The biggest clue is fever. Teething does not cause a true fever. If your baby’s temperature is above 100.4°F, you’re likely dealing with an ear infection, not a new tooth. But fever is just one piece of the puzzle, and many symptoms of teething and ear infections look nearly identical, especially in a baby who can’t tell you what hurts. Here’s how to sort through what you’re seeing.
Why These Two Look So Similar
Teething typically begins around 6 months of age, and this is exactly when the temporary immunity babies receive from their mother starts to fade. That means babies are more vulnerable to infections at the same time teeth are coming in. The overlap isn’t just in timing. Both conditions cause ear pulling, fussiness (especially at night), trouble sleeping, and changes in feeding. A parent watching their baby tug on an ear at 7 months has genuinely equal odds of either cause.
Each teething episode lasts about 3 to 8 days, with pain peaking in the days just before and after a tooth breaks through the gum. Ear infections develop over a similar window but behave differently over time, which is one of the ways to tell them apart.
Symptoms That Point to Teething
Teething discomfort tends to be intermittent. Your baby may be cranky for a stretch, then seem perfectly fine, then get fussy again. Look inside their mouth: you’ll often see red, swollen gums where a tooth is pushing through, and sometimes a small bluish blister on the gum surface. Increased drooling and a strong desire to chew on firm objects are classic teething signs that don’t show up with ear infections.
Ear pulling during teething is usually mild and one-sided, on the same side where the tooth is erupting. The pain from a new molar, for example, can radiate along the jaw and make the ear on that side feel uncomfortable. Feeding may be slightly disrupted by gum soreness, but most teething babies will still eat. If your baby’s temperature creeps up at all, it should stay below 100.4°F. Anything above that threshold is not from teething.
Teething also does not cause a cough, runny nose, or chest congestion. If those symptoms are present, something else is going on.
Symptoms That Point to an Ear Infection
Ear infections typically arrive with a supporting cast of cold symptoms. A runny nose, cough, or congestion in the days before the ear pain starts is a strong signal. The fussiness tends to be more sudden and more intense than what you see with teething, and it gets noticeably worse when the baby lies flat. That’s because lying down increases pressure on the middle ear, which is already swollen and filled with trapped fluid.
Watch for these signs that teething won’t cause:
- Fever above 100.4°F. This is the single most reliable differentiator.
- Fluid draining from the ear. It looks like a clear liquid, similar to nasal discharge, and is very different from earwax.
- Feeding refusal. Sucking and swallowing change the pressure inside the ear, so babies with ear infections often pull away from the breast or bottle mid-feed, crying.
- Loss of balance. If your baby is crawling or walking, you may notice unusual clumsiness or unsteadiness.
- Reduced response to sounds. Fluid behind the eardrum can muffle hearing, so your baby may not react to your voice or noises the way they normally would.
Ear pulling with an infection is often more forceful than with teething and may involve both ears rather than just one side.
The Lying-Down Test
One of the most practical things you can do at home is pay attention to what happens when your baby lies flat. If the crying and fussiness spike dramatically when you lay them down for sleep or a diaper change, that pattern fits an ear infection. The fluid trapped behind the eardrum shifts when the head is level, increasing pressure and pain. Teething discomfort doesn’t change much with position. A teething baby may be generally irritable at bedtime, but the act of lying down itself won’t trigger a sharp increase in distress.
Check the Gums, Check for a Cold
Two quick checks can narrow things down considerably. First, gently run a clean finger along your baby’s gums. If you feel a hard ridge or see swollen, reddened tissue where a tooth is about to break through, teething is at least part of what’s happening. Second, think about whether your baby has had cold symptoms in the past week. Ear infections frequently follow upper respiratory infections because the swelling blocks the small tubes that drain the middle ear. If your baby had a stuffy nose for several days and is now pulling at their ears with a fever, that sequence strongly suggests an ear infection.
It’s also entirely possible for both to happen at the same time. A baby cutting a tooth while fighting off a cold can develop an ear infection on top of teething pain. If the symptoms don’t fit neatly into one category, that overlap may be the reason.
How Each One Resolves
Teething symptoms come and go in waves over 3 to 8 days per tooth. The worst discomfort typically fades once the tooth breaks through the gum. A chilled teething ring or gentle gum massage with a clean finger can provide noticeable relief. If those simple measures help your baby calm down, that’s another point in favor of teething.
Ear infections caused by a virus often clear up on their own within about a week. When symptoms are mild and the baby is older than 6 months, pediatricians sometimes recommend a watchful waiting period of 48 to 72 hours before prescribing antibiotics. If symptoms don’t improve within that window, or if they’re severe from the start, antibiotics are typically the next step. Most babies bounce back quickly, often feeling noticeably better within 24 hours of starting treatment.
The key difference in trajectory: teething pain fluctuates and responds to soothing measures, while ear infection pain tends to be more persistent and escalates, particularly at night and when lying down. If your baby’s discomfort is getting steadily worse rather than waxing and waning, an ear infection is more likely.
What a Pediatrician Looks For
There’s no way to confirm an ear infection at home. A pediatrician uses a small lighted instrument to look at the eardrum. The hallmark of an ear infection is a bulging eardrum with fluid visible behind it. Without that finding, the diagnosis isn’t made, no matter how many other symptoms are present. This is why a visit matters when you’re unsure. The exam takes seconds and gives you a definitive answer, which is something no amount of symptom-watching at home can fully provide.