees F or higher, they likely have an illness that coincidentally timed with teething, and the fever should be evaluated by your pediatrician rather than dismissed as "just teething."
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.
How to Advocate for Your Child's Needs
You know your child better than anyone, and your observations matter. If you feel something is not right with your child's development or health, you have every right to ask questions, request evaluations, and seek second opinions. Advocating for your child is not being difficult - it is being a good parent.