When Ear Pulling Raises Questions
A baby tugging at an ear or acting fussy can leave caregivers wondering what hurts. Young children often cannot describe pain, and ear pulling may occur with teething or an ear infection. It can also be a habit, so the gesture alone does not reveal the cause.
Teething may bring drooling, tender gums, and mild discomfort that sometimes seems to spread toward the ear. An infection may come with fever, disrupted sleep, reduced feeding, or fluid from the ear. These are clues, not a diagnosis. Johns Hopkins Medicine’s guidance on ear infections in babies and toddlers notes that several symptoms can signal infection, but a clinician must assess the child.
This guide explains which patterns may help distinguish teething from infection and when to seek care. At Kids & Teens Primary Healthcare in Decatur, Georgia, children from birth through age 21 can receive sick visits and care for common childhood conditions. When symptoms are concerning or unclear, a medical evaluation can help identify the cause and guide next steps.
Why Ear Infections Happen
Middle-ear infections often develop during or after a cold or another upper respiratory infection. Swelling can interfere with drainage, allowing fluid to collect behind the eardrum, where viruses or bacteria may cause infection. The germs can spread from person to person, but the ear infection itself is not contagious. Johns Hopkins Medicine explains how these infections affect babies and toddlers.
Young children are more susceptible because their immune systems are still developing, and their eustachian tubes, which help drain fluid from the middle ear, are smaller and less effective than adults’ tubes. Children under age two are especially vulnerable. Kids and Teens Primary Healthcare provides sick visits and care for common childhood conditions, including ear infections; its ear infections in children guide offers more information.
Signs can include ear pain, crying or fussiness, trouble sleeping, fever, reduced appetite, or fluid draining from the ear. Babies who cannot explain what hurts may tug or rub an ear. Some children have difficulty hearing or responding to sounds, or seem off balance. Symptoms vary, and an infection can occur without fever or with only a few noticeable signs.
Ear-pulling alone does not confirm an infection. If your child has concerning symptoms or you are unsure what is causing the discomfort, contact Kids and Teens Primary Healthcare for guidance and an examination. A clinician can assess the ear and help determine the cause.
Clues That Separate Teething From Infection
Sore or swollen gums, extra drooling, chewing on objects, and mild fussiness can accompany teething. Some babies also rub or tug at an ear when gum discomfort radiates nearby. But ear pulling by itself cannot tell you whether your child is teething or has an ear infection. Teething guidance from Children’s Hospital Los Angeles also cautions that ear rubbing can have more than one cause.
An ear infection may be more likely when discomfort is worsening or persistent, or comes with fever, cold symptoms, trouble hearing, or fluid draining from the ear. Fever and ear drainage are not typical teething signs, so do not assume that a child with these symptoms is simply cutting a tooth. Teething does not cause an ear infection, though both can occur at the same time.
These clues can guide your next step, but they cannot confirm the cause. A clinician needs to examine the eardrum to diagnose an ear infection. Contact your child’s pediatrician if you are unsure, the pain is severe or persistent, or your child seems very unwell. Kids & Teens Primary Healthcare provides sick visits for children and young adults from birth through age 21; its information about ear infections in children offers related guidance.
How Clinicians Check the Ear
When a child has ear discomfort, a pediatrician first asks about symptoms such as pain, fever, irritability, and changes in hearing. They will also consider when symptoms began and whether the child recently had a cold. At Kids & Teens Primary Healthcare, pediatric sick visits include assessment of common childhood conditions, helping clinicians evaluate concerns in the context of a child’s overall health.
The clinician then uses an otoscope, a lighted instrument, to inspect the ear canal and eardrum. They look for fluid behind the eardrum and signs of inflammation, particularly bulging. A red eardrum by itself does not confirm an acute middle-ear infection, and symptoms alone are not enough; diagnosis depends on the child’s symptoms together with objective examination findings. Clinical diagnostic guidance emphasizes the need for evidence of middle-ear fluid.
The clinician may use pneumatic otoscopy, which gently changes air pressure to assess how the eardrum moves. Tympanometry can also help identify fluid behind the eardrum. Imaging and other tests are not usually needed to diagnose a routine ear infection.
At home, caregivers can note symptoms such as pain, fever, unusual fussiness, trouble hearing, or drainage, and gently check the outer ear for redness or swelling. These clues can have other causes, so they cannot establish an infection. Do not insert cotton swabs or other objects into the ear canal. Even a home otoscope cannot reliably confirm or rule out an infection because a clinician must assess the eardrum and interpret what they see.
Contact your child’s pediatrician if symptoms are severe, persistent, or worsening. Ear drainage or a child who seems very unwell calls for prompt medical attention. Kids & Teens Primary Healthcare provides pediatric sick visits for children and young adults, including evaluation of common illnesses; families can seek guidance when symptoms raise concern.
Other Causes of Ear Discomfort
Ear discomfort does not always mean a middle-ear infection. A cold or other viral illness can bring fever and fussiness, and these symptoms may occur alongside ear redness without an active middle-ear infection. Fluid can also remain behind the eardrum after an illness; this may affect comfort or hearing even when there is no current infection. Middle-ear fluid and ear infections can have different causes and need clinical assessment.
Pain may also seem to come from the ear when it starts elsewhere. Teething can make gums sore, while a sore throat or another nearby source of referred pain may lead a child to complain of an earache. A clinician can consider these possibilities alongside the child’s symptoms and examination.
An outer-ear infection affects the ear canal, rather than the space behind the eardrum, and can be associated with swimming or irritation. It is different from a middle-ear infection, which involves the area behind the eardrum. The distinction matters because the causes and appropriate care can differ.
These conditions can share signs such as pain, irritability, or changes in hearing, so symptoms alone may not reveal what is causing the discomfort. At Kids & Teens Primary Healthcare, pediatric sick visits provide an opportunity for a clinician to examine a child and guide care for common conditions. An ear examination helps identify the likely cause and determine what follow-up or treatment is appropriate.
Treatment Depends on the Examination
Treatment Depends on the Examination
Treatment depends on the child’s age, symptoms, and what the clinician sees during an ear examination. When an infection is suspected, an evaluation helps distinguish an active infection from other causes of discomfort and guides care suited to the child.
Pain relief may be part of treatment. A clinician can advise whether acetaminophen or ibuprofen is appropriate and provide guidance on safe dosing for the child’s age and weight. Families should not give medication based on guesswork, especially to a young infant.
For some mild infections, a clinician may suggest watchful waiting, with a plan to monitor symptoms and seek follow-up if the child does not improve. Many ear infections resolve without antibiotics, so observation can help avoid medication that may not be needed. The American Academy of Family Physicians’ guidance on otitis media describes observation as an option for selected children, with follow-up or a backup treatment plan if symptoms persist.
Antibiotics may be more likely when symptoms are severe, when certain infections affect both ears, or when a child worsens or fails to improve during observation. The decision rests on the examination and the child’s circumstances, not on ear pulling or fussiness alone.
Do not start leftover antibiotics or use ear drops unless the child’s clinician recommends them. If an antibiotic is prescribed, give it exactly as directed and complete the course unless the clinician says otherwise. Kids & Teens Primary Healthcare provides pediatric sick visits for children and young adults through age 21, where families can seek assessment and guidance for concerning symptoms.
Lowering the Risk of Ear Infections
Some everyday steps may lower a child’s risk, though none can prevent every ear infection. Keeping routine vaccinations up to date and avoiding tobacco smoke and other respiratory irritants can support a healthier environment for growing children.
Breastfeeding, when possible, may offer some protection against infections. Families can also ask their pediatrician whether limiting pacifier use makes sense for their child. The advice may vary with a child’s age and health, so it is worth discussing during a routine visit.
Because ear infections can follow respiratory illnesses, handwashing and avoiding close contact with people who are sick may help reduce the spread of germs. These precautions are useful, but they cannot remove all risk. At Kids & Teens Primary Healthcare, pediatric care includes newborn and well-child visits, where families can discuss prevention questions and get guidance suited to their child.
If your child develops ear pain, fever, drainage, or other concerning symptoms despite these measures, contact their pediatrician for advice. A clinician can assess the child and recommend next steps based on their symptoms and overall health.
For more on how respiratory illnesses can precede ear infections, see the Johns Hopkins guide to ear infections in babies and toddlers.
Trust the Clues, Then Get Guidance
Tender gums, drooling, and chewing may fit teething, but ear pulling alone cannot confirm or exclude an infection. Teething symptoms can overlap with signs of illness, so consider the whole picture.
Contact your child’s pediatric clinician if symptoms are severe, persistent, worsening, or unclear. A pediatric exam can help identify the cause and guide next steps. At Kids & Teens Primary Healthcare, pediatric sick visits provide care for common childhood concerns, including possible ear infections.
