Teething or Ear Infection? How to Tell the Difference in a Baby

Your baby is fussy, drooling, not sleeping, and keeps tugging at one ear. Is a tooth coming in, or is it an ear infection? The two overlap so much that even experienced parents get it wrong, and that matters because one needs a teething ring and the other may need a doctor. The good news: a handful of signs reliably separate them. The most useful one is fever. This guide walks through what each looks like, why ear-pulling shows up with both, and exactly when to call your provider.

A quick note before we start. Developmental ranges are wide, and babies do not read the textbook. Teething can start anywhere from a few months to past the first birthday, and ear infections can look mild or dramatic. Nothing here replaces an exam, because the only way to actually see the eardrum is to look at it.

The fast answer: look at fever first

If you remember one thing, remember this. Teething does not cause a true fever.

It can cause a slight rise in temperature, but not a real fever. The American Academy of Pediatrics is direct about it: if your child is particularly miserable or has a temperature higher than 101 degrees Fahrenheit, it is probably not from teething (HealthyChildren.org). Ear infections, on the other hand, often come with a fever.

So a baby who is drooly, chewing on everything, and a touch warm is likely teething. A baby who is genuinely hot, crying hard, and pulling at an ear is more likely fighting an infection.

What teething actually looks like

Teething symptoms tend to be mild and centered on the mouth. Common signs include excessive drooling, a desire to gnaw on hard things, swollen or tender gums, and mild irritability (HealthyChildren.org).

You may also see flushed cheeks, more chewing on hands and toys, and slightly disrupted sleep. The discomfort usually flares for a day or two as a specific tooth pushes through the gum, then settles down once it breaks the surface.

What teething does not do is make a baby systemically sick. There is no real fever, no fluid draining from the ear, and no hours of inconsolable crying that nothing eases. If your baby seems unwell beyond cranky, teething is probably not the whole story.

Soothing a teething baby

A clean finger or a cool, firm rubber teething ring to chew on is the safe, simple fix. Skip teething gels, homeopathic teething tablets, and amber teething necklaces. The U.S. Food and Drug Administration has warned that benzocaine teething gels can be dangerous for babies and that necklaces pose strangulation and choking risks (FDA).

What an ear infection looks like

Ear infections usually show up after a cold or other respiratory bug, when fluid collects behind the eardrum and germs grow in it. The picture is more intense than teething.

Signs to watch for include a fever, ear pain that is often worse when lying down (so worse at night), and pus or fluid draining from the ear, which is a strong sign of infection (HealthyChildren.org). A baby who cannot tell you their ear hurts may instead cry hard, sleep badly, feed poorly, or seem off in a way that does not match a tooth coming in.

The pattern matters too. Teething tends to track with chewing and drooling. An ear infection tends to follow a recent cold and brings fever and pain that build rather than ease.

Why both make babies pull their ears

Ear-pulling is the symptom that fools everyone, because it happens with both. During teething, pain from the gums can radiate up toward the ear, so a baby rubs or tugs at the ear even though nothing is wrong inside it. Plenty of babies also just discover their ears and pull them to self-soothe, with no problem at all.

So ear-pulling by itself tells you almost nothing. Read it in context. Ear-pulling with drool, gum-chewing, and a calm-enough baby leans teething. Ear-pulling with a fever, fluid from the ear, or hard crying leans infection.

A quick side-by-side

• Fever: Teething, none or barely warm. Ear infection, often a true fever.
• Drooling and gum-chewing: Teething, prominent. Ear infection, not a feature.
• Fluid draining from the ear: Teething, never. Ear infection, a clear red flag.
• Recent cold: Teething, unrelated. Ear infection, often right before it.
• Crying: Teething, fussy but soothable. Ear infection, can be intense and hard to settle, often worse lying down.
• Ear-pulling: Both. Not a deciding clue on its own.

When to call your provider

You cannot see an eardrum from the outside, so when the signs point toward infection, an exam is the answer. Call your provider if your baby has any of these.

• A fever, fluid or pus draining from the ear, or hard, inconsolable crying.
• Trouble sleeping or feeding, or symptoms that last more than a day or two.
• Anything that makes your baby seem genuinely sick rather than just cranky.

Trust your gut here. You know your baby better than anyone. If something feels wrong, or you simply cannot tell teething from an infection, that uncertainty is a perfectly good reason to get an exam. Pediatric offices field this exact question every day, and looking in the ear takes about ten seconds.

If it turns out to be teething after all, you will leave with reassurance and a plan. If it is an ear infection, you will leave with the right treatment instead of waiting it out with a teething ring that was never going to help.