Babies with ear infections typically show a combination of fussiness, trouble sleeping, and ear-grabbing behavior, often alongside a low-grade fever. Since infants can’t tell you their ear hurts, you have to read the clues: changes in how they eat, sleep, and act are usually the first tip-off that something is going on in the middle ear.
Behavioral Clues to Watch For
The most recognizable sign is pulling or tugging at the ear. Older babies will grab the affected ear directly, but babies under one often just hit the side of their head because they can’t quite pinpoint where the pain is coming from. Ear tugging alone doesn’t guarantee an infection (babies explore their ears for all sorts of reasons), but paired with other symptoms, it’s a strong signal.
Irritability that seems out of proportion to normal fussiness is another hallmark. Ear infections cause steady, throbbing pain that gets worse when a baby lies flat. That’s because lying down shifts pressure inside the middle ear, making the discomfort spike. You may notice your baby is fine when upright but screams when placed in the crib, or wakes repeatedly through the night after being a decent sleeper.
Feeding problems show up in two ways. First, the virus behind most ear infections also irritates the gut, so your baby may have diarrhea, vomiting, or simply refuse to eat. Second, the sucking and swallowing motions of breastfeeding or bottle-feeding change pressure in the ear canal, which can be painful enough that a hungry baby pulls away after just a few sips.
Physical Symptoms You Can See
A fever often accompanies an ear infection, though not always. The CDC flags a temperature of 102.2°F (39°C) or higher as a sign worth acting on. For babies under three months, the threshold is much lower: any fever of 100.4°F (38°C) or above warrants an immediate call to your pediatrician, regardless of the suspected cause.
Fluid draining from the ear is one of the more obvious signs. This discharge can be clear, yellowish, or greenish, and it may be thin or thick. Sometimes it has a foul smell. Drainage means the eardrum has likely ruptured from pressure buildup, which sounds alarming but actually tends to relieve pain quickly. The eardrum usually heals on its own within a few weeks. Still, visible ear drainage is a clear reason to see a doctor.
Ear Infection vs. Teething
Teething and ear infections share several symptoms: fussiness, ear pulling, drooling, mild fever, and disrupted sleep. The overlap makes it genuinely tricky to tell them apart. A few differences can help you sort it out.
Teething pain tends to come and go and often improves with something to chew on. Ear infection pain is more constant, gets worse when lying down, and doesn’t respond to a teething ring. Teething fevers are typically very low-grade, rarely reaching 101°F, while ear infections more commonly push temperatures above that. And teething doesn’t cause ear drainage, vomiting, or the kind of inconsolable crying that a middle ear infection can produce. If your baby has a combination of high fever, sleep disruption that worsens when lying flat, and feeding refusal, an ear infection is the more likely culprit.
Temporary Hearing Changes
Fluid trapped behind the eardrum dampens sound vibrations, so your baby may temporarily hear less clearly during and after an infection. The hearing loss is usually mild to moderate, enough that your baby might not startle at sounds they’d normally react to, or might seem less responsive to your voice. This type of hearing loss is almost always temporary and resolves once the fluid drains.
In rare cases, repeated infections with thick, glue-like fluid can cause longer-lasting hearing issues. If your baby has had several ear infections in a short period, it’s worth paying attention to whether their hearing and babbling seem to bounce back between episodes. Persistent fluid that lingers for months after an infection is something your pediatrician can check with a simple in-office test.
What Happens at the Doctor’s Office
A pediatrician diagnoses an ear infection by looking at the eardrum with a small handheld scope. They’re checking for specific things: a bulging eardrum, redness, loss of the normal translucent appearance, and sometimes visible fluid behind the membrane. In some cases, they’ll use a small puff of air to see whether the eardrum moves normally. A healthy eardrum flexes easily; one backed by trapped fluid barely moves.
Not every ear infection needs antibiotics right away. Current guidelines from the American Academy of Pediatrics recommend immediate antibiotics for babies six months and older who have severe symptoms (high fever, significant pain, or infection in both ears). For milder, one-sided infections in older babies, doctors may suggest a “watchful waiting” approach: managing pain for 48 to 72 hours to see if the infection clears on its own, since many do. Your doctor will tell you what to watch for during that window and when to come back if things aren’t improving.
Signs That Need Urgent Attention
Most ear infections resolve without complications, but in rare cases the infection can spread to the bone behind the ear, a condition called mastoiditis. Watch for swelling, redness, or a soft, doughy feeling in the bone directly behind the ear. The ear on the affected side may visibly stick out more than the other. On darker skin tones, the discoloration behind the ear may appear purplish rather than red.
Other red flags include pus-like ear drainage that won’t stop, worsening hearing loss, a high fever that doesn’t respond to treatment, extreme lethargy, confusion, or a stiff neck. These symptoms suggest the infection may be spreading beyond the middle ear and need prompt medical evaluation to prevent serious complications like meningitis or lasting hearing damage.