Ear Infection vs Teething: Key Differences
Content reviewed against published AAP, AAP, NICE guidelines
Last reviewed:
Ear pulling, fussiness, and disrupted sleep are common to both ear infections and teething. Parents often struggle to tell them apart. Understanding the key differences helps you know when to call the doctor.
Key takeaways
- High fever (over 100.4°F) suggests ear infection, NOT teething
- Ear infections almost always follow a cold; teething does not
- Ear infection pain is persistent and worsens; teething pain comes and goes
- Significant increase in drooling with chewing behavior points to teething
: Cause
Ear Infection (Otitis Media): Bacterial or viral infection of middle ear (often follows a cold)
Teething: Normal eruption of teeth through gums
: Fever
Ear Infection (Otitis Media): Often present (can be high, over 102°F/38.9°C)
Teething: May cause slight temperature rise (under 100.4°F/38°C); does NOT cause high fever
: Ear pulling
Ear Infection (Otitis Media): Persistent tugging due to pain
Teething: May pull ears due to referred gum discomfort, but inconsistent
: Cold symptoms
Ear Infection (Otitis Media): Usually preceded by runny nose, congestion (3-5 days prior)
Teething: No preceding cold symptoms
: Pain pattern
Ear Infection (Otitis Media): Worse lying down; persistent; wakes from sleep in pain
Teething: Comes and goes; worse before tooth breaks through
: Appetite
Ear Infection (Otitis Media): May refuse bottle or breast (sucking increases ear pressure)
Teething: Wants to chew on everything; may refuse spoon-feeding
: Drooling
Ear Infection (Otitis Media): Not specifically increased
Teething: Significantly increased drooling
: Duration
Ear Infection (Otitis Media): Worsens without treatment; lasts 7-10 days
Teething: Intermittent discomfort for a few days per tooth
: Ear discharge
Ear Infection (Otitis Media): Yellow or bloody fluid from ear if eardrum ruptures
Teething: Never causes ear discharge
: Treatment
Ear Infection (Otitis Media): Antibiotics often needed; pain relief
Teething: Teething rings, cold washcloths, age-appropriate pain relief
| Ear Infection (Otitis Media) | Teething | |
|---|---|---|
| Cause | Bacterial or viral infection of middle ear (often follows a cold) | Normal eruption of teeth through gums |
| Fever | Often present (can be high, over 102°F/38.9°C) | May cause slight temperature rise (under 100.4°F/38°C); does NOT cause high fever |
| Ear pulling | Persistent tugging due to pain | May pull ears due to referred gum discomfort, but inconsistent |
| Cold symptoms | Usually preceded by runny nose, congestion (3-5 days prior) | No preceding cold symptoms |
| Pain pattern | Worse lying down; persistent; wakes from sleep in pain | Comes and goes; worse before tooth breaks through |
| Appetite | May refuse bottle or breast (sucking increases ear pressure) | Wants to chew on everything; may refuse spoon-feeding |
| Drooling | Not specifically increased | Significantly increased drooling |
| Duration | Worsens without treatment; lasts 7-10 days | Intermittent discomfort for a few days per tooth |
| Ear discharge | Yellow or bloody fluid from ear if eardrum ruptures | Never causes ear discharge |
| Treatment | Antibiotics often needed; pain relief | Teething rings, cold washcloths, age-appropriate pain relief |
When to Worry
- Fever over 102°F (38.9°C) — this is not teething and needs evaluation
- Fluid or pus draining from the ear
- Baby inconsolable for more than a few hours
- Child not responding to sounds or seems to have hearing difficulty
- Symptoms worsen after 2-3 days despite comfort measures
- Any fever in an infant under 3 months needs immediate medical evaluation
Frequently asked questions
What is the main difference between Ear Infection (Otitis Media) and Teething?
How can I tell if my baby has Ear Infection (Otitis Media) or Teething?
When should I worry?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Bottom line
Both Ear Infection (Otitis Media) and Teething are common in young children. The key differences in symptoms can help you identify what your child may have, but when in doubt, consult your pediatrician.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.