Baby Ear Pulling: Is It Teething or an Ear Infection? A Pediatrician's Guide

If your baby is pulling at one or both ears and otherwise looks well, with no fever and no other symptoms, the cause is usually not an ear infection. The American Academy of Pediatrics and Seattle Children's both report that ear pulling alone, without fever or other symptoms, has many possible causes other than infection. The most common reasons are habit and curiosity (especially between 4 and 12 months), gum discomfort during teething, ear-canal irritation, and ear-wax buildup. The fastest way to tell the difference between teething and an ear infection is to check for fever, drooling, gum-rubbing, and changes in feeding or sleep. The rest of this guide walks you through that check, signal by signal.

Key Takeaways

• Ear pulling without fever or other symptoms is usually not an ear infection (per AAP and Seattle Children's pediatric guidance).
• Teething does not cause a fever above 100.4°F (38°C). If your baby has both ear pulling and a fever, the cause is more likely an infection than teething.
• Recent research (Kahn 2025, Journal of Pediatrics, a study of 849 babies) suggests teething does not measurably disrupt sleep; a sleep change without other teething signs points to a different cause.
• Babies under 3 months with any fever (≥100.4°F rectal) need same-day in-person evaluation, not telehealth.
• Only a pediatrician using an otoscope can confirm an ear infection. If your baby has fever, ear pain, or drainage, get them seen.

Not sure if it is teething or an ear infection? Start a Blueberry visit.

Why is my baby pulling their ear?

Most baby ear pulling is harmless habit, mild teething, or ear-canal irritation. Real ear infections usually come with fever, ear drainage, or feeding refusal.

Most ear pulling in babies has a benign explanation. Below are the five most common causes pediatricians see, in roughly the order to consider them; for non-diagnostic causes outside teething and infection, see other reasons babies pull their ears.

Teething (ages 4 to 24 months)

Teething starts around 4 to 7 months and continues through about 24 months. Some babies pull at their ears during teething because pain in the gums can spread to the ear region (the trigeminal nerve carries sensation from both gums and ears). Look for drooling, gum-rubbing, biting on objects, swollen gums, and mild irritability; those are the symptoms a 2025 systematic review actually links to teething. Ear pulling alone, without those signs, is not a reliable sign of teething.

Ear infection (otitis media)

Acute otitis media (a middle-ear infection) is most common between 6 and 24 months. The textbook signs are fever, ear pain that worsens when lying flat, fussiness, decreased appetite or trouble feeding, and sometimes fluid draining from the ear. A pediatrician confirms the diagnosis by looking at the eardrum with an otoscope. Ear pulling shows up here as a sign of pain, but it is not how the diagnosis is made.

Ear wax build-up

Ear wax can press against the canal and feel itchy or full, especially after a bath or change in temperature. Wax usually clears on its own. Do not insert cotton swabs or anything else into the ear canal; that can push wax deeper or injure the eardrum.

Habit or curiosity

Babies discover their ears around 4 months. This kind of infant ear pulling is often pure exploration. Seattle Children's notes that habit pulling is "usually not seen before 4 months of age and usually not seen after 12 months old," so a younger or older baby with persistent ear pulling is worth a closer look.

Water or outer-ear irritation

Trapped water from a bath or pool, eczema in the ear canal, or contact with shampoos and lotions can irritate the outer ear and trigger pulling. This is sometimes called swimmer's ear when an infection is involved. Drying ears gently after baths and avoiding soap inside the canal usually helps.

Teething ear pulling vs ear infection ear pulling: side by side

The clearest tell is fever: teething does not cause one above 100.4°F. The table below maps the most useful day-to-day signals.

The fastest way to tell teething ear pulling from infection ear pulling is to compare a few observable signs. Use this table as a quick guide; it is not a substitute for a pediatrician's exam.

How to tell if it is teething

It is teething when ear pulling pairs with heavy drooling, gum-rubbing, no fever, and normal feeding and sleep, in a 4 to 24 month old baby.

If most of the following are true, teething is the likely cause:

• Your baby is between 4 and 24 months old.
• You can see or feel a swollen gum, or a tooth is breaking through.
• There is heavy drooling and frequent biting on fingers, toys, or a teething ring.
• Mood improves with cold (refrigerated) teething rings or gum massage.
• There is no fever above 100.4°F (38°C), no ear drainage, and feeding is normal.

If those signs match, the next section on soothing will likely be enough. If anything points the other way, treat it as a possible ear infection until a pediatrician says otherwise.

How to tell if it is an ear infection

Suspect an ear infection when ear pulling comes with fever, refused feeding, poor sleep, or fluid draining from the ear, especially after a recent cold.

Suspect an ear infection if any of the following are present, especially in a baby 6 to 24 months old:

• Fever of 100.4°F (38°C) or higher, or any fever in a baby under 3 months.
• Ear pain that gets worse when lying down or during feeding.
• Fluid draining from the ear (yellow, white, or blood-tinged).
• Trouble sleeping, more crying than usual, or pulling away from the bottle or breast.
• A recent cold or upper-respiratory illness in the past one to two weeks.

Only an otoscope exam can confirm acute otitis media, which is why a pediatrician visit, in person or via Blueberry telehealth with a parent-assisted otoscope camera, is the right next step when these signs appear. Not sure how to read your baby's temperature? Our pediatricians' baby fever guide walks you through what counts as a fever and when to call.

How to soothe a teething baby pulling their ear

Cold (not frozen) teething rings, clean-finger gum massage, and pediatrician-approved acetaminophen are the safest first steps. Skip benzocaine gels and amber teething necklaces.

The AAP and FDA agree on a short list of safe options:

• Refrigerated (not frozen) firm rubber teething ring, suitable from about 4 months.
• Clean-finger gum massage, safe at any age.
• Cool, damp washcloth for chewing, once your baby can hold it without choking.
• Acetaminophen, weight-based dosing per your pediatrician (mandatory pediatrician approval under 12 weeks). See our infant Tylenol dosing guide for weight-based amounts.
• Ibuprofen for babies 6 months and older, weight-based dosing per your pediatrician.

Avoid these, even though some store shelves still carry them:

• Benzocaine teething gels (Anbesol, Orajel, and similar) under 2 years; the FDA warned in 2018 that they can trigger methemoglobinemia, a rare but life-threatening drop in blood oxygen.
• Homeopathic teething tablets, recalled by the FDA in 2017 over dangerous belladonna content.
• Amber teething necklaces or any teething jewelry; the FDA documented strangulation and choking deaths, and the AAP advises against any infant jewelry.
• Frozen teething rings, which are too hard and can bruise gums or injure the mouth. Refrigerate, do not freeze.

How an ear infection is treated

Many mild ear infections in babies older than six months are watched for two to three days, with antibiotics added if pain or fever does not improve.

For mild ear infections in babies older than 6 months, typically when only one ear is affected, pain is mild, and there is no fluid draining, the AAP supports watchful waiting: 48 to 72 hours of pain relief and observation, with antibiotics started only if symptoms do not improve. Most mild cases resolve on their own in two to three days with analgesia alone. When antibiotics are needed, amoxicillin is first-line. Babies under 6 months with a confirmed infection are typically prescribed antibiotics right away. Your pediatrician will choose the right path for your child.

Caught between teething and an infection? Start a Blueberry visit.

When to call your pediatrician

Call within the day if your baby has fever, ear drainage, refused feeding, or persistent fussiness, or any fever in a baby under three months.

Reach out to your pediatrician within the day for any of these:

• Any fever of 100.4°F (38°C) or higher in a baby under 3 months.
• Fever ≥102°F (38.9°C) at any age, or a fever lasting more than 24 hours in a baby 3 to 24 months.
• Ear pain that does not improve, fluid draining from the ear, or a baby who cannot be consoled.
• Decreased wet diapers, refusal to feed, or unusual sleepiness.
• Persistent ear pulling without any teething signs (drooling, gum-rubbing, biting on objects), especially with fussiness or feeding changes.

Go to the emergency room (not telehealth, not next-day office) for any of these red flags:

• Difficulty breathing, blue lips, or persistent grunting.
• Stiff neck, severe headache, or repeated vomiting.
• Seizure, including a febrile seizure.
• A petechial or purpuric (small purple-red dot) rash.
• A baby who is unresponsive or extremely difficult to wake.

When a Blueberry telehealth visit is the right next step

If your baby is over three months and feeding well, a Blueberry telehealth visit can quickly sort teething from infection and route you to in-person care if needed.

If your baby is over 3 months old, alert and feeding, and the question is "is this teething or an ear infection?", a Blueberry telehealth visit is a fast first step. Our pediatricians can review symptoms, walk you through signs to watch for, and arrange an in-person visit or otoscope check if needed. Babies under 3 months with any fever, or babies with the red-flag signs above, should be seen in person, and Blueberry will tell you that directly. In our telehealth visits, the most common "is it teething or an ear infection?" questions come from parents of 6 to 18 month olds whose baby has a low-grade temperature, refused a feeding, or stayed up tugging their ear, and what we usually find on the otoscope exam is a normal eardrum and a teething pattern, not an infection. "For most well-appearing babies pulling at one ear, the answer is reassurance plus a few specific things to watch for," says Dr. Melissa Tribuzio, MD, Board-Certified Pediatrician. "When we do see signs of a real infection, we tell families that directly and route them to in-person care the same day."

Not sure if it is teething or an ear infection? Start a Blueberry visit.

Frequently asked questions

Why does my baby keep pulling on her ear but no fever?

Without fever or other symptoms, ear pulling is most often habit, mild teething discomfort, or ear-canal irritation. The AAP and Seattle Children's both note that ear pulling alone in a well-appearing baby is rarely an ear infection. If it has gone on more than a day or two, or your baby seems uncomfortable, message your Blueberry doctor for a quick check.

Can teething cause ear pulling?

Sometimes. Pain from a teething molar can spread to the ear because the same nerve serves both areas. But ear pulling alone, without drooling, gum-rubbing, or visible gum changes, is not a reliable teething sign according to a 2025 systematic review.

At what age do babies stop pulling their ears?

Habit ear pulling generally fades after about 12 months. Persistent ear pulling in a baby older than a year, especially with fever or fussiness, is worth a pediatrician visit.

How do I know if it is teething or an ear infection?

Use the comparison table above as a starting point. The fastest signals are fever (teething does not cause it; infection often does), feeding behavior (usually normal with teething, often disrupted with infection), and ear drainage (never from teething). When in doubt, an otoscope exam is the only way to be sure.

Is ear pulling a sign of tiredness in babies?

For some babies, yes. Tugging at the ear can be a self-soothing motion at sleep time, similar to thumb sucking. Consider time of day and your baby's tired cues alongside ear pulling.

When should I worry about my baby pulling their ear?

Worry, and contact a clinician, if there is fever, ear drainage, refusal to feed, severe fussiness, or pulling that continues for more than a day or two without other teething signs. For babies under 3 months, any fever needs same-day in-person evaluation.

Have a question we did not cover? Message your Blueberry doctor.