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

Quick answer: Teething and ear infections share signs, such as fussiness, poor sleep and rubbing or tugging at the ear, so you often cannot tell them apart at home. The NHS lists a slightly raised temperature under 38C, drooling, a red sore gum and chewing as teething signs, while the NIDCD lists fever, fluid draining from the ear and trouble sleeping as ear infection signs. A doctor has to look in the ear to confirm an infection, so get advice if you are worried.

A fussy baby who is pulling at an ear sends most parents straight to the internet. This guide sets out what two health agencies list for each, where the signs overlap and when to get medical advice. It is general information, not medical advice, and it cannot diagnose your baby.

Signs the NHS Lists for Teething

• A sore, red gum where the tooth is coming through.
• A slightly raised temperature, but less than 38C.
• One flushed cheek.
• A rash on the face.
• Rubbing the ear.
• Drooling more than usual.
• Chewing and gnawing on things a lot.
• Being more fretful than usual, or sleeping poorly.

The NHS says teething does not cause diarrhoea, and that there is no evidence to support this.

Signs the NIDCD Lists for an Ear Infection

For a child who cannot yet say that an ear hurts, the NIDCD lists tugging or pulling at the ears, fussiness and crying, trouble sleeping, fever (especially in infants and younger children), fluid draining from the ear, clumsiness or balance problems, and trouble hearing or responding to quiet sounds. It says ear infections are usually caused by bacteria and often follow a sore throat, cold or other upper respiratory infection, when fluid builds up behind the eardrum.

Where the Signs Overlap

A Note on Drool Rash

The NHS lists a rash on the face among the signs of teething, which often matches the skin around the mouth and chin getting irritated by drool. We did not open an official page on treating drool rash, so ask your pediatrician about what to use, and see them if the rash is not improving, looks infected or comes with a fever.

When to Get Medical Advice

• Any symptoms that worry you. The NHS says to get medical advice if your baby has any symptoms that are causing you concern.
• Fluid draining from the ear, or a fever that is more than slightly raised.
• Several days pass and your child still seems sick, as the NIDCD says.
• Diarrhoea, since teething does not cause it according to the NHS.
• A very young baby with any fever, or a baby who seems unusually drowsy, floppy or hard to wake: seek urgent medical care.

How a Doctor Confirms and Treats an Ear Infection

A doctor examines the ear to confirm an infection. The NIDCD says doctors often prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days, and that pain relievers such as acetaminophen or ibuprofen, or eardrops, may help with pain and fever. It says not to give aspirin unless a doctor instructs it, because of the risk of Reye's syndrome. If the diagnosis is unclear and there is no severe ear pain or fever, a doctor may suggest waiting a day or two, and AAP guidelines say antibiotics should start if there is no improvement within 48 to 72 hours of symptom onset. Finish the full course of any antibiotic.

For humidifier safety when your baby has a cold, see our guide to cool mist vs warm mist humidifiers for babies. LabelBaby scans baby food and product labels, and it is a mobile app that is coming soon. This guide is general information, not medical advice.