Teething or Ear Infection? How to Spot the Difference

Teething vs. ear infection

The nerves connecting your baby's gums and ears create a network of shared sensation. When molars push through swollen gums, the pain radiates to the ears. When fluid builds in the middle ear, the pressure can feel like it's coming from the jaw. This anatomical connection means teething babies often pull their ears, and babies with ear infections sometimes seem to have gum pain.

The timing makes diagnosis even trickier. Peak teething months (6-30 months) overlap perfectly with peak ear infection susceptibility. Your baby's immune system is still developing while the tubes connecting ear to throat are shorter and more horizontal than adults', creating perfect conditions for both teething discomfort and ear infections.

When it could be teething

Teething pain follows predictable patterns that can help distinguish it from illness:

1. Teething discomfort typically begins and intensifies in the 3-5 days before a tooth breaks through the gum.

2. Your baby might drool excessively, enough that you're changing shirts multiple times daily and dealing with chin rashes from constant moisture.

3. You can often see or feel swollen, red gums where the tooth is trying to emerge, sometimes with a clear or bluish bubble called an eruption cyst.

4. The pain comes in waves rather than being constant. Your baby might be happily playing, then suddenly become fussy as a wave of discomfort hits. They seek relief by chewing on everything within reach: your shoulder, their toys, even their own hands. This counter-pressure temporarily eases the throbbing in their gums.

Teething can cause mild temperature elevation, but it won't cause a fear. Anything higher than 100.4°F (38°C) suggests illness rather than teething alone. Sleep disruption happens, but it's typically limited to the few nights before a tooth breaks through, then improves once the sharp edge emerges.

When an ear infection is more likely

Ear infections hit differently than teething pain. The discomfort is often more severe and persistent, not coming in manageable waves but creating constant misery that doesn't respond to typical comfort measures.

1. Ear infections frequently cause fever, though not always. The pain typically worsens when your baby lies flat, which explains why ear infection crying often peaks at bedtime and in the early morning hours.

2. You might notice thick, yellow, or bloody fluid draining from your baby's ear. While alarming, this can indicate that pressure has been released through a small perforation in the eardrum—often bringing some pain relief. The eardrum typically heals on its own once the infection clears, but healing depends on factors like the size of the perforation, the presence of ongoing infection, and whether there the infection is recurrent.

Ear infections often follow cold symptoms. If your baby had a runny nose, cough, or congestion in the days before the crying started, an ear infection becomes more likely as fluid from the upper respiratory infection can travel to the middle ear.

Brooke, mother of 9-month-old Anya, describes the difference: "When Anya was teething, she'd cry hard but could still be distracted by toys or nursing. When she had her first ear infection, nothing helped. She cried inconsolably for hours and wouldn't let me put her down. The fever was the final clue that this wasn't teething."

Whether to wait or not

When you're staring at your crying baby at 3 a.m., work through these questions to help decide whether this can wait until morning:

• How high is their temperature? Anything over 100.4°F in babies under 6 months warrants a call to your pediatrician, regardless of the time. Fever above 102°F at any age combined with severe fussiness needs medical evaluation.

• How long have they been inconsolable? Teething discomfort usually responds to comfort measures: nursing, rocking, or teething toys provide some relief. If absolutely nothing helps and they've been screaming for hours, lean toward seeking medical care.

• Are they showing other illness symptoms? Cold symptoms, unusual tiredness, difficulty breathing, or refusing to eat entirely suggest something beyond teething.

• What does your gut tell you? Trust your parental instincts. If something feels different about this crying episode, it's worth getting checked.

Immediate comfort for baby

While you're trying to determine what's wrong, focus on providing comfort.

For suspected teething, offer safe items to chew on: teething rings, wet washcloths, or mesh feeders with cold fruit for babies eating solids. Gently massaging swollen gums with a clean finger often provides immediate, temporary relief.

For suspected ear infections, keeping your baby upright as much as possible can reduce pressure and pain. A warm compress held against the outside of the ear sometimes helps, though some babies prefer cold. Pain medication appropriate for your baby's age and weight can provide relief while you determine next steps.

According to the American Academy of Pediatrics, both acetaminophen (for infants over 2 months) and ibuprofen (for babies over 6 months) are safe and effective for managing pain from either condition. Use weight-based dosing charts and don't hesitate to provide appropriate pain relief while you figure out what's causing the discomfort.

When to call the doctor immediately

Some situations require immediate medical attention regardless of whether you think it's teething or an ear infection. Call your pediatrician right away if your baby has fever of 100.4°F or higher and is under 3 months old, shows signs of dehydration, has fluid draining from their ears, or seems unusually lethargic or difficult to wake.

Trust your instincts if your baby seems to be in severe pain that doesn't respond to comfort measures or pain medication. Severe, persistent crying that feels different from your baby's normal fussiness warrants evaluation.

If you're unsure but concerned, most pediatric offices have after-hours nurse lines that can help you determine whether your situation needs immediate attention or can wait until regular office hours.

Crisis contacts to keep handy

For immediate medical concerns:

• Your pediatrician's after-hours number

• Local urgent care centers that see infants

• Pediatric emergency room locations

For middle-of-the-night guidance:

• Many pediatric offices have 24-hour nurse consultation lines

• Keep your insurance information and pharmacy details easily accessible

Why guessing is actually normal

Even pediatricians need to examine your baby's ears directly to diagnose an ear infection definitively. You're not failing if you can't tell the difference from observing symptoms; the conditions are genuinely difficult to distinguish.

Your job isn't to become a medical expert overnight. Your job is to provide comfort, monitor for concerning symptoms, and seek appropriate medical care when needed. Sometimes that means middle-of-the-night urgent care visits for what turns out to be teething. Sometimes it means treating teething pain at home when it's actually an early ear infection. Both scenarios are normal parts of parenting.

Supporting your baby through the discomfort

Whether the cause is teething or an ear infection, your baby is experiencing real pain and needs your comfort and patience. This phase, while miserable, is temporary. Teeth will eventually break through. Ear infections will clear with treatment or time.

Your consistent presence and comfort during these painful episodes builds trust and security. Every time you respond to their distress with patience and care, you're teaching them that they can count on you when they're suffering.

The uncertainty and worry you feel watching your baby in pain shows your deep love and commitment to their wellbeing. Trust your instincts, provide appropriate comfort, and don't hesitate to seek medical care when something feels wrong.