The best way to tell the difference between teething and ear infection is to have a medical practitioner examine the baby or toddler’s ears. There are some other signs suggestive of one or the other condition, but sometimes babies can have both. An infection indicates the presence of bacteria, and without treatment this could cause damage. It always makes sense to see a doctor, if in doubt. Still, parents can look for other signs that differentiate between teething and ear infection such as drooling, response to pressure on the gums, type of nasal mucus, worsening illness, and greater discomfort in a prone position.
One of the difficulties with trying to tell teething and an ear infection apart is that both conditions may be accompanied by a slight fever. Usually, fever with teething doesn’t exceed 100 degrees F (37.78 degrees C), but sometimes an ear infection presents without fever or a low grade fever. Alone, this symptom is unreliable in telling the difference between the two.
Some classic symptoms of teething may help make this judgment call. Teething is usually accompanied by an increase in drooling, which isn’t common in ear infections. Babies may also respond if the gums are pressed down lightly. This may either be comforting or provoke an annoyed or pained response. Looking in the baby’s mouth can help determine if any teeth are appearing. Gums might look swollen or bulging and there could be evidence of a tooth or more than one breaking through the gums.
One test to tell the difference between teething and ear infection is the lying down test. Teething babies tend to be uncomfortable all day long, but babies with ear infection are often most uncomfortable when they’re lying down. During naps and at nights, pain of ear infections may surge, making it difficult to sleep. Teething babies may also have trouble sleeping, but they tend to show consistent irritation during the day. This test isn’t fully reliable.
Another way to evaluate these differences is to consider nasal discharge. It’s uncommon for a baby who is teething to show much evidence of nasal discharge, though they might have a small amount of clear nasal mucus. Ear infections are often more indicated when a baby has a classic stuffy nose with yellow or green mucus. Recent illness on the part of the baby also makes ear infection a more likely diagnosis.
Teething and ear infection can share in common the following symptoms:
Pulling on the ears
High irritation
Fever
Poor sleep
Difficulty eating
Positive response to pain medicine
Mouth pain
Diarrhea
Given these shared symptoms it simply makes sense to see a doctor if there is any reasonable suspicion of ear infection. Protecting a baby’s hearing through appropriate treatment, as needed, is important.